Pendulous Breast Radiotherapy in Prone Position

INTRODUCTION: Adjuvant radiotherapy is the standard treatment for breast cancer patients who underwent breast conserving surgery. One of the most important factors affecting cosmetic results after radiotherapy is breast size. The aim of this study was to evaluate the cosmesis and dosimetric distribution of patients undergoing radiotherapy in the prone position due to pandular breast.
METHODS: Between July 2015 and August 2017, 17 patients who had breast conserving surgery and radiotherapy were evaluated. Patients were simulated in prone position. Fifty Gy to the breast; median 14 Gy (10-16 Gy) boost to the tumor bed were applied. Dosimetric results were evaluated from treatment planning system. Acute and late side effects were evaluated by using RTOG toxicity criteria.
RESULTS: Seventeen patients with pendulous breasts who underwent breast conserving surgery and radiotherapy were evaluated. The mean age was 59 (38-87); mean tumor size was 2.2 cm (0.7-5.5 cm). Median 50 Gy (48-50 Gy) radiotherapy was applied to the whole breast with a median 14 Gy (10-16 Gy) boost to the tumor bed. PTV minimum, maximum and mean doses were 3341 cGy, 5544 cGy, 5161 cGy; mean dose of lung and V5, V20, V30 values were 414 cGy, 10.5%, 5%, 3.6%; hear tmean dose and V5, V10, V30 values were; 256cGy, 7.7%, 3.3%, 1.2%; maximum and mean doses of the contrlateral breast were 1128 cGy and 44 cGy. In 7 patients grade 2 radiodermitis; in 1 patient grade 3 radiodermitis was observed. There was no recurrence or poor cosmetic outcome during the14.5 months follow-up (1-24 months).
DISCUSSION AND CONCLUSION: More dose inhomogenity is seen in the supine position radiotherapy of pendulous breasts and as a result bad cosmetic results may be observed. Also lung and heart toxicity increases with the irradiation of large areas. Good dose homogenities and cosmetic results may be achieved by prone position.

Prone Pozisyonda Pandüler Meme Radyoterapisi

GÝRÝÞ ve AMAÇ: Meme koruyucu cerrahi uygulanmýþ meme kanseri tanýlý hastalarda adjuvan radyoterapi standart tedavidir. Radyoterapi sonrasý kozmetik sonuçlarý en çok etkileyen faktörlerden birisi de meme boyutudur. Bu çalýþmanýn amacý pandüler meme nedeni ile prone pozisyonda radyoterapi uyguladýðýmýz hastalarda kozmezis ve dozimetrik daðýlýmýnýn deðerlendirilmesidir.
YÖNTEM ve GEREÇLER: Temmuz 2015-Aðustos 2017 tarihleri arasýnda meme koruyucu cerrahi uygulanmýþ 17 hastaya prone pozisyonda radyoterapi uygulandý. Hastalara prone meme yataðý ile simülasyon yapýldý ve konvansiyonel fraksinasyonla tüm memeye 50 Gy; tümör yataðýna ortanca 14 Gy (10-16 Gy) radyoterapi uygulandý. Tedavi planlama sisteminden hedef hacim ve kritik organlarýn dozimetrik deðerlendirmeleri yapýldý. RTOG tokisisite kriterleri kullanýlarak akut ve geç yan etkiler deðerlendirildi.
BULGULAR: : Meme koruyucu cerrahi uygulanan büyük ve sarkýk (panduler) memeli 17 hasta deðerlendirildi. Ortalama yaþ 59 (38-87); ortalama tümör boyutu 2.2 cm (0,7-5.5 cm) idi. Tüm memeye 50 Gy, tümör yataðýna median 14 Gy (10-16 Gy) boost uygulandý. PTV meme minimum, maksimum, ortalama dozlarý; 3341cGy, 5544 cGy, 5161 cGy;.akciðer ortalama doz ve V5, V20, V30 ortalama yüzdeleri: 414 cGy, %10.5,% 5, %3.6;kalp ortalama doz ve V5,V10,V30 ortalama yüzdeleri; 256cGy, %7.7, %3.3, %1.2; karþý meme maksimum ve ortalama doz; 1128 cGy ve 44 cGy idi.7 hastada grade 2, 1 hastada grade 3 radyodermit geliþti. Ortalama 14.5 aylýk (1-24 ay) takipte nüks veya kötü kozmetik sonuç gözlenmedi.
TARTIÞMA ve SONUÇ: Panduler memelerin supine pozisyonda alýnmasý ile daha çok doz inhomojenitesi görülmekte ve bunun sonucu olarak kozmezis bozulmaktadýr. Ayrýca büyük alanlarýn ýþýnlanmasý ile akciðer ve kalp toksisitesi artmaktadýr. Panduler meme ýþýnlamalarýnda prone pozisyon ile iyi doz homojenitesi ve kozmezis saðlanabilmektedir.