Research support & innovation

Prone

Breast cancer patients commonly receive radiotherapy in the supine position, lying face-up. Randomized studies have shown that treatment in the prone position for breast cancer reduces acute toxicity and cosmetic changes. Prone breast treatment helps to reduce radiation exposure to surrounding organs and tissues, particularly the heart and lungs. This may lower the risk of complications, such as future heart disease and lung cancer. Furthermore, breast motion due to respiration is reduced I the prone position, helping to improve treatment accuracy and facilitating deep inspiration breath hold techniques to minimize heart and lung dose.

Prone DIBH

During deep-inspiration breath hold (DIBH) the heart is retracted away from the irradiated breast. By increasing distance, unwanted dose to the heart can be strongly reduced if radiation is delivered during periods of DIBH. DIBH has thoracic and abdominal components from which the latter is of specific interest for prone-treated patients. With abdominal DIBH (A-DIBH) in supine position, the breast tends to move caudally thereby damping the increase of heart-breast distance which is the key variable to lower heart dose. This is not the case for prone DIBH. Breast motion by deep-inspiration is much smaller in prone than in supine position and caudal shift of the breast by A-DIBH is efficiently blocked by OABC. Training by Radion-D focuses on A-DIBH. The figure illustrates the rationale behind combining A-DIBH with prone position.

Legend: SB: shallow breathing; T-DIBH: thoracic deep-inspiration breath hold; A-DIBH: abdominal DIBH. contours: red: breast; blue: heart; green: lung.

Deep inspiration breath hold (DIBH) in prone position is efficient. Prone DIBH is an easy and robust procedure because the breast hardly moves with respiration.

We’ve got the experience to support prone DIBH position, using a special developed bra. This bra gives the possibility to separate the contra-lateral breast as much as possible out of the treatment field.

Prone innovation

Thanks to the good collaboration with RTT’s, we embrace and work on continuous improvement and innovative projects.

Prone multiplanar techniques

We use multiplanar techniques to reduce the dose to the heart and lungs. Here we can refer to some publications

·         see resources/publications "Speleers, B., 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"

·         see resources/publication “Speleers, B., et al., Effects of deep inspiration breath hold on prone photon or proton irradiation or breast and regional lymph nodes. Sci Rep. 2021 Mar 16;11(1):6085

We have knowledge to guide your site on the training from coplanar planning to multiplanar planning.

Legend: Illustration of coplanar multiple overlaying short-arc VMAT technique. The long yellow lines indicate the edges of beam apertures taken from the control point sequences of the arcs. The short yellow lines are not beam edges but lines orthogonal to the beam directions at the isocenter plane. The figure illustrates avoidance of organs-at-risk such as lung, heart, ipsilateral arm and contralateral breast. The long yellow lines show that avoidance is such that no part of the primary beams passes through heart or contralateral breast. Figure taken from  Deseyne et al. Radiat Oncol. 2017 May 26;12(1):89. doi: 10.1186/s13014-017-0828-6 (open access)."