title: Hypofractionated whole breast irradiation for patients with large breasts: a randomized trial comparing prone and supine positions.
abstract: OBJECTIVE
  Comparison of acute toxicity of whole-breast irradiation (WBI) in prone and supine positions.
  
  
  METHODS
  This non-blinded, randomized, prospective, mono-centric trial was undertaken between December 29, 2010, and December 12, 2012. One hundred patients with large breasts were randomized between supine multi beam (MB) and prone tangential field (TF) intensity modulated radiotherapy (IMRT). Dose-volume parameters were assessed for the breast, heart, left anterior descending coronary artery (LAD), ipsilateral lung and contralateral breast. The primary endpoint was acute moist skin desquamation. Secondary endpoints were dermatitis, edema, pruritus and pain.
  
  
  RESULTS
  Prone treatment resulted in: improved dose coverage (p<0.001); better homogeneity (p<0.001); less volumes of over-dosage (p=0.001); reduced acute skin desquamation (p<0.001); a 3-fold decrease of moist desquamation p=0.04 (chi-square), p=0.07 (Fisher's exact test)); lower incidence of dermatitis (p<0.001), edema (p=0.005), pruritus (p=0.06) and pain (p=0.06); 2- to 4-fold reduction of grades 2-3 toxicity; lower ipsilateral lung (p<0.001) and mean LAD (p=0.007) dose; lower, though statistically non-significant heart and maximum LAD.
  
  
  CONCLUSIONS
  This study provides level I evidence for replacing the supine standard treatment by prone IMRT for whole-breast irradiation in patients with large breasts. A confirmatory trial in a multi-institutional setting is warranted.
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Belgium. Electronic address: thomas.mulliez@uzgent.be.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mulliez
authors.forename: Liv
authors.initials: L
authors.lastname: Veldeman
authors.forename: Annick
authors.initials: A
authors.lastname: van Greveling
authors.forename: Bruno
authors.initials: B
authors.lastname: Speleers
authors.forename: Simin
authors.initials: S
authors.lastname: Sadeghi
authors.forename: Dieter
authors.initials: D
authors.lastname: Berwouts
authors.forename: Frederik
authors.initials: F
authors.lastname: Decoster
authors.forename: Tom
authors.initials: T
authors.lastname: Vercauteren
authors.forename: Werner
authors.initials: W
authors.lastname: De Gersem
authors.forename: Rudy
authors.initials: R
authors.lastname: Van den Broecke
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Neve
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D001940:Breast / Q000002:abnormalities* / Q000528:radiation effects; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006984:Hypertrophy; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D056888:Patient Positioning / Q000379:methods*; D011379:Prognosis; D016684:Prone Position; D011446:Prospective Studies; D011832:Radiation Injuries / Q000175:diagnosis* / Q000453:epidemiology; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D016683:Supine Position; D016896:Treatment Outcome
keywords: Acute toxicity; Breast cancer; Hypofractionation; Prone; Radiotherapy