Skip to main content
Erschienen in: Strahlentherapie und Onkologie 4/2024

02.09.2023 | Original Article

Use of immobilisation bra for daily setup of patients with pendulous breasts undergoing radiotherapy

verfasst von: J. Z. Chua, MSc, L. H. Lim, MSc, E. P. P. Pang, PhD, Dr. med. G. Kusumawidjaja, FRCR

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 4/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

A feasibility study to evaluate the Chabner XRT® Radiation Bra (CIVCO Radiotherapy & Qfix, Coralville, IA, USA) as a customised immobilisation device for patients with pendulous breasts undergoing radiotherapy was conducted.

Methods

A total of 34 patients with large pendulous breasts were fitted with the Chabner XRT® Radiation Bra during RT. A mixed-method questionnaire was administered to both radiation therapists (RTTs) and patients. RTTs evaluated the effectiveness of the bra in setup. Patients appraised its comfort level and ease of wearing. Setup reproducibility was evaluated based on a departmental imaging protocol. Acute skin side effects were documented with photos and assessed using the Radiation Therapy Oncology Group (RTOG) classification.

Results

Of the patients, 27 (79.4%) completed the questionnaire. 23 patients felt comfortable wearing the bra while 20 felt less exposed during treatment. Reproducibility was acceptable, with a median (range) setup error (isocentre) of 0.0 cm (−0.6 to 0.7 cm; left/right), −0.1 cm (−0.5 to 1.2 cm; posterior) and 0.2 cm (−0.5 to 0.9 cm; inferior) achieved based on matched field borders on skin. However, repeated setups and imaging were required for 3 patients due to large breast size (cups D–G; size 4–5). Minimal skin toxicity (grade 0–1) was observed. No grade ≥ 2 was reported. 10 RTTs completed the survey. Male RTTs (n = 4) were not confident in assisting patients with bra fitting. 8 RTTs agreed that although it was difficult to reproduce the breast tissue for treatment, it helped patients to maintain the treatment position.

Conclusion

Our study demonstrated the feasibility of using a customised bra which provided optimal setup reproducibility while maintaining minimal skin toxicity and patient comfort, especially the value-added modesty felt among Asian women during their breast cancer radiotherapy.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Office NRoD (2019) Singapore cancer registry annual report 2019 Office NRoD (2019) Singapore cancer registry annual report 2019
2.
Zurück zum Zitat McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM (2016) Clinical diagnosis and management of breast cancer. J Nucl Med 57(Suppl 1):9S–16SCrossRefPubMed McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM (2016) Clinical diagnosis and management of breast cancer. J Nucl Med 57(Suppl 1):9S–16SCrossRefPubMed
3.
Zurück zum Zitat Jatoi I, Proschan MA (2005) Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results. Am J Clin Oncol 28:289–294CrossRefPubMed Jatoi I, Proschan MA (2005) Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results. Am J Clin Oncol 28:289–294CrossRefPubMed
4.
Zurück zum Zitat Haviland JS, A’Hern R, Bentzen SM, Whelan T, Bliss JM (2014) Radiotherapy for breast cancer, the TARGIT‑A trial. Lancet 383:1716–1717CrossRefPubMed Haviland JS, A’Hern R, Bentzen SM, Whelan T, Bliss JM (2014) Radiotherapy for breast cancer, the TARGIT‑A trial. Lancet 383:1716–1717CrossRefPubMed
5.
Zurück zum Zitat Pignol JP, Vu TT, Mitera G, Bosnic S, Verkooijen HM, Truong P (2015) Prospective evaluation of severe skin toxicity and pain during postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 91:157–164CrossRefPubMed Pignol JP, Vu TT, Mitera G, Bosnic S, Verkooijen HM, Truong P (2015) Prospective evaluation of severe skin toxicity and pain during postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 91:157–164CrossRefPubMed
6.
Zurück zum Zitat Meattini I, Guenzi M, Fozza A, Vidali C, Rovea P, Meacci F et al (2017) Overview on cardiac, pulmonary and cutaneous toxicity in patients treated with adjuvant radiotherapy for breast cancer. Breast Cancer 24:52–62CrossRefPubMed Meattini I, Guenzi M, Fozza A, Vidali C, Rovea P, Meacci F et al (2017) Overview on cardiac, pulmonary and cutaneous toxicity in patients treated with adjuvant radiotherapy for breast cancer. Breast Cancer 24:52–62CrossRefPubMed
7.
Zurück zum Zitat Ratosa I, Jenko A, Oblak I (2018) Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning. Radiol Oncol 52:233–244CrossRefPubMedPubMedCentral Ratosa I, Jenko A, Oblak I (2018) Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning. Radiol Oncol 52:233–244CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Bentel GC, Marks LB, Whiddon CS, Prosnitz LR (1999) Acute and late morbidity of using a breast positioning ring in women with large/pendulous breasts. Radiother Oncol 50:277–281CrossRefPubMed Bentel GC, Marks LB, Whiddon CS, Prosnitz LR (1999) Acute and late morbidity of using a breast positioning ring in women with large/pendulous breasts. Radiother Oncol 50:277–281CrossRefPubMed
9.
Zurück zum Zitat Das IJ, Cheng CW, Fein DA, Fowble B (1997) Patterns of dose variability in radiation prescription of breast cancer. Radiother Oncol 44:83–89CrossRefPubMed Das IJ, Cheng CW, Fein DA, Fowble B (1997) Patterns of dose variability in radiation prescription of breast cancer. Radiother Oncol 44:83–89CrossRefPubMed
10.
Zurück zum Zitat Freedman GM, Anderson PR, Li J, Eisenberg DF, Hanlon AL, Wang L et al (2006) Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. Am J Clin Oncol 29:66–70CrossRefPubMed Freedman GM, Anderson PR, Li J, Eisenberg DF, Hanlon AL, Wang L et al (2006) Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. Am J Clin Oncol 29:66–70CrossRefPubMed
11.
Zurück zum Zitat Goodman KA, Hong L, Wagman R, Hunt MA, McCormick B (2004) Dosimetric analysis of a simplified intensity modulation technique for prone breast radiotherapy. Int J Radiat Oncol Biol Phys 60:95–102CrossRefPubMed Goodman KA, Hong L, Wagman R, Hunt MA, McCormick B (2004) Dosimetric analysis of a simplified intensity modulation technique for prone breast radiotherapy. Int J Radiat Oncol Biol Phys 60:95–102CrossRefPubMed
12.
Zurück zum Zitat Latimer JG, Beckham W, West M, Holloway L, Delaney G (2005) Support of large breasts during tangential irradiation using a micro-shell and minimizing the skin dose—a pilot study. Med Dosim 30:31–35CrossRefPubMed Latimer JG, Beckham W, West M, Holloway L, Delaney G (2005) Support of large breasts during tangential irradiation using a micro-shell and minimizing the skin dose—a pilot study. Med Dosim 30:31–35CrossRefPubMed
13.
Zurück zum Zitat Remouchamps VM, Letts N, Yan D, Vicini FA, Moreau M, Zielinski JA et al (2003) Three-dimensional evaluation of intra- and interfraction immobilization of lung and chest wall using active breathing control: a reproducibility study with breast cancer patients. Int J Radiat Oncol Biol Phys 57:968–978CrossRefPubMed Remouchamps VM, Letts N, Yan D, Vicini FA, Moreau M, Zielinski JA et al (2003) Three-dimensional evaluation of intra- and interfraction immobilization of lung and chest wall using active breathing control: a reproducibility study with breast cancer patients. Int J Radiat Oncol Biol Phys 57:968–978CrossRefPubMed
14.
Zurück zum Zitat Buijsen J, Jager JJ, Bovendeerd J, Voncken R, Borger JH, Boersma LJ et al (2007) Prone breast irradiation for pendulous breasts. Radiother Oncol 82:337–340CrossRefPubMed Buijsen J, Jager JJ, Bovendeerd J, Voncken R, Borger JH, Boersma LJ et al (2007) Prone breast irradiation for pendulous breasts. Radiother Oncol 82:337–340CrossRefPubMed
15.
Zurück zum Zitat Ferrari A, Ivaldi G, Leonardi MC, Rondi E, Orecchia R (2009) Prone breast radiotherapy in a patient with early stage breast cancer and a large pendulous breast. Tumori 95:394–397CrossRefPubMed Ferrari A, Ivaldi G, Leonardi MC, Rondi E, Orecchia R (2009) Prone breast radiotherapy in a patient with early stage breast cancer and a large pendulous breast. Tumori 95:394–397CrossRefPubMed
16.
Zurück zum Zitat Merchant TE, McCormick B (1994) Prone position breast irradiation. Int J Radiat Oncol Biol Phys 30:197–203CrossRefPubMed Merchant TE, McCormick B (1994) Prone position breast irradiation. Int J Radiat Oncol Biol Phys 30:197–203CrossRefPubMed
17.
Zurück zum Zitat Moody AM, Mayles WP, Bliss JM, A’Hern RP, Owen JR, Regan J et al (1994) The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol 33:106–112CrossRefPubMed Moody AM, Mayles WP, Bliss JM, A’Hern RP, Owen JR, Regan J et al (1994) The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol 33:106–112CrossRefPubMed
18.
Zurück zum Zitat Barrett-Lennard MJTS (2013) Comparing immobilisation methods for the tangential treatment of large pendulous breasts. Radiographer 55:7–13CrossRef Barrett-Lennard MJTS (2013) Comparing immobilisation methods for the tangential treatment of large pendulous breasts. Radiographer 55:7–13CrossRef
19.
Zurück zum Zitat Keller L, Cohen R, Sopka DM, Li T, Li L, Anderson PR et al (2013) Effect of bra use during radiotherapy for large-breasted women: acute toxicity and treated heart and lung volumes. Pract Radiat Oncol 3:9–15CrossRefPubMedPubMedCentral Keller L, Cohen R, Sopka DM, Li T, Li L, Anderson PR et al (2013) Effect of bra use during radiotherapy for large-breasted women: acute toxicity and treated heart and lung volumes. Pract Radiat Oncol 3:9–15CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Group ST, Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ et al (2008) The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331–341CrossRef Group ST, Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ et al (2008) The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331–341CrossRef
21.
Zurück zum Zitat Murray Brunt A, Haviland JS, Wheatley DA, Sydenham MA, Alhasso A, Bloomfield DJ et al (2020) Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5‑year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 395:1613–1626CrossRefPubMedPubMedCentral Murray Brunt A, Haviland JS, Wheatley DA, Sydenham MA, Alhasso A, Bloomfield DJ et al (2020) Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5‑year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 395:1613–1626CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Mulliez T, Veldeman L, van Greveling A, Speleers B, Sadeghi S, Berwouts D et al (2013) Hypofractionated whole breast irradiation for patients with large breasts: a randomized trial comparing prone and supine positions. Radiother Oncol 108:203–208CrossRefPubMed Mulliez T, Veldeman L, van Greveling A, Speleers B, Sadeghi S, Berwouts D et al (2013) Hypofractionated whole breast irradiation for patients with large breasts: a randomized trial comparing prone and supine positions. Radiother Oncol 108:203–208CrossRefPubMed
24.
Zurück zum Zitat Veldeman L, Schiettecatte K, De Sutter C, Monten C, van Greveling A, Berkovic P et al (2016) The 2‑year cosmetic outcome of a randomized trial comparing prone and supine whole-breast irradiation in large-breasted women. Int J Radiat Oncol Biol Phys 95:1210–1217CrossRefPubMed Veldeman L, Schiettecatte K, De Sutter C, Monten C, van Greveling A, Berkovic P et al (2016) The 2‑year cosmetic outcome of a randomized trial comparing prone and supine whole-breast irradiation in large-breasted women. Int J Radiat Oncol Biol Phys 95:1210–1217CrossRefPubMed
25.
Zurück zum Zitat Veldeman L, Speleers B, Bakker M, Jacobs F, Coghe M, De Gersem W et al (2010) Preliminary results on setup precision of prone-lateral patient positioning for whole breast irradiation. Int J Radiat Oncol Biol Phys 78:111–118CrossRefPubMed Veldeman L, Speleers B, Bakker M, Jacobs F, Coghe M, De Gersem W et al (2010) Preliminary results on setup precision of prone-lateral patient positioning for whole breast irradiation. Int J Radiat Oncol Biol Phys 78:111–118CrossRefPubMed
26.
Zurück zum Zitat Boute B, De Neve W, Speleers B, Van Greveling A, Monten C, Van Hoof T et al (2017) Potential benefits of crawl position for prone radiation therapy in breast cancer. J Appl Clin Med Phys 18:200–205CrossRefPubMedPubMedCentral Boute B, De Neve W, Speleers B, Van Greveling A, Monten C, Van Hoof T et al (2017) Potential benefits of crawl position for prone radiation therapy in breast cancer. J Appl Clin Med Phys 18:200–205CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Mulla Z, Iskanderani O, Weber A, AlMohamad A, Al-Amoodi MS, Soaida S (2021) Comparing accuracy of thermoplastic mask versus commercial bra for the immobilization of pendulous breast during radiation therapy treatment: a retrospective cohort study. Adv Radiat Oncol 6:100592CrossRefPubMed Mulla Z, Iskanderani O, Weber A, AlMohamad A, Al-Amoodi MS, Soaida S (2021) Comparing accuracy of thermoplastic mask versus commercial bra for the immobilization of pendulous breast during radiation therapy treatment: a retrospective cohort study. Adv Radiat Oncol 6:100592CrossRefPubMed
28.
Zurück zum Zitat Agostinelli SGS, Bellini A, Pupillo F, Guenzi M, Bosetti D, Blandino G, Taccini G (2015) Helical Tomotherapy of the breast: can thermoplastic immobilization improve the reproducibility of the treatment setup and the accuracy of the delivered dose? Phys Med 31:49–53CrossRefPubMed Agostinelli SGS, Bellini A, Pupillo F, Guenzi M, Bosetti D, Blandino G, Taccini G (2015) Helical Tomotherapy of the breast: can thermoplastic immobilization improve the reproducibility of the treatment setup and the accuracy of the delivered dose? Phys Med 31:49–53CrossRefPubMed
29.
Zurück zum Zitat Cheng KF, Wu VW (2014) Comparison of the effectiveness of different immobilization systems in different body regions using daily megavoltage CT in helical tomotherapy. Br J Radiol 87:20130494CrossRefPubMedPubMedCentral Cheng KF, Wu VW (2014) Comparison of the effectiveness of different immobilization systems in different body regions using daily megavoltage CT in helical tomotherapy. Br J Radiol 87:20130494CrossRefPubMedPubMedCentral
30.
Zurück zum Zitat Rudat V, Nour A, Ghaida SA, Alaradi A (2016) Impact of hypofractionation and tangential beam IMRT on the acute skin reaction in adjuvant breast cancer radiotherapy. Radiat Oncol 11:100CrossRefPubMedPubMedCentral Rudat V, Nour A, Ghaida SA, Alaradi A (2016) Impact of hypofractionation and tangential beam IMRT on the acute skin reaction in adjuvant breast cancer radiotherapy. Radiat Oncol 11:100CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Murray Brunt A, Wheatley DA, Arnold J, Somaiah N, Kelly S, Harnett A et al (2016) Acute skin toxicity associated with a 1-week schedule of whole breast radiotherapy compared with a standard 3‑week regimen delivered in the UK FAST-Forward Trial. Radiother Oncol 120:114–118CrossRefPubMed Murray Brunt A, Wheatley DA, Arnold J, Somaiah N, Kelly S, Harnett A et al (2016) Acute skin toxicity associated with a 1-week schedule of whole breast radiotherapy compared with a standard 3‑week regimen delivered in the UK FAST-Forward Trial. Radiother Oncol 120:114–118CrossRefPubMed
Metadaten
Titel
Use of immobilisation bra for daily setup of patients with pendulous breasts undergoing radiotherapy
verfasst von
J. Z. Chua, MSc
L. H. Lim, MSc
E. P. P. Pang, PhD
Dr. med. G. Kusumawidjaja, FRCR
Publikationsdatum
02.09.2023
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 4/2024
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-023-02131-4

Weitere Artikel der Ausgabe 4/2024

Strahlentherapie und Onkologie 4/2024 Zur Ausgabe

"Limited stage" SCLC: Konsolidierung schenkt Lebensjahre

14.06.2024 ASCO 2024 Kongressbericht

Standardtherapie bei einem inoperablen kleinzelligen Lungenkarzinom im Stadium I-III (LS-SCLC) ist die Radiochemotherapie. Eine anschließende Konsolidierung mit Durvalumab kann das mediane Überleben um fast zwei Jahre verlängern.

Fortgeschrittenes Ovarial-Ca.: Unverdächtige Lymphknoten entfernen?

13.06.2024 ASCO 2024 Kongressbericht

Beim fortgeschrittenen Ovarialkarzinom und klinisch verdächtigen Lymphknoten in der Debulking-Op. ist die abdominale retroperitoneale Lymphadenektomie (RPL) Standard. Ohne verdächtige Lymphknoten ist der Nutzen fraglich.

Myasthenia gravis durch Krebsimmuntherapie

13.06.2024 Myasthenia gravis Nachrichten

Sie sind sehr selten, können aber schwerwiegende Folgen haben: immunologische Nebenwirkungen unter Checkpointhemmern. Ein Behandlungsteam berichtet nun über einen Mann, der während einer Darmkrebsbehandlung eine Myasthenia gravis entwickelt.

Aktive Prostata-Überwachung lohnt sich für die meisten

13.06.2024 Prostatakarzinom Nachrichten

Für die meisten Männer mit einem Prostatakarzinom und geringem Progressionsrisiko ist die aktive Überwachung eine gute Wahl: Nach zehn Jahren ist mehr als die Hälfte immer noch progressionsfrei, und weniger als 2% haben Metastasen entwickelt.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.