Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.

Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.



UkraineOncoGlobal

UkraineOncoGlobal

Журнал «Практична онкологія» Том 6, №2, 2023

Повернутися до номеру

Чи є положення лежачи на животі безпечним для органів ризику при променевій терапії молочної залози? Клінічний випадок та огляд літератури

Автори: Sumeyra Oz, Aslı Sabah, Ilyas Anıl Kılınc, Oguzhan Bascik, Yunus Babayigit, Burak Baturalp Contu, Ipek Sucak, Yasemin Celik, Cengiz Kurtman
Ankara University Medical Faculty, Department of Radiation Oncology, Ankara, Turkey

Рубрики: Онкологія

Розділи: Довідник фахівця

Версія для друку


Резюме

Ад’ювантна променева терапія є важливою у хворих на рак молочної залози, однак її довгострокові ускладнення є проблемою, особливо для серця та легенів. Описано випадок раку в 77-річної пацієнтки, якій виконано операцію зі збереження грудей та ад’ювантну променеву терапію. Жінка мала великі відвислі тканини молочної залози, тому комп’ютерну томографію проведено в положенні лежачи на животі або на спині. Оскільки в нашій клініці не було спеціального пристрою, за допомогою блоків із пінополістиролу та ліжка з нахилом ми розробили механізм для проведення радіотерапії в положенні пацієнтки лежачи на животі. Завдяки цьому знижується променеве навантаження на серце та легені, без шкоди для зони охоплення. Таким чином, радіотерапія в положенні лежачи є ефективним методом у пацієнток із раком молочної залози, тому в кожному випадку слід оцінювати, яким положенню та методу буде віддано перевагу.

Adjuvant radiotherapy is essential for breast cancer patients, but its long-term complications are an issue, especially for heart and lungs. We reported a 77-year-old female patient diagnosed with breast cancer and treated with breast-conserving surgery and adjuvant radiotherapy. Patient has large, pendulous breast tissue and she was simulated on either supine or prone positions. A prone mechanism was created by us using styrofoams and abdominal prone bed because we don’t have breast prone bed in our clinic. Radiotherapy in prone position resulted in a better heart and lung dosimetry without any compromising coverage. In conclusion, radiotherapy in prone position is an effective method for breast cancer patients. So, which position and method will be preferred, should be evaluated case by case.


Ключові слова

молочна залоза; новоутворення молочної залози; променева терапія; положення лежачи на животі

breast; breast neoplasms; radiotherapy; prone position


Для ознайомлення з повним змістом статті необхідно оформити передплату на журнал.


Список літератури

1. Darby S., McGale P., Correa C. et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011 Nov 12. 378(9804). 1707-16. doi: 10.1016/S0140-6736(11)61629-2.
2. Cancer Stat Facts: Female Breast Cancer. Available from: https://seer.cancer.gov/statfacts/html/breast.html.
3. Clarke M., Collins R., Darby S. et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005 Dec 17. 366(9503). 2087-106. doi: 10.1016/S0140-6736(05)67887-7.
4. Darby S.C., Ewertz M., McGale P. et al. Risk of ische–mic heart disease in women after radiotherapy for breast cancer. N. Engl. J. Med. 2013 Mar 14. 368(11). 987-98. doi: 10.1056/NEJMoa1209825.
5. Taylor C., Correa C., Duane F.K. et al. Estimating the Risks of Breast Cancer Radiotherapy: Evidence From Modern Radiation Doses to the Lungs and Heart and From Previous Randomized Trials. J. Clin. Oncol. 2017 May 20. 35(15). 1641-1649. doi: 10.1200/JCO.2016.72.0722.
6. Radiation Therapy Oncology Group. Breast cancer atlas for radiation therapy planning: consensus definitions. 2013.
7. Duane F., Aznar M.C., Bartlett F. et al. A cardiac contouring atlas for radiotherapy. Radiother. Oncol. 2017 Mar. 122(3). 416-422. doi: 10.1016/j.radonc.2017.01.008.
8. Feng M., Moran J.M., Koelling T. et al. Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int. J. Radiat. Oncol. Biol. Phys. 2011 Jan 1. 79(1). 10-8. doi: 10.1016/j.ijrobp.2009.10.058.
9. Huppert N., Jozsef G., Dewyngaert K., Formenti S.C. The role of a prone setup in breast radiation therapy. Front. Oncol. 2011. 1. 31. doi: 10.3389/fonc.2011.00031.
10. Mamounas E.P., Bandos H., White J.R. NRG Onco–logy/NSABP B-51/RTOG 1304: Phase III trial to determine if chest wall and regional nodal radiotherapy (CWRNRT) post mastectomy (Mx) or the addition of RNRT to whole breast RT post breast-conserving surgery (BCS) reduces invasive breast cancer recurrence-free interval (IBCR-FI) in patients (pts) with pathologically positive axillary (PPAx) nodes who are ypN0 after neoadjuvant chemotherapy (NC). Journal of Clinical Oncology. 2019. 37(15). doi: 10.1200/JCO.2019.37.15_suppl.TPS600.
11. Duma M.N., Baumann R., Budach W. et al. Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther. Onkol. 2019 Oct. 195(10). 861-871. doi: 10.1007/s00066-019-01495-w.
12. Merchant T.E., McCormick B. Prone position breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 1994 Aug 30. 30(1). 197-203. doi: 10.1016/0360-3016(94)90535-5.
13. Piroth M.D., Baumann R., Budach W. et al. Heart toxi–city from breast cancer radiotherapy: current findings, assessment, and prevention. Strahlenther. Onkol. 2019 Jan. 195(1). 1-12. doi: 10.1007/s00066-018-1378-z.
14. Grann A., McCormick B., Chabner E.S. et al. Prone breast radiotherapy in early-stage breast cancer: a preliminary analysis. Int. J. Radiat. Oncol. Biol. Phys. 2000 May 1. 47(2). 319-25. doi: 10.1016/s0360-3016(00)00448-x.
15. Goodman K.A., Hong L., Wagman R., Hunt M.A., McCormick B. Dosimetric analysis of a simplified intensity modulation technique for prone breast radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 2004 Sep 1. 60(1). 95-102. doi: 10.1016/j.ijrobp.2004.02.016.
16. Kurtman C., Nalça Andrieu M., Hiçsönmez A., Celebioğlu B. Three-dimensional conformal breast irradiation in the prone position. Braz. J. Med. Biol. Res. 2003 Oct. 36(10). 1441-6. doi: 10.1590/s0100-879x2003001000023.
17. Formenti S.C., Gidea-Addeo D., Goldberg J.D. et al. Phase I–II trial of prone accelerated intensity modulated radiation therapy to the breast to optimally spare normal tissue. J. Clin. Oncol. 2007 Jun 1. 25(16). 2236-42. doi: 10.1200/JCO.2006.09.1041.
18. Chino J.P., Marks L.B. Prone positioning causes the heart to be displaced anteriorly within the thorax: implications for breast cancer treatment. Int. J. Radiat. Oncol. Biol. Phys. 2008 Mar 1. 70(3). 916-20. doi: 10.1016/j.ijrobp.2007.11.001.
19. Formenti S., Lymberis S., Parhar P. Results of NYU 05-181: A Prospective Trial to Determine Optimal Position (Prone versus Supine) for Breast Radiotherapy. Internatio–nal Journal of Radiation Oncology, Biology, Physics. 2009. 75(3).
20. Kirby A.M., Evans P.M., Donovan E.M., Convery H.M., Haviland J.S., Yarnold J.R. Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother. Oncol. 2010 Aug. 96(2). 178-84. doi: 10.1016/j.radonc.2010.05.014.
21. Mulliez T., Veldeman L., van Greveling A. et al. Hypofractionated whole breast irradiation for patients with large breasts: a randomized trial comparing prone and supine positions. Radiother. Oncol. 2013 Aug. 108(2). 203-8. doi: 10.1016/j.radonc.2013.08.040.
22. Saini A.S., Hwang C.S., Biagioli M.C., Das I.J. Evaluation of sparing organs at risk (OARs) in left-breast irradiation in the supine and prone positions and with deep inspiration breath-hold. J. Appl. Clin. Med. Phys. 2018 Jul. 19(4). 195-204. doi: 10.1002/acm2.12382.
23. Lymberis S.C., deWyngaert J.K., Parhar P. et al. Prospective assessment of optimal individual position (prone versus supine) for breast radiotherapy: volumetric and dosimetric correlations in 100 patients. Int. J. Radiat. Oncol. Biol. Phys. 2012 Nov 15. 84(4). 902-9. doi: 10.1016/j.ijrobp.2012.01.040.
24. Lai J., Zhong F., Deng J. et al. Prone position versus supine position in postoperative radiotherapy for breast cancer: a meta-analysis. Medicine (Baltimore). 2021 May 21. 100(20). e26000. doi: 10.1097/MD.0000000000026000.
25. Chung Y., Yu J.I., Park W., Choi D.H. Korean First Prospective Phase II Study, Feasibility of Prone Position in Postoperative Whole Breast Radiotherapy: A Dosimetric Comparison. Cancer Res. Treat. 2019 Oct. 51(4). 1370-1379. doi: 10.4143/crt.2018.423.
26. Würschmidt F., Stoltenberg S., Kretschmer M., Petersen C. Incidental dose to coronary arteries is higher in prone than in supine whole breast irradiation. A dosimetric comparison in adjuvant radiotherapy of early stage breast cancer. Strahlenther. Onkol. 2014 Jun. 190(6). 563-8. doi: 10.1007/s00066-014-0606-4.
27. Bergom C., Kelly T., Morrow N. et al. Prone whole-breast irradiation using three-dimensional conformal radiotherapy in women undergoing breast conservation for early disease yields high rates of excellent to good cosmetic outcomes in patients with large and/or pendulous breasts. Int. J. Radiat. Oncol. Biol. Phys. 2012 Jul 1. 83(3). 821-8. doi: 10.1016/j.ijrobp.2011.08.020
28. Vesprini D., Davidson M., Bosnic S. et al. Effect of Supine vs Prone Breast Radiotherapy on Acute Toxic Effects of the Skin Among Women With Large Breast Size: A Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1. 8(7). 994-1000. doi: 10.1001/jamaoncol.2022.1479.
29. Varga Z., Hideghéty K., Mezo T., Nikolényi A., Thurzó L., Kahán Z. Individual positioning: a comparative study of adjuvant breast radiotherapy in the prone versus supine position. Int. J. Radiat. Oncol. Biol. Phys. 2009 Sep 1. 75(1). 94-100. doi: 10.1016/j.ijrobp.2008.10.045.
30. Fargier-Bochaton O., Wang X., Dipasquale G. et al. Prone versus supine free-breathing for right-sided whole breast radiothe–rapy. Sci. Rep. 2022 Jan 11. 12(1). 525. doi: 10.1038/s41598-021-04385-3.
31. Kainz K., White J., Chen G.P., Hermand J., England M., Li X.A. Simultaneous irradiation of the breast and regional lymph nodes in prone position using helical tomotherapy. Br. J. Radiol. 2012 Oct. 85(1018). e899-905. doi: 10.1259/bjr/18685881.
32. Deseyne P., Speleers B., De Neve W. et al. Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer. Radiat. Oncol. 2017 May 26. 12(1). 89. doi: 10.1186/s13014-017-0828-6.
33. Gielda B.T., Strauss J.B., Marsh J.C., Turian J.V., Griem K.L. A dosimetric comparison between the supine and prone positions for three-field intact breast radiotherapy. Am. J. Clin. Oncol. 2011 Jun. 34(3). 223-30. doi: 10.1097/COC.0b013e3181dbb9c1.
34. Speleers B.A., Belosi F.M., De Gersem W.R. et al. Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain. Sci. Rep. 2019 Mar 18. 9(1). 4755. doi: 10.1038/s41598-019-41283-1.
35. Sethi R.A., No H.S., Jozsef G., Ko J.P., Formenti S.C. Comparison of three-dimensional versus intensity-modulated radiotherapy techniques to treat breast and axil–lary level III and supraclavicular nodes in a prone versus supine position. Radiother Oncol. 2012 Jan. 102(1). 74-81. doi: 10.1016/j.radonc.2011.09.008.
36. Alonso-Basanta M., Ko J., Babcock M., Dewyngaert J.K., Formenti S.C. Coverage of axillary lymph nodes in supine vs. prone breast radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 2009 Mar 1. 73(3). 745-51. doi: 10.1016/j.ijrobp.2008.04.040.
37. Shin S.M., No H.S., Vega R.M. et al. Breast, chest wall, and nodal irradiation with prone set-up: results of a hypofractionated trial with a median follow-up of 35 months. Pract. Radiat. Oncol. 2016. 6(4). e81-e88. doi: 10.1016/j.prro.2015.10.022.
38. Pandeli C., Smyth L.M.L., David S., See A.W. Dose reduction to organs at risk with deep-inspiration breath-hold during right breast radiotherapy: a treatment planning study. Radiat. Oncol. 2019 Dec 10. 14(1). 223. doi: 10.1186/s13014-019-1430-x.
39. Verhoeven K., Sweldens C., Petillion S. et al. Breathing adapted radiation therapy in comparison with prone position to reduce the doses to the heart, left anterior descending coronary artery, and contralateral breast in whole breast radiation therapy. Pract. Radiat. Oncol. 2014. 4(2). 123-129. doi: 10.1016/j.prro.2013.07.005.
40. Lin H., Liu T., Shi C. et al. Feasibility study of individualized optimal positioning selection for left-sided whole breast radiotherapy: DIBH or prone. J. Appl. Clin. Med Phys. 2018 Mar. 19(2). 218-229. doi: 10.1002/acm2.12283.
41. Gerber N.K., Yan S.X., Levinson B.A. et al. A Prospective Trial to Compare Deep Inspiratory Breath Hold With Prone Breast Irradiation. Pract. Radiat. Oncol. 2020. 10(5). 330-338. doi: 10.1016/j.prro.2020.01.001.
42. Yan S.X., Maisonet O.G., Perez C.A. et al. Radiation effect on late cardiopulmonary toxicity: an analysis comparing supine DIBH versus prone techniques for breast treatment. Breast J. 2020 May. 26(5). 897-903. doi: 10.1111/tbj.13742.
43. Bartlett F.R., Colgan R.M., Donovan E.M. et al. The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiothe–rapy after breast conserving surgery. Radiother. Oncol. 2015. Jan. 114(1). 66-72. doi: 10.1016/j.radonc.2014.11.018.
44. Mulliez T., Veldeman L., Speleers B. et al. Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother. Oncol. 2015 Jan. 114(1). 79-84. doi: 10.1016/j.radonc.2014.11.038.
45. Goyal U., Saboda K., Roe D., Gonzalez V.J. Prone Positio–ning With Deep Inspiration Breath Hold for Left Breast Radiotherapy. Clin. Breast Cancer. 2021 Aug. 21(4). e295-e301. doi: 10.1016/j.clbc.2020.11.004.
46. Saini A.S., Das I.J., Hwang C.S., Biagioli M.C., Lee W.E. Biological Indices Evaluation of Various Treatment Techniques for Left-Sided Breast Treatment. Pract. Radiat. Oncol. 2019 Nov. 9(6). e579-e590. doi: 10.1016/j.prro.2019.06.020.
47. Kirby A.M., Evans P.M., Helyer S.J., Donovan E.M., Convery H.M., Yarnold J.R. A randomised trial of supine versus prone breast radiotherapy (SuPr study): comparing set-up errors and respiratory motion. Radiother. Oncol. 2011 Aug. 100(2). 221-6. doi: 10.1016/j.radonc.2010.11.005.

Повернутися до номеру