title: Breast radiotherapy in the prone position primarily reduces the maximum out-of-field measured dose to the ipsilateral lung.
abstract: OBJECTIVE
  To quantify the potential advantages of prone position breast radiotherapy in terms of the radiation exposure to out-of-field organs, particularly, the breast or the lung. Several dosimetric studies have been reported, based on commercial treatment planning software (TPS). These TPS approaches are not, however, adequate for characterizing out-of-field doses. In this work, relevant out-of-field organ doses have been directly measured.
  
  
  METHODS
  The authors utilized an adult anthropomorphic phantom to conduct measurements of out-of-field doses in prone and supine position, using 50 Gy prescription dose intensity modulated radiation therapy (IMRT) and 3D-CRT plans. Measurements were made using multiple MOSFET dosimeters in various locations in the ipsilateral lung, the contralateral lung and in the contralateral breast.
  
  
  RESULTS
  The closer the organ (or organ segment) was to the treatment volume, the more dose sparing was seen for prone vs supine positioning. Breast radiotherapy in the prone position results in a marked reduction in the dose to the proximal part of the ipsilateral lung, compared with treatment in the conventional supine position. This is true both for 3D-CRT and for IMRT. For IMRT, the maximum measured dose to the lung was reduced from 4 to 1.6 Gy, while for 3D-CRT, the maximum measured lung dose was reduced from 5 to 1.7 Gy. For the proximal part of the ipsilateral lung, as well as for the contralateral lung and the contralateral breast, there is little difference in the measured organ doses whether the treatment is given in the prone or the supine-position.
  
  
  CONCLUSIONS
  The decrease in the maximum dose to the proximal part of the ipsilateral lung produced by prone position radiotherapy is of potentially considerable significance. The dose-response relation for radiation-induced lung cancer increases monotonically in the zero to 5-Gy dose range, implying that a major decrease in the maximum lung dose may result in a significant decrease in the radiation-induced lung cancer risk.
authors.affiliation: Department of Radiation Oncology, New York University Langone Medical Center, New York, NY 10016, USA. stewart.becker@nyumc.org
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Becker
authors.forename: Carl
authors.initials: C
authors.lastname: Elliston
authors.forename: Keith
authors.initials: K
authors.lastname: Dewyngaert
authors.forename: Gabor
authors.initials: G
authors.lastname: Jozsef
authors.forename: David
authors.initials: D
authors.lastname: Brenner
authors.forename: Silvia
authors.initials: S
authors.lastname: Formenti
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008168:Lung / Q000528:radiation effects*; D058958:Organs at Risk / Q000528:radiation effects*; D019047:Phantoms, Imaging; D016684:Prone Position; D011829:Radiation Dosage; D011874:Radiometry; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*