Prone Whole-Breast Radiotherapy—Better Than Supine?
Mené au Canada entre 2013 et 2018 sur 378 patientes atteintes d'un cancer du sein (âge moyen : 61 ans), cet essai randomisé multicentrique de phase III évalue la toxicité, du point de vue de la desquamation et par rapport au traitement standard en décubitus dorsal, de la radiothérapie en décubitus ventral chez les femmes aux seins volumineux
The benefits of adjuvant breast radiotherapy on local recurrence and survival are weighed against potential toxic effects, both short and long term. Among patients treated with outmoded radiotherapy techniques, the morbidity of excessive cardiopulmonary radiation exposure offset the benefits. Incremental progress over several decades has resulted in marked improvement of the therapeutic ratio through developing techniques to more accurately delineate targets while delivering dose with improved conformality and homogeneity, thereby better sparing adjacent critical organs. Perhaps the most meaningful development over the past decade has been greater understanding of radiation-associated cardiac toxic effects, underscoring the continued need for strategies to mitigate this risk. Prone positioning represents an additional method for improving the toxicity profile of whole-breast radiotherapy by decreasing excess lung exposure and improving dose homogeneity, which may particularly benefit women with large and/or pendulous breasts who typically have a higher risk of moist desquamation.
JAMA Oncology 2022