Prone breast radiotherapy in early-stage breast cancer: A preliminary analysis

Purpose: Women with large breasts have marked dose inhomogeneity and often an inferior cosmetic outcome when treated with breast conservation compared to smaller-sized patients. We designed a prone breast board, which both mi nimizes breast separation and irradiated lung or heart volume. We report fe asibility, cosmesis, and preliminary local control and survival for selecte d women with Stage 0-II breast cancer. Materials and Methods: Fifty-six patients with clinical Stage 0-II breast c ancer were treated with lumpectomy and breast irradiation utilizing a proto type prone breast board. A total of 59 breasts were treated. Indications fo r treatment in the prone position were large or pendulous breast size (rt = 57), or a history of cardiopulmonary disease (n = 2). The median bra size was 41D (range, 34D-44EE). Cosmesis was evaluated on a 1-10 (worst-to-best) scale. Results: Acute toxicity included skin erythema (80% of patients experienced Grade I or Grade II erythema), breast edema (72% of patients experienced m ild edema), pruritus (20 % of patients), and fatigue (20 % of patients repo rted mild fatigue). One patient required a treatment break. The only late t oxicity was related to long-term cosmesis. The mean overall cosmesis score for 53 patients was 9.37 (range, 8-10). Actuarial 3- and 5-year local contr ol rates are 98%. Actuarial overall survival at 3 and 5 years are 98% and 9 4%. Conclusion: Our data indicate that treating selected women with prone breas t radiotherapy is feasible and tolerated. The approach results in excellent cosmesis, and short-term outcome is comparable to traditional treatment te chniques. This technique offers an innovative alternative to women who migh t not otherwise be considered candidates for breast conservation. (C) 2000 Elsevier Science Inc.