- Email: [email protected]
Prospective Trial of Individual Optimal Positioning (Prone Versus Supine) for Whole Breast Radiotherapy: Results of the First 168 Patients
I. J. Radiation Oncology d Biology d Physics
S74
Volume 69, Number 3, Supplement, 2007
Author Disclosure: J.P. Chino, None; L.B. Marks, None.
129
Prospective Trial of Individual Optimal Positioning (Prone Versus Supine) for Whole Breast Radiotherapy: Results of the First 168 Patients
S. C. Formenti, P. K. Parhar, J. D. Goldberg, J. K. DeWyngaert New York University Medical Center, New York, NY Purpose/Objective(s): Prone whole breast radiotherapy is feasible and can be delivered with an hypo-fractionated, concomitant boost IMRT regimen (JCO, vol. 25,16, 2007). We hypothesized that in occasional patients a supine set up could better spare heart and lung while optimally treat the target breast, and that specific anatomic characteristics could be identified that are more likely associated with these cases. NYU 05-181 protocol was designed to test this hypothesis. Materials/Methods: Early stage breast cancer patients after segmental mastectomy are eligible for this IRB-approved prospective study. A supine CT simulation with images acquired every 2.5 mm is performed. The patient is then repositioned prone using a dedicated breast mattress that allows the index breast to freely fall through an opening and a second CT is obtained. Contouring is done for both sets of images. The treatment volume (TV) is the whole index breast, determined according to conventional breast simulation with the patient in the supine position. Each patient is planned in both positions and is treated based on the optimal plan defined as the one that best satisfies each of the following criteria: 1) inclusion of the TV; 2) maximum heart sparing; 3) maximum lung sparing. Results: Currently 168 patients have accrued to the study: 91 with a left and 77 with a right breast cancer. In each case the optimal set up was chosen for treatment: 156 patients (92.9%), received radiation in the prone position and 12 received radiation in the supine position (7.1%). In 82/91 (90%) left breast cancer carriers and 74/77 (96%) right breast cancer carriers the prone position was better. Tables 1 and 2 describe the paired t-test results of in-field heart and lung volumes, based on position, for left and right breast cancers carriers respectively. Conclusions: Based on our criteria for an optimal plan, the majority of the patients benefit from the prone position. The study continues accrual to the planned number of 200 patients. Author Disclosure: S.C. Formenti, None; P.K. Parhar, None; J.D. Goldberg, None; J.K. DeWyngaert, None.
130
Chronic Breast Pain after Breast-Conserving Therapy
J. Johansen1, P. M. Tørring1, M. Overgaard2 1
Odense University Hospital, Odense, Denmark, 2Aarhus University Hospital, Aarhus, Denmark
Purpose/Objective(s): An exploratory analysis to identify predictive factors of chronic breast pain after radiation treatment in patients participating in a randomized breast conservation trial. Materials/Methods: We analyzed data from 266 patients who entered a randomized national breast conservation trial (DBCG82TM protocol). The patients were treated with lumpectomy and axillary dissection followed by external beam radiotherapy to the residual breast. 94 high-risk patients and 31 low-risk patients also received radiation to the regional lymph nodes. Adjuvant systemic treatment was given to all high-risk patients, either eight cycles of sequential CMF or tamoxifen depending on menopausal status. The patients underwent a single interview consisting of a study-specific questionnaire and a physical examination. Self-assessments and objective cosmetic outcome scores were obtained together with specific skin and breast changes. Outcome measures included breast pain, sensory symptoms, and motor dysfunction which were scored on a 4-point categorical scale after median 6.6 years (range 3.5–10.5 years). Individual data on surgical procedures, tumor pathology, systemic treatment, and
S74
Volume 69, Number 3, Supplement, 2007
Author Disclosure: J.P. Chino, None; L.B. Marks, None.
129
Prospective Trial of Individual Optimal Positioning (Prone Versus Supine) for Whole Breast Radiotherapy: Results of the First 168 Patients
S. C. Formenti, P. K. Parhar, J. D. Goldberg, J. K. DeWyngaert New York University Medical Center, New York, NY Purpose/Objective(s): Prone whole breast radiotherapy is feasible and can be delivered with an hypo-fractionated, concomitant boost IMRT regimen (JCO, vol. 25,16, 2007). We hypothesized that in occasional patients a supine set up could better spare heart and lung while optimally treat the target breast, and that specific anatomic characteristics could be identified that are more likely associated with these cases. NYU 05-181 protocol was designed to test this hypothesis. Materials/Methods: Early stage breast cancer patients after segmental mastectomy are eligible for this IRB-approved prospective study. A supine CT simulation with images acquired every 2.5 mm is performed. The patient is then repositioned prone using a dedicated breast mattress that allows the index breast to freely fall through an opening and a second CT is obtained. Contouring is done for both sets of images. The treatment volume (TV) is the whole index breast, determined according to conventional breast simulation with the patient in the supine position. Each patient is planned in both positions and is treated based on the optimal plan defined as the one that best satisfies each of the following criteria: 1) inclusion of the TV; 2) maximum heart sparing; 3) maximum lung sparing. Results: Currently 168 patients have accrued to the study: 91 with a left and 77 with a right breast cancer. In each case the optimal set up was chosen for treatment: 156 patients (92.9%), received radiation in the prone position and 12 received radiation in the supine position (7.1%). In 82/91 (90%) left breast cancer carriers and 74/77 (96%) right breast cancer carriers the prone position was better. Tables 1 and 2 describe the paired t-test results of in-field heart and lung volumes, based on position, for left and right breast cancers carriers respectively. Conclusions: Based on our criteria for an optimal plan, the majority of the patients benefit from the prone position. The study continues accrual to the planned number of 200 patients. Author Disclosure: S.C. Formenti, None; P.K. Parhar, None; J.D. Goldberg, None; J.K. DeWyngaert, None.
130
Chronic Breast Pain after Breast-Conserving Therapy
J. Johansen1, P. M. Tørring1, M. Overgaard2 1
Odense University Hospital, Odense, Denmark, 2Aarhus University Hospital, Aarhus, Denmark
Purpose/Objective(s): An exploratory analysis to identify predictive factors of chronic breast pain after radiation treatment in patients participating in a randomized breast conservation trial. Materials/Methods: We analyzed data from 266 patients who entered a randomized national breast conservation trial (DBCG82TM protocol). The patients were treated with lumpectomy and axillary dissection followed by external beam radiotherapy to the residual breast. 94 high-risk patients and 31 low-risk patients also received radiation to the regional lymph nodes. Adjuvant systemic treatment was given to all high-risk patients, either eight cycles of sequential CMF or tamoxifen depending on menopausal status. The patients underwent a single interview consisting of a study-specific questionnaire and a physical examination. Self-assessments and objective cosmetic outcome scores were obtained together with specific skin and breast changes. Outcome measures included breast pain, sensory symptoms, and motor dysfunction which were scored on a 4-point categorical scale after median 6.6 years (range 3.5–10.5 years). Individual data on surgical procedures, tumor pathology, systemic treatment, and