The Benefits of Prone Breast Radiotherapy: Reducing the Inclusion of the Lungs and Heart
Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Traditionally, prone breast irradiation has been advised for patients with large and/or pendulous breasts. In recent years, clinical studies have shown prone positioning to be advantageous not only for those with larger breasts, but in most patients, since it consistently reduces or eliminates the inclusion of heart and lung within the field. In addition, most patients are already familiar with the prone position as it is utilized during biopsies and MRIs.
Jason Ye, MD is an assistant professor of clinical radiation oncology at the Keck School of Medicine of USC, and a radiation oncologist at USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC. Dr. Ye specializes in various advanced radiation treatment techniques, such as stereotactic body radiotherapy (SERT), intensity modulated radiation therapy (IMRT), and prone breast radiotherapy.
Dr. Ye co-authored the article, “Prone Accelerated Partial Breast Irradiation Comparing Five versus Three Fractions for Early-Stage Breast Cancer: A Multi-Institutional Prospective Randomized Trial,” which reports on the early results of prone breast radiotherapy in postmenopausal women who completed breast conserving surgery with invasive breast cancer or grade 1-2 DCIS <2cm. The ongoing clinical trial is in collaboration with New York-Presbyterian/Weill Cornell Medical Center.
Prone breast radiotherapy takes advantage of gravity to pull breast away from the chest wall, resulting in less dose to the lungs, and, in most cases, the heart. It is also useful in women with large breasts to avoid "bolus effect" and acute skin toxicity.
“It's certainly important for [physicians and patients] to know that this is an option for a Lot of patients, because we are finding cancers earlier and earlier,” says Ye.
The technique poses a set of challenges which are not present in the traditional supine positioning, and for that reason, patients must be screened for tolerability of the position. With proper setup and advanced on-board imaging offered at Keck Medicine of USC, the prone technique provides a reproducible and reliable way to treat patients with breast cancer.
Over a decade ago, breast radiation was scheduled Monday through Friday, once a day for about six to seven weeks. About 10 years ago, patients started to receive a shorter fractionated radiation therapy, over three to four weeks. In select patients eligible for the new partial breast radiation technique, radiation is focused on the lumpectomy cavity, with reduced dose to the normal tissue and adjacent organs, and can be completed in approximately one week.
About USC Norris Comprehensive Cancer
USC Norris Comprehensive Cancer is a leader in the quest to make cancer a disease of the past. Their mission is to treat and prevent cancer by advancing and integrating education, research, and personalized patient care.
As one of the eight original National Cancer Institute (NCI)-designated comprehensive cancer centers in the United States, USC Norris is one of the nation's preeminent academic medical institutions and one of California's top cancer centers. The hospital has been revolutionizing cancer research for more than 40 years with innovative surgical techniques and novel cancer treatments. Their nationally and internationally renowned physicians represent extensive areas of expertise, giving them the ability to provide truly customized care for their patients.