Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes
OBJECTIVE: Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcome...
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| Veröffentlicht in: | ACTA ONCOLOGICA 2023-09, Vol.62 (9), p.1036-1044 |
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| creator | Vakaet, Vincent Deseyne, Pieter Bultijnck, Renee Post, Giselle West, Catharine Azria, David Bourgier, Celine Farcy-Jacquet, Marie-Pierre Rosenstein, Barry Green, Sheryl de Ruysscher, Dirk Sperk, Elena Veldwijk, Marlon Herskind, Carsten De Santis, Maria Carmen Rancati, Tiziana Giandini, Tommaso Chang-Claude, Jenny Seibold, Petra Lambrecht, Maarten Weltens, Caroline Janssens, Hilde Vega, Ana Taboada-Valladares, Maria Begona Aguado-Barrera, Miguel Elias Reyes, Victoria Altabas, Manuel Gutierrez-Enriquez, Sara Monten, Christel Van Hulle, Hans Veldeman, Liv |
| description | OBJECTIVE: Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data. METHODS: REQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years. RESULTS: At the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p |
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However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data. METHODS: REQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years. RESULTS: At the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p < .001). At 2 years, patients treated in prone position had less atrophy (p = .01), and higher body image (p < .001), and social functioning (p < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years (p = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, p < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, p < .001). CONCLUSIONS: Prone radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.</description><identifier>ISSN: 0284-186X</identifier><language>eng</language><publisher>TAYLOR & FRANCIS LTD</publisher><ispartof>ACTA ONCOLOGICA, 2023-09, Vol.62 (9), p.1036-1044</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,315,780,784,27860</link.rule.ids></links><search><creatorcontrib>Vakaet, Vincent</creatorcontrib><creatorcontrib>Deseyne, Pieter</creatorcontrib><creatorcontrib>Bultijnck, Renee</creatorcontrib><creatorcontrib>Post, Giselle</creatorcontrib><creatorcontrib>West, Catharine</creatorcontrib><creatorcontrib>Azria, David</creatorcontrib><creatorcontrib>Bourgier, Celine</creatorcontrib><creatorcontrib>Farcy-Jacquet, Marie-Pierre</creatorcontrib><creatorcontrib>Rosenstein, Barry</creatorcontrib><creatorcontrib>Green, Sheryl</creatorcontrib><creatorcontrib>de Ruysscher, Dirk</creatorcontrib><creatorcontrib>Sperk, Elena</creatorcontrib><creatorcontrib>Veldwijk, Marlon</creatorcontrib><creatorcontrib>Herskind, Carsten</creatorcontrib><creatorcontrib>De Santis, Maria Carmen</creatorcontrib><creatorcontrib>Rancati, Tiziana</creatorcontrib><creatorcontrib>Giandini, Tommaso</creatorcontrib><creatorcontrib>Chang-Claude, Jenny</creatorcontrib><creatorcontrib>Seibold, Petra</creatorcontrib><creatorcontrib>Lambrecht, Maarten</creatorcontrib><creatorcontrib>Weltens, Caroline</creatorcontrib><creatorcontrib>Janssens, Hilde</creatorcontrib><creatorcontrib>Vega, Ana</creatorcontrib><creatorcontrib>Taboada-Valladares, Maria Begona</creatorcontrib><creatorcontrib>Aguado-Barrera, Miguel Elias</creatorcontrib><creatorcontrib>Reyes, Victoria</creatorcontrib><creatorcontrib>Altabas, Manuel</creatorcontrib><creatorcontrib>Gutierrez-Enriquez, Sara</creatorcontrib><creatorcontrib>Monten, Christel</creatorcontrib><creatorcontrib>Van Hulle, Hans</creatorcontrib><creatorcontrib>Veldeman, Liv</creatorcontrib><title>Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes</title><title>ACTA ONCOLOGICA</title><description>OBJECTIVE: Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data. METHODS: REQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years. RESULTS: At the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p < .001). At 2 years, patients treated in prone position had less atrophy (p = .01), and higher body image (p < .001), and social functioning (p < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years (p = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, p < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, p < .001). CONCLUSIONS: Prone radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.</description><issn>0284-186X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>FZOIL</sourceid><recordid>eNqVjEtOAzEQRGcBEuFzh14jBjmeDBnYRkGwJAoSO6uxe4ghY1vuNjD34aCEzwFgVU-lV7VXTZTuZvW0u3g4qA6Zn5VSupm3k-pjEYeE2XMMEHtIOQYCDA64JL_DFNmLj8GHJ-hjhsdMyAIWg6UMGZ2PsqGMaYTCX9JqeXd_u16CQ8ErcLv5QJLHM0Bb5Oda3iKMhJkhbUb21mP47hOKpyB1phSzkINYxMaB-Lja73HLdPKbR9Xp9XK9uKlfypbKKwXjOKElo5VplTJTfTnTZt7oVnfNP-XzP8tG3qX5BFefb3o</recordid><startdate>20230902</startdate><enddate>20230902</enddate><creator>Vakaet, Vincent</creator><creator>Deseyne, Pieter</creator><creator>Bultijnck, Renee</creator><creator>Post, Giselle</creator><creator>West, Catharine</creator><creator>Azria, David</creator><creator>Bourgier, Celine</creator><creator>Farcy-Jacquet, Marie-Pierre</creator><creator>Rosenstein, Barry</creator><creator>Green, Sheryl</creator><creator>de Ruysscher, Dirk</creator><creator>Sperk, Elena</creator><creator>Veldwijk, Marlon</creator><creator>Herskind, Carsten</creator><creator>De Santis, Maria Carmen</creator><creator>Rancati, Tiziana</creator><creator>Giandini, Tommaso</creator><creator>Chang-Claude, Jenny</creator><creator>Seibold, Petra</creator><creator>Lambrecht, Maarten</creator><creator>Weltens, Caroline</creator><creator>Janssens, Hilde</creator><creator>Vega, Ana</creator><creator>Taboada-Valladares, Maria Begona</creator><creator>Aguado-Barrera, Miguel Elias</creator><creator>Reyes, Victoria</creator><creator>Altabas, Manuel</creator><creator>Gutierrez-Enriquez, Sara</creator><creator>Monten, Christel</creator><creator>Van Hulle, Hans</creator><creator>Veldeman, Liv</creator><general>TAYLOR & FRANCIS LTD</general><scope>FZOIL</scope></search><sort><creationdate>20230902</creationdate><title>Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes</title><author>Vakaet, Vincent ; Deseyne, Pieter ; Bultijnck, Renee ; Post, Giselle ; West, Catharine ; Azria, David ; Bourgier, Celine ; Farcy-Jacquet, Marie-Pierre ; Rosenstein, Barry ; Green, Sheryl ; de Ruysscher, Dirk ; Sperk, Elena ; Veldwijk, Marlon ; Herskind, Carsten ; De Santis, Maria Carmen ; Rancati, Tiziana ; Giandini, Tommaso ; Chang-Claude, Jenny ; Seibold, Petra ; Lambrecht, Maarten ; Weltens, Caroline ; Janssens, Hilde ; Vega, Ana ; Taboada-Valladares, Maria Begona ; Aguado-Barrera, Miguel Elias ; Reyes, Victoria ; Altabas, Manuel ; Gutierrez-Enriquez, Sara ; Monten, Christel ; Van Hulle, Hans ; Veldeman, Liv</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-kuleuven_dspace_20_500_12942_7325283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vakaet, Vincent</creatorcontrib><creatorcontrib>Deseyne, Pieter</creatorcontrib><creatorcontrib>Bultijnck, Renee</creatorcontrib><creatorcontrib>Post, Giselle</creatorcontrib><creatorcontrib>West, Catharine</creatorcontrib><creatorcontrib>Azria, David</creatorcontrib><creatorcontrib>Bourgier, Celine</creatorcontrib><creatorcontrib>Farcy-Jacquet, Marie-Pierre</creatorcontrib><creatorcontrib>Rosenstein, Barry</creatorcontrib><creatorcontrib>Green, Sheryl</creatorcontrib><creatorcontrib>de Ruysscher, Dirk</creatorcontrib><creatorcontrib>Sperk, Elena</creatorcontrib><creatorcontrib>Veldwijk, Marlon</creatorcontrib><creatorcontrib>Herskind, Carsten</creatorcontrib><creatorcontrib>De Santis, Maria Carmen</creatorcontrib><creatorcontrib>Rancati, Tiziana</creatorcontrib><creatorcontrib>Giandini, Tommaso</creatorcontrib><creatorcontrib>Chang-Claude, Jenny</creatorcontrib><creatorcontrib>Seibold, Petra</creatorcontrib><creatorcontrib>Lambrecht, Maarten</creatorcontrib><creatorcontrib>Weltens, Caroline</creatorcontrib><creatorcontrib>Janssens, Hilde</creatorcontrib><creatorcontrib>Vega, Ana</creatorcontrib><creatorcontrib>Taboada-Valladares, Maria Begona</creatorcontrib><creatorcontrib>Aguado-Barrera, Miguel Elias</creatorcontrib><creatorcontrib>Reyes, Victoria</creatorcontrib><creatorcontrib>Altabas, Manuel</creatorcontrib><creatorcontrib>Gutierrez-Enriquez, Sara</creatorcontrib><creatorcontrib>Monten, Christel</creatorcontrib><creatorcontrib>Van Hulle, Hans</creatorcontrib><creatorcontrib>Veldeman, Liv</creatorcontrib><collection>Lirias (KU Leuven Association)</collection><jtitle>ACTA ONCOLOGICA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vakaet, Vincent</au><au>Deseyne, Pieter</au><au>Bultijnck, Renee</au><au>Post, Giselle</au><au>West, Catharine</au><au>Azria, David</au><au>Bourgier, Celine</au><au>Farcy-Jacquet, Marie-Pierre</au><au>Rosenstein, Barry</au><au>Green, Sheryl</au><au>de Ruysscher, Dirk</au><au>Sperk, Elena</au><au>Veldwijk, Marlon</au><au>Herskind, Carsten</au><au>De Santis, Maria Carmen</au><au>Rancati, Tiziana</au><au>Giandini, Tommaso</au><au>Chang-Claude, Jenny</au><au>Seibold, Petra</au><au>Lambrecht, Maarten</au><au>Weltens, Caroline</au><au>Janssens, Hilde</au><au>Vega, Ana</au><au>Taboada-Valladares, Maria Begona</au><au>Aguado-Barrera, Miguel Elias</au><au>Reyes, Victoria</au><au>Altabas, Manuel</au><au>Gutierrez-Enriquez, Sara</au><au>Monten, Christel</au><au>Van Hulle, Hans</au><au>Veldeman, Liv</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes</atitle><jtitle>ACTA ONCOLOGICA</jtitle><date>2023-09-02</date><risdate>2023</risdate><volume>62</volume><issue>9</issue><spage>1036</spage><epage>1044</epage><pages>1036-1044</pages><issn>0284-186X</issn><abstract>OBJECTIVE: Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk. To confirm these findings, we compared toxicity outcomes, photographic assessment, and dosimetry between both positions using REQUITE data. METHODS: REQUITE is an international multi-centre prospective observational study that recruited 2069 breast cancer patients receiving radiotherapy. Data on toxicity, health-related quality of life (HRQoL), and dosimetry were collected, as well as a photographic assessment. A matched case control analysis compared patients treated prone (n = 268) versus supine (n = 493). Exact matching was performed for the use of intensity-modulated radiotherapy, boost, lymph node irradiation, chemotherapy and fractionation, and the nearest neighbour for breast volume. Primary endpoints were dermatitis at the end of radiotherapy, and atrophy and cosmetic outcome by photographic assessment at two years. RESULTS: At the last treatment fraction, there was no significant difference in dermatitis (p = .28) or any HRQoL domain, but prone positioning increased the risk of breast oedema (p < .001). At 2 years, patients treated in prone position had less atrophy (p = .01), and higher body image (p < .001), and social functioning (p < .001) scores. The photographic assessment showed no difference in cosmesis at 2 years (p = .22). In prone position, mean heart dose (MHD) was significantly lower for left-sided patients (1.29 Gy vs 2.10 Gy, p < .001) and ipsilateral mean lung dose (MLD) was significantly lower for all patients (2.77 Gy vs 5.89 Gy, p < .001). CONCLUSIONS: Prone radiotherapy showed lower MLD and MHD compared to supine position, although the risk of developing breast oedema during radiotherapy was higher. At 2 years the photographic assessment showed no difference in the cosmetic outcome, but less atrophy was seen in prone-treated patients and this seems to have a positive influence on the HRQoL domain of body image.</abstract><pub>TAYLOR & FRANCIS LTD</pub></addata></record> |
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| source | Lirias (KU Leuven Association); Taylor & Francis Online; Alma/SFX Local Collection; EZB Electronic Journals Library |
| title | Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes |
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