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Prone position may be safer during radiation

Issue: November 10, 2012

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Patients with breast cancer who underwent CT scans in the prone position experienced significantly less radiation exposure to their hearts and lungs than patients who were in the supine position, according to study results.

The study included 400 patients with stage 0 to stage IIA disease. Additional eligibility criteria included segmental mastectomy, negative surgical margins, and three or fewer involved lymph nodes.

Of the 400 patients, 86 had ductal carcinoma in situ and 314 had invasive breast cancer. Of those with invasive breast cancer, 47 had involved sentinel or axillary lymph nodes.

All patients had been referred to New York University Radiation Oncology between Nov. 15, 2005, and Dec. 26, 2008. The three breast volume groups identified in the study were <750 cm³, 750 cm³ to 1,500 cm³ and >1,500 cm³.

Patients underwent CT simulation scans while in two positions: supine and prone. The investigators took measures to ensure safe, targeted radiation doses.

Results for all patients indicated that the prone position was associated with reductions in in-field lung volumes compared with the supine position (mean difference: 104.6 cm³; 95% CI, 94.26-114.95, an 86.2% reduction for right breast cancer; 89.85 cm³; 95% CI, 80.16-99.55, a 91.1% reduction for left breast cancer).

In the left breast cohort, in-field heart volumes were reduced in the prone position compared with supine (mean difference: 7.5 cm³; 95% CI, 5.16-9.85, an 85.7% reduction).

Fifteen percent of patients with left breast cancer experienced less in-field heart volume in the supine position than in the prone position (mean difference: 6.15 cm³; 95% CI, 2.97-9.33).

All reductions were statistically significant, except for the heart in women with breast size <750 cm³.

The study is limited because patients were treated at a single institution, the 
researchers said.

“A multi-institutional prospective trial with outcome measures is warranted to confirm these findings,” they wrote. “If prone positioning better protects normal tissue adjacent to the breast, the risks of long-term deleterious effects of radiotherapy may be reduced.”

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