title: Prone breast radiotherapy in early-stage breast cancer: a preliminary analysis.
abstract: OBJECTIVE
  Women with large breasts have marked dose inhomogeneity and often an inferior cosmetic outcome when treated with breast conservation compared to smaller-sized patients. We designed a prone breast board, which both minimizes breast separation and irradiated lung or heart volume. We report feasibility, cosmesis, and preliminary local control and survival for selected women with Stage 0-II breast cancer.
  
  
  METHODS
  Fifty-six patients with clinical Stage 0-II breast cancer were treated with lumpectomy and breast irradiation utilizing a prototype prone breast board. A total of 59 breasts were treated. Indications for treatment in the prone position were large or pendulous breast size (n = 57), or a history of cardiopulmonary disease (n = 2). The median bra size was 41D (range, 34D-44EE). Cosmesis was evaluated on a 1-10 (worst-to-best) scale.
  
  
  RESULTS
  Acute toxicity included skin erythema (80% of patients experienced Grade I or Grade II erythema), breast edema (72% of patients experienced mild edema), pruritus (20% of patients), and fatigue (20% of patients reported mild fatigue). One patient required a treatment break. The only late toxicity was related to long-term cosmesis. The mean overall cosmesis score for 53 patients was 9.37 (range, 8-10). Actuarial 3- and 5-year local control rates are 98%. Actuarial overall survival at 3 and 5 years are 98% and 94%.
  
  
  CONCLUSIONS
  Our data indicate that treating selected women with prone breast radiotherapy is feasible and tolerated. The approach results in excellent cosmesis, and short-term outcome is comparable to traditional treatment techniques. This technique offers an innovative alternative to women who might not otherwise be considered candidates for breast conservation.
authors.affiliation: Department of Radiation Oncology Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: A
authors.initials: A
authors.lastname: Grann
authors.forename: B
authors.initials: B
authors.lastname: McCormick
authors.forename: E S
authors.initials: ES
authors.lastname: Chabner
authors.forename: S V
authors.initials: SV
authors.lastname: Gollamudi
authors.forename: K D
authors.initials: KD
authors.lastname: Schupak
authors.forename: B R
authors.initials: BR
authors.lastname: Mychalczak
authors.forename: A S
authors.initials: AS
authors.lastname: Heerdt
authors.forename: T E
authors.initials: TE
authors.lastname: Merchant
authors.forename: M A
authors.initials: MA
authors.lastname: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000033:anatomy & histology; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D004954:Esthetics; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D016684:Prone Position; D013525:Surgical Instruments