title: Prone breast intensity modulated radiation therapy: 5-year results.
abstract: OBJECTIVE
  To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed.
  
  
  METHODS
  Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs.
  
  
  RESULTS
  Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm(3), mean 19.65 cm(3). In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm(3), mean 1.59 cm(3). There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good.
  
  
  CONCLUSIONS
  Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and fractionation approach to standard 6-week radiation therapy with a sequential boost.
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine, New York, New York.
authors.forename: Etin-Osa O
authors.initials: EO
authors.lastname: Osa
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine, New York, New York.
authors.forename: Keith
authors.initials: K
authors.lastname: DeWyngaert
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Roses
authors.affiliation: Department of Medical Oncology, New York University School of Medicine, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Speyer
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Amber
authors.initials: A
authors.lastname: Guth
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, New York.
authors.forename: Deborah
authors.initials: D
authors.lastname: Axelrod
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine, New York, New York.
authors.forename: Maria
authors.initials: M
authors.lastname: Fenton Kerimian
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Judith D
authors.initials: JD
authors.lastname: Goldberg
authors.affiliation: Department of Radiation Oncology, New York University School of Medicine, New York, New York. Electronic address: Silvia.formenti@nyumc.org.
authors.forename: Silvia C
authors.initials: SC
authors.lastname: Formenti
mesh_terms: D001940:Breast / Q000528:radiation effects; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000528:radiation effects; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology; D058958:Organs at Risk / Q000528:radiation effects; D056888:Patient Positioning / Q000379:methods*; D016684:Prone Position; D011446:Prospective Studies; D011832:Radiation Injuries / Q000517:prevention & control; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors