Abstract 554P
Background
Treating breast cancer patients in the prone position has dosimetric advantage of reducing lung and cardiac doses and less acute skin toxicities compared to supine position. This systematic review and meta-analysis aims to summarize the existing literature on clinical outcomes of treating breast cancer patients in prone compared to supine position during breast RT.
Methods
A systematic search was performed in Medline, Embase and Cochrane Library from database inception up to April 8, 2024 to include studies comparing clinical outcomes of patients treated in prone versus supine positions during breast RT. Acute and chronic skin toxicities, cardiopulmonary adverse events and patient reported outcomes were extracted. Results were reported as risk ratios (RRs) for dichotomous outcomes along with their 95% intervals (CIs). Heterogeneity was evaluated using the I2 statistic.
Results
10 articles representing 8 clinical studies and 1371 patients met inclusion criteria. 4 studies (50%) were randomized controlled trials. Compared to supine position, patients treated in prone had a lower incidence of moist desquamation (RR=0.50; 95% CI: 0.28-0.91; p = 0.02; I2=0%), but not grade 2 or above radiation dermatitis (RR=0.82; 95% CI: 0.49-1.37; p=0.44; I2=60%). Regarding long term toxicities, patients treated in prone position had less breast atrophy (RR=0.82; 95% CI:0.71-0.95; p<0.01; I2=0%) and chronic edema (RR=0.65; 95% CI: 0.43-0.99; p=0.04; I2=0%), but no difference for chronic pigmentation, telangiectasia and fibrosis. None reported long-term cardiopulmonary adverse events. Two studies reported on quality of life and one collected patient comfort scores during RT, which showed no difference between patients treating in prone versus supine.
Conclusions
Treating patients in prone position during breast RT reduces the incidence of moist desquamation, and may reduce chronic skin toxicities compared to supine position. Further research incorporating patient reported outcomes and longer follow up will be important to confirm these findings, guide patient selection, and understand whether it will translate into less cardiopulmonary adverse events.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.