What is the best position of the arms in mantle field for Hodgkin's disease?
OBJECTIVE
To evaluate the best position of the arms in mantle field for Hodgkin's disease.


METHODS
In 12 patients, with surgical clips placed at the time of an axillary dissection for breast cancer, the radiological projection of the clips according to three arm positions was prospectively evaluated: akimbo (A), extended (E), and up over the head (U). The surgical clips were arbitrarily separated into two groups: lower and upper. In each patient, the distance between the surgical clips and chest wall was measured, and the possibility of shielding the lungs and humeral heads was evaluated.


RESULTS
The mean displacement of the lower clips away from the chest wall when the patients were in A, E, and U positions was 2.5, 3.0, and 4.6 cm, respectively. The upper group clips showed a lower difference in distance from chest wall. In the U position, there was always a clip of the lower group that projected over the humeral head, making it impossible to block this structure.


CONCLUSIONS
In the A position, there is the possibility of blocking the humeral head, but it is necessary to irradiate more lung parenchyma. Type E treatment setup allows the shielding of both lung and humeral head, while maintaining adequate margins around the axillary nodes. In the U position, there is a greater possibility of shielding the lung parenchyma, but it is impossible to block the humeral heads.
Pergolizzi
S
S
Department of Radiotherapy, University of Messina, Italy. pergoste@solnet.it
Settineri
N
N
Gaeta
M
M
Scribano
E
E
Santacaterina
A
A
Ascenti
G
G
Frosina
P
P
de Renzis
C
C
D001132:Arm; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D006811:Humerus / Q000528:radiation effects; D008168:Lung / Q000528:radiation effects; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000528:radiation effects; D015182:Lymphatic Irradiation / Q000379:methods*; D019047:Phantoms, Imaging; D011446:Prospective Studies; D011835:Radiation Protection / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted