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Background <p>This study aimed to compare the dosimetric characteristics of three radiotherapy techniques—supine free-breathing (FB), supine deep inspiration breath-hold (DIBH), and prone positioning—in terms of normal tissue sparing during whole-breast irradiation following breast-conserving surgery.</p> Methods <p>A total of 75 breast cancer patients (34 right-sided and 41 left-sided) were included in this dosimetric planning study. The study was approved by the local ethics board and registered at <a href="https://www.clinicaltrials.gov">www.clinicaltrials.gov</a> on 2023-1-31 (NCT05609058). They all underwent a computed tomography (CT) scan in standard supine position in free-breathing (FB), supine position with deep inspiratory breath hold (DIBH), and prone position (prone). Three-dimensional treatment plans were made for all 3 CTs. The primary endpoint of the study was the comparative evaluation of OAR dose reduction. Data were analyzed with ANOVA or Friedman test with appropriate post-hoc comparisons. Values of <i>p</i> &lt; 0.05 were considered to be statistically significant.</p> Results <p>The Dmean to the ipsilateral lung was significantly lower in the prone position than in the supine position (3.31&#xa0;Gy vs. 7.73&#xa0;Gy, 7.25&#xa0;Gy, <i>P</i> = 0.000). Despite a 62% increase in lung volume with DIBH (range: 15–132%), no pulmonary dose reduction was achieved versus FB. In light of the anatomical characteristics of the heart and the left anterior descending artery (LAD) and right coronary artery (RA), we conducted an analysis of these three indicators, which were divided into two categories: right breast cancer and left breast cancer. For left-sided breast cancer, DIBH significantly reduced the Dmean and Vx doses to the heart and LAD. For right-sided breast cancer, the prone position significantly increased the Dmean and Vx to the heart and RA. DIBH has not shown to significantly decrease the radiation dose to the heart.</p> Conclusion <p>For left-sided breast cancer, DIBH is optimal for heart protection, while prone positioning benefits lung sparing. For right-sided cancer, free-breathing suffices is adequate.</p> Trial registration <p>The study was approved by the local ethics board and registered on&#xa0;<a href="https://www.clinicaltrials.gov">www.clinicaltrials.gov</a>&#xa0;(NCT05609058).</p>

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Evaluation of organs at risk (OARs) in whole-breast irradiation: a comparison of prone, supine position and with deep inspiration breath-hold techniques–subgroup analysis from a prospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月22日

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  • Lingling Feng,
  • Ying Liang,
  • Jiaxin Huang,
  • Sisi Xu,
  • Wenjue Zhang,
  • Xiaoye Su,
  • Yutong Tan,
  • Tongda Lei,
  • Xiaoyong Xiang,
  • Lining Chen,
  • Junqin Lei,
  • Nan Hu,
  • Jing Jin,
  • Qin Xiao,
  • Ning Li

摘要

Background

This study aimed to compare the dosimetric characteristics of three radiotherapy techniques—supine free-breathing (FB), supine deep inspiration breath-hold (DIBH), and prone positioning—in terms of normal tissue sparing during whole-breast irradiation following breast-conserving surgery.

Methods

A total of 75 breast cancer patients (34 right-sided and 41 left-sided) were included in this dosimetric planning study. The study was approved by the local ethics board and registered at www.clinicaltrials.gov on 2023-1-31 (NCT05609058). They all underwent a computed tomography (CT) scan in standard supine position in free-breathing (FB), supine position with deep inspiratory breath hold (DIBH), and prone position (prone). Three-dimensional treatment plans were made for all 3 CTs. The primary endpoint of the study was the comparative evaluation of OAR dose reduction. Data were analyzed with ANOVA or Friedman test with appropriate post-hoc comparisons. Values of p < 0.05 were considered to be statistically significant.

Results

The Dmean to the ipsilateral lung was significantly lower in the prone position than in the supine position (3.31 Gy vs. 7.73 Gy, 7.25 Gy, P = 0.000). Despite a 62% increase in lung volume with DIBH (range: 15–132%), no pulmonary dose reduction was achieved versus FB. In light of the anatomical characteristics of the heart and the left anterior descending artery (LAD) and right coronary artery (RA), we conducted an analysis of these three indicators, which were divided into two categories: right breast cancer and left breast cancer. For left-sided breast cancer, DIBH significantly reduced the Dmean and Vx doses to the heart and LAD. For right-sided breast cancer, the prone position significantly increased the Dmean and Vx to the heart and RA. DIBH has not shown to significantly decrease the radiation dose to the heart.

Conclusion

For left-sided breast cancer, DIBH is optimal for heart protection, while prone positioning benefits lung sparing. For right-sided cancer, free-breathing suffices is adequate.

Trial registration

The study was approved by the local ethics board and registered on www.clinicaltrials.gov (NCT05609058).