Radiation dose to the nodal regions during prone versus supine breast irradiation

Abstract

Background

Prone positioning for breast radiotherapy is preferable when the aim is a reduction of the dose to the ipsilateral lung or the heart in certain left-sided cases.

Materials and methods

In 100 breast cancer cases awaiting postoperative whole-breast radiotherapy, conformal radiotherapy plans were prospectively generated in both prone and supine positions. The axillary nodal region (levels I–III) and internal mammary (IM) lymph-node region in the upper three intercostal spaces were retrospectively contoured. The mean doses to the nodal regions and the volume receiving 25 Gy (V_25Gy), V_45Gy, and V_47.5Gy were compared between the two treatment positions.

Results

In most cases, the doses to axillary levels I–III and the IM lymph nodes were inadequate, regardless of the treatment position. The nodal doses were significantly lower in the prone than in the supine position. The radiation doses to levels II–III and IM nodes were especially low. The V_45Gy and V_47.5Gy of the level I axillary lymph nodes were 54.6% and 40.2%, respectively, in the supine, and 3.0% and 1.7%, respectively, in the prone position. In the supine position, only 17 patients (17%) received a mean dose of 45 Gy to the axillary level I nodes.

Conclusion

The radiation dose to the axillary and IM lymph nodes during breast radiotherapy is therapeutically insufficient in most cases, and is significantly lower in the prone position than in the supine position.

Keywords:

• axillary lymph nodes
• breast radiotherapy
• internal mammary nodes
• prone positioning
• supine positioning

Author contributions

MC participated in the preparation, acquisition, analysis, and interpretation of data, and made contributions to the drafting of the manuscript. DU participated in the preparation, acquisition, analysis, and interpretation of data. AC was involved in the design and conception of the study, and checked the preparation of the data. ZK participated in the conception and design of the study, the analysis and interpretation of the data, and the drafting of the manuscript. ZV participated in the conception and design of the study, carried out the collection and analysis of the data, was involved in the drafting of the manuscript, and carried out all statistical analyses. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.