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Clinical Outcomes and Setup Reproducibility in Patients Receiving Synchronous Bilateral Breast Radiation in the Prone
Aishwarya Shah1, Paulina Galavis1, Sarah Morris1
1Department of Radiation Oncology, New York University Langone Health and Perlmutter Cancer Center, New York, New York.
Practical Radiation Oncology
|March 13, 2026
Summary
Prone radiation therapy for synchronous bilateral breast cancer (SBBC) is feasible, showing minimal setup shifts and field overlap. However, whole breast irradiation in the prone position was associated with higher rates of acute dermatitis compared to partial breast irradiation.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Accurate radiation therapy (RT) positioning and planning are crucial for minimizing toxicity in patients with synchronous bilateral breast cancer (SBBC).
- The prone position is increasingly utilized for breast cancer RT to reduce dose to organs at risk.
Purpose of the Study:
- To evaluate clinical outcomes and setup reproducibility in SBBC patients treated with RT in the prone position.
- To assess the feasibility and toxicity profile of prone bilateral RT for SBBC.
Main Methods:
- Retrospective analysis of SBBC patients treated in the prone position between 2012-2022.
- Data collected included demographics, RT dose/field, dosimetry, on-treatment imaging, toxicity, and outcomes.
- Radiochromic films were used to assess field overlap, and positional shifts were recorded.
Main Results:
- 45 patients were included, with a median follow-up of 64 months.
- Higher rates of grade 2 and 3 acute dermatitis were observed in patients receiving bilateral whole breast irradiation (WBI) compared to partial breast irradiation (PBI).
- Mean positional shifts were minimal (sub-centimeter/sub-degree), and only 10% of patients showed field overlap on radiochromic films.
Conclusions:
- Prone bilateral RT is a feasible treatment option for SBBC with good setup reproducibility.
- While feasible, bilateral WBI in the prone position may lead to increased acute dermatitis.
- Further investigation is warranted to optimize treatment planning and minimize toxicity in this patient population.
