title: Effect of bra use during radiation therapy for large-breasted women: Acute toxicity and treated heart and lung volumes.
abstract: OBJECTIVE
  Large breast size presents special problems during radiation simulation, planning, and patient treatment, including increased skin toxicity, in women undergoing breast-conserving surgery and radiation therapy (BCT). We report our experience using a bra during radiation in large-breasted women and its effect on acute toxicity and heart and lung dosimetry.
  
  
  METHODS
  From 2001 to 2006, 246 consecutive large-breasted women (bra size ≥38 or ≥D cup) were treated with BCT using either 3-dimensional conformal radiation therapy (3DCRT) or intensity modulated radiation therapy (IMRT). In 58 cases, at the physicians' discretion, a custom-fit bra was used during simulation and treatment. Endpoints were acute radiation dermatitis and dosimetric comparison of heart and lung volumes in a subgroup of 12 left-sided breast cancer patients planned with and without a bra.
  
  
  RESULTS
  The majority of acute skin toxicities were grade 2 and were experienced by 90% of patients in a bra compared with 70% of patients not in a bra (P = .003). On multivariate analysis significant predictors of grade 2 or 3 skin toxicity included the use of 3DCRT instead of IMRT (odds ratio, 3.9; 95% confidence interval, 1.8-8.5) and the use of a bra (odds ratio, 5.5; 95% confidence interval, 1.6-18.8). For left-sided patients, the use of a bra was associated with a volume of heart in the treatment fields decreased by 63.4% (P = .002), a volume of left lung decreased by 18.5% (P = .25), and chest wall separation decreased by a mean of 1 cm (P = .03).
  
  
  CONCLUSIONS
  The use of a bra to augment breast shape and position in large-breasted women is an alternative to prone positioning and associated with reduced chest wall separation and reduced heart volume within the treatment field.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. Electronic address: Lanea.Keller@fccc.edu.
authors.forename: Lanea M M
authors.initials: LMM
authors.lastname: Keller
authors.affiliation: Department of Radiation Oncology, University of Maryland, Baltimore, Maryland.
authors.forename: Randi
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Sopka
authors.affiliation: Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.affiliation: Bryn Mawr Hospital Radiation Oncology, Philadelphia, Pennsylvania.
authors.forename: Linna
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Penny R
authors.initials: PR
authors.lastname: Anderson
authors.affiliation: Department of Radiation Oncology, University of San Fransisco, San Fransisco, California.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Fowble
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Freedman