Work

Alternative Treatment Positions over Supine in Adjuvant Whole Breast RT: Prone, Lateral or What Else? A Comprehensive Narrative Review

Year: 2026

Type: review

Abstract: Whole breast radiotherapy in adjuvant breast cancer (BC) treatment is commonly delivered in supine positioning since more than 50 years ago. Its widespread use is related to the broad availability of simply and common breast board immobilization devices which exploit the natural recumbent position of the body with arms above the head, the good match with linac tables and well established set up procedures. However, several criticisms have been raised over time in case of scenarios like painful arm discomfort in patients with post-surgery arm or arthritic limitation, unfavorable chest geometry like pectus excavatum, large and pendulous breasts in obese women, cardiac morbidity in left sided BC. In these scenarios supine position seems very uncomfortable for patients and troublesome for radiation oncologists. Heart dosimetry in pectus excavatum (PE) and left sided breasts, breast size and shape matter when DIBH is not allowed. In fact, not all patients are suitable DIBH candidates because of the limiting factors like obesity or pulmonary morbidities. Thus, adjuvant whole breast radiotherapy in supine positioning could be very critical. Alternative positions have been analyzed in these last twenty years starting from a lot of trials testing prone positioning variants with and without DIBH, lateral decubitus or up-right standing radiotherapy. Customized immobilization devices have been developed to make these alternative positions more comfortable and consistent with beams angles arrangements and modern RT delivery avoiding collisions with the device or the Linac. To standardize the target delineation in these positions, customized guidelines have been also provided and recently several atlas-based segmentation processes have been provided to reduce bias by incorporating an interobserver quality analysis. Researches and a better recognition of new treatment position options in BC adjuvant therapy may provide more opportunities for a personalized radiotherapy mainly in that population not suitable for supine RT, to ensure them an appropriate, safe and comfortable treatment.

Source: Journal of Personalized Medicine

DOI: 10.3390/jpm16050233