title: Comparison of three-dimensional versus intensity-modulated radiotherapy techniques to treat breast and axillary level III and supraclavicular nodes in a prone versus supine position.
abstract: OBJECTIVE
  To determine the optimal method of targeting breast and regional nodes in selected breast cancer patients after axillary dissection, we compared the results of IMRT versus no IMRT, and CT-informed versus clinically-placed fields, in supine and prone positions.
  
  
  METHODS
  Twelve consecutive breast cancer patients simulated both prone and supine provided the images for this study. Four techniques were used to target breast, level III axilla, and supraclavicular fossa in either position: a traditional three-field three-dimensional conformal radiotherapy (3DCRT) plan, a four-field 3DCRT plan using a posterior axillary boost field, and two techniques using a CT-informed target volume consisting of an optimized 3DCRT plan (CT-planned 3D) and an intensity-modulated radiotherapy (IMRT) plan. The prescribed dose was 50 Gy in 25 fractions.
  
  
  RESULTS
  CT-planned 3D and IMRT techniques improved nodal PTV coverage. Supine, mean nodal PTV V50 was 50% (3-field), 59% (4-field), 92% (CT-planned 3D), and 94% (IMRT). Prone, V50 was 29% (3-field), 42% (4-field), 97% (CT-planned 3D), and 95% (IMRT). Prone positioning, compared to supine, and IMRT technique, compared to 3D, lowered ipsilateral lung V20.
  
  
  CONCLUSIONS
  Traditional 3DCRT plans provide inadequate nodal coverage. Prone IMRT technique resulted in optimal target coverage and reduced ipsilateral lung V20.
authors: Department of Radiation Oncology, New York University Langone Medical Center, New York, USA.
authors: Rajni A
authors: RA
authors: Sethi
authors: Hyun Soo
authors: HS
authors: No
authors: Gabor
authors: G
authors: Jozsef
authors: Jane P
authors: JP
authors: Ko
authors: Silvia C
authors: SC
authors: Formenti
mesh_terms: D000704:Analysis of Variance; D001365:Axilla; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods*; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D056888:Patient Positioning; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome