A patient’s seemingly simple move from lying on the back to the stomach is having major impacts in the treatment of breast cancer, doctors say.
University of Toledo Medical Center and ProMedica are among treatment centers using prone therapy boards for breast cancer radiation in hopes of reducing the risk of radiation to healthy heart and lung tissue. Photo Courtesy Ohio State University
Dr. Julia White of Ohio State University’s James Cancer Hospital and Solove Research Institute has helped develop a modified treatment board that allows patients to lie comfortably on their stomachs while the breast tissue falls away from the chest wall, allowing the radiation to target the cancer.
Often referred to as a prone therapy board, the method is utilized at the University of Toledo Medical Center as well as ProMedica hospitals.
A representative of Mercy was not able to be reached for comment.
“Most women, when they get that breast radiation, it’s given with the patient lying on their back,” said White, who is director of breast radiation oncology at Ohio State’s Stefanie Spielman Comprehensive Breast Center. “And it’s good — I’m not saying there’s anything wrong with it, but it has some limitations.”
Those limitations include exposing organs in the chest cavity — including the heart and lungs — to radiation fields.
Recent studies show prone radiation treatment cuts the amount of lung and heart tissue affected by radiation by 90 percent. Another side effect of the on-the-back treatment is the cosmetic damage it does to the breast shape, often leaving the breast with a conical shape.
White developed the prone therapy board with Qfix, a world leader in radiotherapy patient positioning and mobilization.
“It’s a board that allows us to treat a patient in a way that there’s a hole for the affected breast,” she said. “The breast falls through the hole in the table. She lies on her unaffected breast and her arms are straight ahead. In doing that, the breast becomes an almost easier radiotherapy target because it’s lying below the chest wall.”
Sharon Nugent, clinical manager of the Hickman Cancer Center at ProMedica Flower Hospital, said the facility has utilized the board for the past three years. It was used initially on larger-busted women but now on an increasing number of patients, regardless of breast size.
Nugent said the women like the board because it’s more comfortable, while physicians prefer it because it offers better positioning and reproducibility in reviewing results.
The prone treatment — which White started working on in 1997 — is most often used on women with stage 1 or early stage 2 breast cancer who have elected to have a lumpectomy and hope to preserve as much of the breast tissue and shape of the breast as possible. Nugent said up to 70 percent of these patients receive therapy in the prone position.
“When we treat a patient prone, we know we don’t have to talk to them about risks to their heart, because their heart won’t be in the field,” White said.
Dr. Julia White looks at images from a patient’s MRI at Ohio State University’s James Cancer Hospital and Solove Research Institute.
“One of the things that happens when we treat a patient on her back is that she breathes, which is obviously good. But it also means we have to take into account chest wall motion with breathing. When a woman lies on her belly, she fixes that chest wall so it allows us to have a very tight margin to place the field right at the rib junction so we can treat all the breast tissue in front of the ribs and exclude that tissue below the ribs into the chest wall cavity where the heart and lungs are.”
“It’s been slower to be adopted than one would think, but … everyone’s been used to doing treatment one way, with women lying on their back. It does take a little more technical savvy, a little more time. Having the new breast boards that are in development now will help enable institutions feeling more comfortable treating patients like this.”
White said it’s important to remember that no one treatment will work for every patient.
“The idea is we give every woman the treatment that’s right for her. For some women, that’s going to be lying on her back. For some women, it could be lying on her belly if the technology is available,” she said. “First and foremost, we want to cure her, but if she elects to keep her breast, we also want to keep her [breast] as intact as possible. If you’re going to go through breast conservation, we want the breast to look as normal as can possibly be afterward, with the minimal amount of long-term effects from the radiotherapy.”
