New York University Experience and Prone Positioning

Abstract

Prone positioning presents several advantages over standard supine positioning for breast irradiation. First, treatment in the prone position drastically reduces the respiratory excursion of the chest and enables better exclusion of the heart and lung from the trajectory of the tangent beams, resulting in consistent dosimetric advantages in sparing normal tissue. Moreover, with gravity displacing the breast from the prone chest wall, the incidence and severity of acute and late adverse skin effects at the inframammary fold are reduced, particularly for women with large and/or pendulous breasts. Originally devised at the University of Southern California [1], the prone breast irradiation program has been studied and further defined at New York University [2]. The rapidly identified dosimetric advantages of prone breast treatment facilitated methodic testing of the feasibility and efficacy of hypofractionated regimens. Over more than a decade, several prospective trials have investigated the optimal prescription dose/fractionation to the whole breast, the timing of lumpectomy bed boost, and the efficacy of prone partial breast irradiation.