Breast Radiation Therapy: Take it Lying Down – Face Down
A study published in the JAMA Network supports a unique offering for women receiving radiation therapy for breast cancer that benefits patients while still delivering high quality radiation treatment.
The prone position, lying face down, can provide more protection than lying on your back when receiving radiation therapy for breast cancer. A specially-designed table allows the patient to lie flat on her stomach with the breast hanging away from the body in an opening. The radiation oncologist administers treatment to the affected breast while the healthy breast and nearby organs and tissues are shielded from radiation.
According to the study, whole breast radiotherapy is associated with damage to the heart and lung, increased cardiovascular death, and lung cancer development, with risks that remain 15 to 20 years after treatment. This occurs when breast cancer patients are treated supine – lying on their backs facing upward. Preliminary data on prone positioning suggest that radiation exposure to the heart and lung can be reduced compared with supine positioning with similar treatment effectiveness.
The prone position protects tissue and nearby organs, including the heart which is especially susceptible when treating the left breast. When you’re on your back, the breasts lie against the body, increasing the chance of radiation exposure to other areas. In the prone position on a special table, the breast hangs away from the body through an opening. When treatment is administered, the heart, lungs and other breast are protected by the table acting as a shield.
In the study, the researchers looked at 400 women diagnosed with early-stage breast cancer (stage 0 to stage IIA) from 2005 to 2008. The women all were treated at New York University. They were about 56 years old and 80% of them were white. About 21% of the women were diagnosed with DCIS (stage 0).
- 200 women were diagnosed with cancer in the left breast
- 200 women were diagnosed with cancer in the right breast
For most women diagnosed with cancer in the left breast, lying face down reduced the amount of heart tissue exposed to radiation by 86% and reduced the amount of lung tissue exposed to radiation by 91% compared to lying face up. For women diagnosed with cancer in the right breast, lying face down reduced the amount of lung tissue exposed to radiation by 86% compared to lying face up. It’s important to remember that only a very small area of the heart and lungs might be exposed to radiation while lying face up.
According to the National Institutes of Health, the prone position has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its use has been delayed in radiation therapy. New technological advances including image-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) have made accelerated treatment and a reduction in overall treatment time a possibility when administered in the prone position.
Historically, the prone position has been used for women with larger breasts. With the advancements in technology, this is an option for all women, regardless of the size of their breasts.”
OHC also offers deep inspiratory breath hold and partial breast radiation which are additional techniques that spare normal tissue. If you have been diagnosed with breast cancer and will be receiving radiation therapy, ask your doctor about the risk of exposure to other organs and if the prone position is best for you, especially if your treatment is for the left breast. For more information about radiation therapy and breast cancer, call OHC at 1-888-649-4800 or click Contact Us on this web site.
Dr. Levick is a board certified radiation oncologist and Chief of Radiation Therapy at OHC. She specializes in breast cancer, prostate cancer, sarcomas and lymphomas. Sources: JAMA Network, National Institute of Health, IGRT.com and breastcancer.org