External-Beam Partial Breast Irradiation: The New York University Prone Technique
Partial breast irradiation performed using external-beam techniques in the prone position has many advantages. In addition to the many advantages associated with the use of a hypofractionated regimen delivered by an external beam, positioning the patient in the prone position often displaces the tumor bed target away from the chest wall, enabling better sparing of lungs and heart. Originally developed at the University of Southern California, prone external-beam partial breast irradiation (prone EB-PBI) was further perfected at New York University, and has confirmed its feasibility and convenience to the patient. Some of the advantages associated with the technique we have developed have resulted in a significant reduction in interfraction variability. For instance, the advantage of using only five fractions also demands very accurate alignment during treatment. Moreover, since the utilization of prone positioning drastically reduces the intrafraction movement associated with respiration, it has been possible to reduce the margins of the planning target volume (PTV), which requires high targeted delivery precision. To address this challenge of precise positioning, our group has pilot-tested the use of image-guided prone EB-PBI. This review describes the clinical evolution of prone EB-PBI and introduces preliminary experiences of using cone-beam CT image guidance with the Varian On-Board Imager kV imaging system daily.
KeywordsPlanning Target Volume Radiat Oncol Biol Phys Cone Beam Compute Tomography Clinical Target Volume Accelerate Partial Breast Irradiation
Unable to display preview. Download preview PDF.
- Becker SJ, Patela RR, Mackie TR (2006) Accelerated partial breast irradiation with helical tomo-therapy: prone or supine setup? Int J Radiat Oncol Biol Phys 66(3):S230Google Scholar
- Chen P Y, Vicini FA (2007) Partial breast irradiation. Patient selection, guidelines for treatment, and current results. Front Radiat Ther Oncol 40:253–71Google Scholar
- DeWyngaert JK, Mitchella JD, Alonso-Basanta M, Formenti SC (2006) Intrafraction organ motion in breast radiation therapy: a comparison of prone versus supine patient positioning. Int J Radiat Oncol Biol Phys 66(3):S177–8Google Scholar
- Ellerin BE, Seidenfeld J, Formenti SC (2004) A systematic review of post-lumpectomy radiation therapy regimens. Proc Am Soc Clin Oncol 23:47Google Scholar
- Fyles A, McCready D, Manchul L (2001) Preliminary results of a randomized study of tamoxifen + /− breast radiation in T1/2 N0 disease in women over 50 years of age. Proc Am Soc Clin Oncol 20:24a (Abstr 92)Google Scholar
- Wernicke AG, Gidea-Addeo D, Magnolfi C, Fenton-Kerimian M, Goldberg J, Formenti SC (2006) External beam partial breast irradiation following breast-conserving surgery: preliminary results of cosmetic outcome of NYU 00-23. Int J Radiat Oncol Biol Phys 66(3):S32Google Scholar