Effects of Different Arm Immobilization Methods on Set-Up Accuracy in Photon and Proton Radiotherapy Techniques for Breast Cancer: A Systematic Review
Abstract
Purpose: This study aimed to review the effects of different arm immobilization methods on set-up accuracy in photon and proton radiotherapy techniques for breast cancer with supraclavicular lymph node (LN) involvement.
Methods: A systematic review was conducted using a comprehensive literature search of English-language sources from PubMed, Google Scholar, ScienceDirect, and Medline databases, with no restrictions on publication date. Two independent reviewers assessed and screened titles and abstracts for inclusion.
Results: Following screening and eligibility determination, 14 articles were included. Of these, 11 studies focused on photon radiotherapy (8 in the supine position and 3 in the prone position), while 3 studies examined proton radiotherapy.
Conclusion: For the supine position, the "both hands above the head" method demonstrated superior set-up accuracy. In the prone position, the crawl position combined with the deep inspiration breath-hold (DIBH) method outperformed other approaches. In proton radiotherapy for breast cancer, both "hands-up" and "hands-down" methods yielded equivalent results.
References
Firouzjah RA, Banaei A, Farhood B, Bakhshandeh M. Dosimetric comparison of four different techniques for supraclavicular irradiation in 3D-conformal radiotherapy of breast cancer. Health Phys. 2019;116(5):631–6.
Nadi S, Abedi-Firouzjah R, Banaei A, Bijari S, Elahi M. Dosimetric comparison of level II lymph nodes between mono-isocentric and dual-isocentric approaches in 3D-CRT and IMRT techniques in breast radiotherapy of mastectomy patients. Journal of Radiotherapy in Practice. 2020;19(3):254-258. doi:10.1017/S146039691900061X.
Bagheri H, Firouzjah RA, Farhood B. Measurement of the photon and thermal neutron doses of contralateral breast surface in breast cancer radiotherapy. J Radiother Pract. 2020; 19(3):226–32.
Xiang Q, Jie W, Zhu K, Wang Q ,Cheng J. Which technique of positioning and immobilization is better for breast cancer patients in postmastectomy IMRT, single‐pole or double‐pole immobilization? J Appl Clin Med Phys. 2019;20(1):168–74.
Feng CH, Gerry E, Chmura SJ, Hasan Y, Al-Hallaq HA. An image-guided study of setup reproducibility of postmastectomy breast cancer patients treated with inverse-planned intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2015 Jan 1;91(1):58-64. doi: 10.1016/j.ijrobp.2014.09.007.
Goldsworthy SS, Sinclair NN, Tremlett JJ, Chalmers AA, Francis MM, Simcock RR. Abducting both arms improves stability during breast radiotherapy: The Bi Arm study in radiotherapy. Journal of Radiotherapy in Practice. 2011;10(4):250-259. doi:10.1017/S1460396910000452
McCune K, Parsons L, Schoenfeld L, Madderford A. A technique for evaluating cast foam positioning and immobilization devices used in breast cancer radiotherapy. Med Dosim. 1991; 16(3):119–25.
Saito AI, Vargas C, Morris CG, Lightsey J, Mendenhall NP. Differences between current and historical breast cancer axillary lymph node irradiation based on arm position: implications for radiation oncologists. Am J Clin Oncol. 2009 Aug;32(4):381-6. doi: 10.1097/COC.0b013e318191718d.
Janus A, Plank A, Middleton M. Influence of individualized stabilization on the consistency of supraclavicular fossa positioning in breast radiation therapy: A retrospective study. J Med Imaging Radiat Sci. 2014; 45(3):210–7.
Creutzberg CL, Althof VG, Huizenga H, Visser AG, Levendag PC. Quality assurance using portal imaging: the accuracy of patient positioning in irradiation of breast cancer. Int J Radiat Oncol Biol Phys. 1993 Feb 15;25(3):529-39. doi: 10.1016/0360-3016(93)90077-9.
Gielda BT, Strauss JB, Marsh JC, Turian JV, Griem KL. A dosimetric comparison between the supine and prone positions for three-field intact breast radiotherapy. Am J Clin Oncol. 2011 Jun;34(3):223-30. doi: 10.1097/COC.0b013e3181dbb9c1.
Costin IC, Marcu LG. Factors impacting on patient setup analysis and error management during breast cancer radiotherapy. Crit Rev Oncol Hematol. 2022;178:103798.
Thilmann C, Adamietz IA, Saran F, Mose S, Kostka A, Böttcher HD. The use of a standardized positioning support cushion during daily routine of breast irradiation. Int J Radiat Oncol Biol Phys. 1998 May 1;41(2):459-63. doi: 10.1016/s0360-3016(98)00022-4.
Zhang Y, Ding K, Cowan G, Tryggestad E, Armour E, Wang KK. Alignment of multiradiation isocenters for megavoltage photon beam. J Appl Clin Med Phys. 2015 Nov 8;16(6):314-324. doi: 10.1120/jacmp.v16i6.5733.
Batumalai V, Holloway L, Delaney GP. A review of setup error in supine breast radiotherapy using cone-beam computed tomography. Med Dosim. 2016; 41(3):225–9.
Kapanen M, Laaksomaa M, Skyttä T, Haltamo M, Pehkonen J, Lehtonen T et al. Residual position errors of lymph node surrogates in breast cancer adjuvant radiotherapy: comparison of two arm fixation devices and the effect of arm position correction. Med Dosim. 2016; 41(1):47–52.
Probst H, Bragg C, Dodwell D, Green D, Hart J A systematic review of methods to immobilise breast tissue during adjuvant breast irradiation. Radiography. 2014; 20(1):70–81.
Mansur DB, Kong FM, El Naqa I, Taylor ME, Zoberi I, Bradley JD, et al. CT localization of axillary lymph nodes in relation to the humeral head: significance of arm position for radiation therapy planning. Radiother Oncol. 2005 Nov;77(2):191-3. doi: 10.1016/j.radonc.2005.09.019.
Winfield E, Deighton A, Venables K, Hoskin PJ, Aird EGA. Survey of UK breast radiotherapy techniques: background prior to the introduction of the quality assurance programme for the START (standardisation of radiotherapy) trial in breast cancer. Clin Onc. 2002;14(4):267–71.
Song Y, Peng J, Chen Q, Luo H. Compare of Interfractional Setup Reproducibility Between Vacuum-Lock Bag and Thermoplastic Mask in Radiotherapy for Breast Cancer. Technol Cancer Res Treat. 2021;20:1-6.
Deseyne P, Speleers B, De Neve W, Boute B, Paelinck L, Van Hoof T, et al. Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer. Radiat Oncol. 2017 May 26;12(1):89. doi: 10.1186/s13014-017-0828-6.
Boute B, De Neve W, Speleers B, Van Greveling A, Monten C, Van Hoof T, et al. Potential benefits of crawl position for prone radiation therapy in breast cancer. J Appl Clin Med Phys. 2017 Jul;18(4):200-205. doi: 10.1002/acm2.12118.
Schoepen M, Speleers B, De Neve W, Vakaet V, Deseyne P, Paelinck L, et al. Four irradiation and three positioning techniques for whole-breast radiotherapy: Is sophisticated always better? J Appl Clin Med Phys. 2022 Nov;23(11):e13720. doi: 10.1002/acm2.13720.
Depauw N, Batin E, Johnson A, MacDonald SM, Jimenez RB. Arms positioning in post-mastectomy proton radiation: Feasibility and development of a new arms down contouring atlas. Phys Imaging Radiat Oncol. 2020 May 26;14:6-11. doi: 10.1016/j.phro.2020.04.003.
Garda AE, Hunzeker AE, Michel AK, Fattahi S, Shiraishi S, Remmes NB, et al. Intensity Modulated Proton Therapy for Bilateral Breast or Chest Wall and Comprehensive Nodal Irradiation for Synchronous Bilateral Breast Cancer: Initial Clinical Experience and Dosimetric Comparison. Adv Radiat Oncol. 2022 Jan 24;7(3):100901. doi: 10.1016/j.adro.2022.100901.
Hong Z, Yang Z, Mei X, Li P, Bao C, Wang Z, et al. A retrospective study of adjuvant proton radiotherapy for breast cancer after lumpectomy: a comparison of conventional-dose and hypofractionated dose. Radiat Oncol. 2023 Mar 23;18(1):56. doi: 10.1186/s13014-023-02213-8.
Hannan R, Thompson RF, Chen Y, Bernstein K, Kabarriti R, Skinner W, et al. Hypofractionated whole-breast radiation therapy: does breast size matter? Int J Radiat Oncol Biol Phys. 2012 Nov 15;84(4):894-901. doi: 10.1016/j.ijrobp.2012.01.093.
Huppert N, Jozsef G, Dewyngaert K, Formenti SC. The role of a prone setup in breast radiation therapy. Front Oncol. 2011 Oct 11;1:31. doi: 10.3389/fonc.2011.00031.
Krengli M, Masini L, Caltavuturo T, Pisani C, Apicella G, Negri E, et al. Prone versus supine position for adjuvant breast radiotherapy: a prospective study in patients with pendulous breasts. Radiat Oncol. 2013 Oct 8;8:232. doi: 10.1186/1748-717X-8-232.
Liang X, Mailhot Vega RB, Li Z, Zheng D, Mendenhall N, Bradley JA. Dosimetric consequences of image guidance techniques on robust optimized intensity-modulated proton therapy for treatment of breast Cancer. Radiat Oncol. 2020 Feb 27;15(1):47. doi: 10.1186/s13014-020-01495-6.
Mutter RW, Choi JI, Jimenez RB, Kirova YM, Fagundes M, Haffty BG, et al. Proton Therapy for Breast Cancer: A Consensus Statement From the Particle Therapy Cooperative Group Breast Cancer Subcommittee. Int J Radiat Oncol Biol Phys. 2021 Oct 1;111(2):337-359. doi: 10.1016/j.ijrobp.2021.05.110.
Cuaron JJ, MacDonald SM, Cahlon O. Novel applications of proton therapy in breast carcinoma. Chin Clin Oncol. 2016; 5 (4):52.
Batin E, Depauw N, MacDonald S, Lu HM. Can surface imaging improve the patient setup for proton postmastectomy chest wall irradiation? Pract Radiat Oncol. 2016 Nov-Dec;6(6):e235-e241. doi: 10.1016/j.prro.2016.02.001.
Dekker J, Essers M, Verheij M, Kusters M, de Kruijf W. Dose coverage and breath-hold analysis of breast cancer patients treated with surface-guided radiotherapy. Radiat Oncol. 2023 Apr 20;18(1):72. doi: 10.1186/s13014-023-02261-0.
