In women with large and pendulous breasts postoperative radiotherapy in the supine position could represent a technical challenge because of the resulting dose inhomogeneity and the large amount of lung and heart receiving a high percentage of the prescribed dose. Breast-conserving surgery is therefore relatively contraindicated in these patients. Alternative positions for radiation therapy treatment have been proposed, and prone breast irradiation in particular has been recognized as a useful alternative to conventional treatment in the supine position. We report the case of a large-breasted patient treated in prone position in our radiation therapy division.
FisherB., AndersonS., BryantJ., MargoleseR.G., DeutschM., FisherE.R., JeongJ.H., WolmarkN.: Twenty-year follow up of a randomized trial comparing total mastectomy, lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 347: 1233–1241, 2002.
2.
VeronesiU., LuiniA., Del VecchioM., GrecoM., GalimbertiV., MersonM., RilkeF., SacchiniV., SaccozziR., SavioT.: Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med, 328: 1587–1591, 1993.
3.
LiljegrenG., HolmbergL., AdamiH.O., WestmanG., GraffmanS., BerghJ.: Sector resection with or without postoperative radiotherapy for stage I breast cancer: five-year results of a randomized trial. Uppsala-Orebro Breast Cancer Study Group. J Natl Cancer Inst, 86: 717–722, 1994.
4.
HughesK.S., SchnaperL.A., BerryD., CirrincioneC., McCormickB., ShankB., WheelerJ., ChampionL.A., SmithT.J., SmithB.L., ShapiroC., MussH.B., WinerE., HudisC., WoodW., SugarbakerD., HendersonI.C., NortonL; Cancer, and Leukemia Group B; Radiation Therapy Oncology Group; Eastern Cooperative Oncology Group: Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med, 351: 971–972, 2004.
5.
SmithI.E., RossG.M.: Breast radiotherapy after lumpectomy-no longer always necessary. N Engl J Med, 351: 1021–1023, 2004.
6.
BolletM.A., CampanaF., KirovaY.M., DendaleR., SaliouM.G., RosenwaldJ.C., FourquetA.: Breast radiotherapy in women with pectus excavatum (funnel chest): is the lateral decubitus technique an answer? A dosimetric study. Br J Radiol, 79: 785–790, 2006.
7.
VeronesiU., CascinelliN., MarianiL., GrecoM., SaccozziR., LuiniA., AguilarM., MarubiniE.: Twenty-year follow up of a randomized study comparing breast conserving surgery with radical mastectomy for early breast cancer. N Engl J Med, 347: 1227–1232, 2002.
8.
MerchantT.E., McCormickB.: Prone position breast irradiation. Int J Radiat Oncol Biol Phys, 30: 197–203, 2004.
9.
BuijsenJ., JagerJ.J., BovendeerdJ., VonckenR., BorgerJ.H., BoersmaL.J., MurrerL.H., LambinP.: Prone breast irradiation for pendulous breasts. Radiother Oncol, 82: 337–340, 2007.
10.
GrannA., McCormickB., ChabnerE.S., GollamudiS.V., SchupakK.D., MychalczakB.R., HeerdtA.S., MerchantT.E., HuntM.A.: Prone breast radiotherapy in early-stage breast cancer: a preliminary analysis. Int J Radiat Oncol Biol Phys, 47: 319–325, 2000.
11.
MaheM.A., ClasseJ.M., DravetF., CussacA., CuilliereJ.C.: Preliminary results for prone-position breast irradiation. Int J Radiat Oncol Biol Phys, 52: 156–160, 2002.
12.
StegmanL.D., BealK.P., HuntM.A., FornierM.N., McCormickB.: Long-term clinical outcomes of whole-breast irradiation delivered in the prone position. Int J Radiat Oncol Biol Phys, 68: 73–81, 2007.
13.
FormentiS.C., TruongM.T., GoldbergJ.D., MukhiV., RosensteinB., RosesD., ShapiroR., GuthA., DewyngaertJ.K.: Prone accelerated partial breast irradiation after breast-conserving surgery: preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol, 60: 493–504, 2004.
14.
GriemK.L., FetherstonP., KuznetzovaM., FosterG.S., ShottS., ChuJ.: Three-dimensional photon dosimetry: a comparison of treatment of the intact breast in the supine and prone position. Int J Radiat Oncol Biol Phys, 57: 891–899, 2003.
15.
KurtmanC., Nalça AndrieuM., HiçsönmezA., CelebiogluB.: Three-dimensional conformal breast irradiation in the prone position. Braz J Med Biol Res, 36: 1441–1446, 2003.
16.
AlganO., FowbleB., McNeeleyS., FeinD.: Use of prone position in radiation treatment for women with early stage breast cancer. Int J Radiat Oncol Biol Phys, 40: 1137–1140, 1998.
17.
CampanaF., KirovaY.M., RosenwaldJ.C., DendaleR., VilcoqJ.R., DreyfusH., FourquetA.: Breast radiotherapy in the lateral decubitus position: A technique to prevent lung and heart irradiation. Int J Radiat Oncol Biol Phys, 61: 1348–1354, 2005.
18.
deSouzaN.M., KormosD.W., KrauszT., CouttsG.A., HallA.S., BurlM., SchwiesoJ.E., PuniR., VernonC.: MR-guided biopsy of the breast after lumpectomy and radiation therapy using two methods of immobilization in the lateral decubitus position. J Magn Reson Imaging, 5: 525–528, 1995.
19.
FourquetA., CampanaF., RosenwaldJ.C., VilcoqJ.R.: Breast irradiation in the lateral decubitus position: technique of the Institute Curie. Radiother Oncol, 22: 261–265, 1991.
20.
CrossM.A., ElsonH.R., AronB.S.: Breast conservation radiation therapy technique for women with large breasts. Int J Radiat Oncol Biol Phys, 17: 199–203, 1989.
21.
HarrisJ.R., LeveneM.B., SvenssonG., HellmanS.: Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys, 5: 257–261, 1979.
22.
ChinL.M., ChengC.W., SiddonR.L., RiceR.K., MijnheerB.J., HarrisJ.R.: Three-dimensional photon dose distributions with and without lung corrections for tangential breast intact treatments. Int J Radiat Oncol Biol Phys, 17: 1327–1335, 1989.
23.
BuchholzT.A., GurgozeE., BiceW.S., PrestidgeB.R.: Dosimetric analysis of intact breast irradiation in off-axis planes. Int J Radiat Oncol Biol Phys, 39: 261–267, 1997.
24.
GrayJ.R., McCormickB., CoxL., YahalomJ.: Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome. Int J Radiat Oncol Biol Phys, 21: 347–354, 1991.
25.
RayG.R., FishV.J.: Biopsy and definitive radiation therapy in stage I and II adenocarcinoma of the female breast: analysis of cosmesis and the role of electron beam supplementation. Int J Radiat Oncol Biol Phys, 9: 813–818, 1999.
26.
ProsnitzL.R., GoldenbergI.S., HarrisJ.R., HellmanS., DanoffB.F., KramerS., WallnerP.E., BradyL.W.: Radiotherapy for carcinoma of the breast instead of mastectomy. An update. Front Radiat Ther Oncol, 17: 69–75, 1983.
27.
ProsnitzL.R., GoldenbergI.S., PackardR.A., LeveneM.B., HarrisJ., HellmanS., WallnerP.E., BradyL.W., MansfieldC.M., KramerS.: Radiation therapy as initial treatment for early stage cancer of the breast without mastectomy. Cancer, 39: 917–923, 1997.
