title: The 2-Year Cosmetic Outcome of a Randomized Trial Comparing Prone and Supine Whole-Breast Irradiation in Large-Breasted Women.
abstract: To report the 2-year cosmetic outcome of a randomized trial comparing prone and supine whole-breast irradiation in large-breasted patients.
  
  
  
  One hundred patients with a (European) cup size ≥C were included. Before and 2 years after radiation therapy, clinical endpoints were scored and digital photographs were taken with the arms alongside the body and with the arms elevated 180°. Three observers rated the photographs using the 4-point Harvard cosmesis scale. Cosmesis was also evaluated with the commercially available Breast Cancer Conservation Treatment.cosmetic results (BCCT.core) software.
  
  
  
  Two-year follow-up data and photographs were available for 94 patients (47 supine treated and 47 prone treated). Patient and treatment characteristics were not significantly different between the 2 cohorts. A worsening of color change occurred more frequently in the supine than in the prone cohort (19/46 vs 10/46 patients, respectively, P=.04). Five patients in the prone group (11%) and 12 patients in the supine group (26%) presented with a worse scoring of edema at 2-year follow-up (P=.06). For retraction and fibrosis, no significant differences were found between the 2 cohorts, although scores were generally worse in the supine cohort. The cosmetic scoring by 3 observers did not reveal differences between the prone and supine groups. On the photographs with the hands up, 7 patients in the supine group versus none in the prone group had a worsening of cosmesis of 2 categories using the BCCT.org software (P=.02).
  
  
  
  With a limited follow-up of 2 years, better cosmetic outcome was observed in prone-treated than in supine-treated patients.
authors.affiliation: Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium; Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium. Electronic address: liv.veldeman@uzgent.be.
authors.forename: Liv
authors.initials: L
authors.lastname: Veldeman
authors.affiliation: Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Schiettecatte
authors.affiliation: Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Charlotte
authors.initials: C
authors.lastname: De Sutter
authors.affiliation: Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Christel
authors.initials: C
authors.lastname: Monten
authors.affiliation: Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Annick
authors.initials: A
authors.lastname: van Greveling
authors.affiliation: Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium; Department of Radiation Oncology, Centre Hospitalier Universitaire de Liège, Liège, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Berkovic
authors.affiliation: Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mulliez
authors.affiliation: Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium; Department of Radiotherapy and Experimental Cancer Research, Ghent University, Ghent, Belgium.
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Neve
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology / Q000528:radiation effects*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D004954:Esthetics; D005260:Female; D006801:Humans; D008875:Middle Aged; D016684:Prone Position; D016683:Supine Position