Radiation treatment in a prone (face-down) position...

otter

I am not getting rads, but I found an interesting article about giving radiation therapy for BC by positioning the woman face-down on a special table. It's supposed to help minimize radiation injury to the heart. I did a search on the BCO boards and saw that some women were getting rads this way. I hope y'all don't mind if I post the news release that I read.  It's from earlier this year.

Gentle hugs to all you rads gals...

otter 

Prone Position for Breast Radiation Spares the Heart

Elsevier Global Medical News. 2008 May 28, ML Zoler

NEW YORK (EGMN) - Positioning women with breast cancer facedown when they undergo radiation therapy may substantially cut the radiation dose that reaches their heart and lungs.Radiation oncologists at Memorial Sloan-Kettering Cancer Center in New York designed a pallet that they call the breast board to help women more comfortably lie in the prone position for radiotherapy. The board has an adjustable cutout through which the ipsilateral breast and chest wall hang down in a dependent fashion away from the thorax, while the contralateral breast is cushioned and remains on top of the board.This setup has been used at Memorial Sloan-Kettering for breast irradiation since 1998, Dr. Beryl L. McCormick said at a symposium on cardiovascular disease in cancer patients sponsored by the University of Texas M.D. Anderson Cancer Center. "We now treat as many of our breast cancer patients as possible with a prone breast board," she said.With a maximum follow-up of 10 years on the first patients treated this way, it's too soon to assess the impact of this approach on long-term outcomes, but the technique has attracted interest from other cancer centers, said Dr. McCormick, acting chair of radiation oncology at the cancer center in New York. The idea is to limit the radiation dose to the heart and lungs as much as possible. "The radiation dose is the same [as with standard treatment]. We just flip the patient over" from the standard supine position to prone, she said in an interview.The danger of irradiation to the heart when breast therapy is delivered in the supine position has been documented in several studies. The heart is especially vulnerable to damage when the left breast is treated this way. For example, study results reported last year by researchers at the University of Michigan, Ann Arbor, from 795 patients with unilateral disease showed that women treated using the conventional radiation approach on their left breast were about eightfold more likely to have a later cardiac event, compared with women whose right breast was treated (Cancer 2007;109:650-7)."Late cardiac events are real and relate to the radiation therapy technique, dose, and the volume of the heart that gets treated," Dr. McCormick said at the meeting, also sponsored by the American College of Cardiology and the Society of Geriatric Cardiology. Adverse effects may be minimized by "avoiding treatment to as much of the heart and lung as possible."

Cindy1960

Otter, thanks for this info.  My IDC is left side, and I have a very strong family history of heart disease at a young age.  Naturally, I've been concerned about left side radiation from the get go.  I considered mast to avoid radiation, but during a pre-surgery consult with a rad onc, he told me I didn't have to worry, because it was his job to protect my heart.  Now, I'm not usually so easily lulled into feeling secure, but I think I just so wanted to believe that everything would be ok, and that he would keep me safe, that I didn't ask any more questions or bring up any of the articles I had read about left side rad danger.  At this point, I'm still waiting for oncotype results to find out if I need chemo or not.  Once I know about that, I need to start seriously thinking about rads, and have started doing more research.  My med onc at Fox Chase told me last week that although rads is not her field, all current research is based on old cases, and I shouldn't worry. HUH!!!!!  I feel like no one is taking my concerns seriously about this. I put a call into the rad onc I spoke with in July...left a message telling him I had more questions.  Of course, he has not returned my call. So, I'm looking for a new rad onc.  It would be so much easier to just smile and blindly follow whatever the docs say, but like you and most women on these boards, I just wasn't cut from that cloth.

Quick question - with all the research you do (I've read many of your posts on here), do you bookmark your websites on any social bookmarking sites, like del.icio.us?  It would be a great way to share links. Right now, I have my cancer links marked private, so my students don't see them.  I'm going to establish a separate del.icio.us account, just for cancer-related things.

Cindy

rock

hey --- Dr. McM is my rad onco! I was on that table today! Thanks for posting this, otter. I was feeling like a bit of  weirdo for having it face down. Now I have a better sense of why it's happening!

jea1013

Do you know if this study took into consideration the new radiation techniques such as IMRT and CD Conformal, that are designed to avoid damage to the heart and lungs?  Or were the statistics from this study about people who were treated with the older radiation therapy?

sharonw

I completed rads in prone position with 15 treatments at NYU Center with Dr. Silvia Formenti - travelled all the way from VA for three weeks - I was early stage node negative and based my treatement on 10 years of studies from Canada/Europe - could not find a single rads doc in the entire Washington DC area that would do this treatment for me yet these newer rads treatments are being perfomed at major centers.  I want to bring this treatment option to the DC area, but my pleas are falling on deaf ears - this is the way to go to spare your heart, lungs, and ribs -

I feel fantastic and didn't burn at all - was not fatigued either -

Sharon

PamNewton

I live in Reston and am 3 weeks post-surgery. I have researched the prone position for my upcoming radiation treatment. Have you learned of any practice offering it as yet in the DC area? Going to NYU would be a hardship, but I am determined to learn all I can before making a final decision. Thank you. Pam

Jo_Ann_K

I live in the Baltimore area and the radiation oncologist told me they use that position only for women with pendulous breasts, because it is too difficult to radiate completely when they are facing forward.  For what it's worth.

PamNewton

Sharonw, I am looking into options of where I could stay if I pursue having my radiation done in November at NYU.  Did you by any chance stay in a hotel with special rates for patients or can you recommend satisfactory housing based on your experience? Thank you. Pam

Robby

FYI, although it's too late for this conversation -- Memorial Sloan Kettering in NYC utilizes the prone position.

jtaylor007

There have been more extensive studies surrounding prone positioning and the preliminary results are outstanding.  I work for a manufacturer of both supine and prone positioning devices and will admit that many centers are moving towards prone... and not necessarily just for pendulous breasted women.  If you google 'prone breast system' - you should find a pink one that I work with. 

 Ask the questions you have on your mind to your Rad Onco docs without fear.  It is their job to know the latest techniques without relying on what they learned in medical school.

Claire123

I have had my initial appointment with a radiation oncologist.  When he dicussed  the side effects of radiation on a left breast, I was not happy. I live in the Boston area and was wondering if anyone knows of a hospital where I could get radiation on a board which is designed to lie prone.  It would be greatly appreciated.

JeanneG

  Sharon, do you know if this is still the case in DC area?  The radiation onc at INOVA Loudoun Certified BC Ctr seems very progressive and has some new state of the art equipment for targeting.  I'm supposed to start late Apr-May and wonder if I should look elsewhere!  THANKS

sharonw

Jeanne-

I had my rads done at NYU Cancer Center two years ago - I can tell you that two years ago both INOVA Loudoun and Fairfax did NOT use the prone position - neither did Hopkins, Georgetown, or Sibley.  I looked everywhere - I can only tell you that I have never regretted going to NYU to be radiated in the way (prone) and 15 treatments that they are doing as routine now at the larger cancer hospitals.  I respected and feared the radiation to my body moreso than even the chemo.  Be also aware that Loudoun just received their BC certification a few months ago - and a in my opinion they have a long way to go to compare with other facilities - check with the Arlington Hospital I think it is now called VA Commonwealth??  Stephanie Akbarie is the breast surgeon there and she is supposed to have put together a very good BC team - Chris Cooley (Redskin) mom went there as did Dan Synder (Redskin owner's) wife - good luck and god bless !

Sharon

springchicken

Thanks for the information on NYU Center in NY. I also live in Northern VA and have had a lot of trouble finding a Radiologist that will do this. I have left a message for a Dr. at John Hopkins thinking they must have this option,but have not heard back yet. Most of the Doctors I have talked to minimize any risks and have quoted only 1 or 2% of women have problem these day due to the new techniques and customized sheilding to the heart, etc, yet all you have to do is read a few blogs to see that many women have had heart and lung problems after radiation to the left breast. The docotrs also claim that it is more difficult to get accurate positioning and immobilization of the patient in the prone position....Whatever. It looks like I am going to have to travel a considerable distance if I really want to receive this treatment in the prone position. I find that although I am only 2 1/2 months into this process, I have already experienced a few examples of how the medical field tries to push treatment methods that they prefer for various reasons while at the same time act as if they are embracing the "team" approach with their patients. I was given two options: brachytherapy and external beam radiation (whole breast) at Arlington (VA Commonwealth). I felt I was encouraged to try bracytherapy although I was considered "young" (under 60) by some standards. I was worried about the lack of long term studies on the side effects since this is a relatively new treatment option. After meeting two times and discussing pros and cons, I decided I would try it. Well, nature saw to it that my surgery incision healed quickly preventing insertion of the device. I asked about targeted external beam radiation since the Dr.had just explained the merits of radiating just the targeted area when he was promoting bracytherapy. I was told he would not do that since it may not have a good cosmetic outcome. I said I did not care since I would rather have uneven breasts than heart and lung problems. Prone radiation also was not an option at Arlington. It seems like each hospital has their preferred methods and we patients have to hunt for the one that is willing (and has the equipment necessary) to provide the service. So I guess I have to look into travel to NY. It makes me just want to skip the radiation altogether. I know it prevents reoccurance by about 30-40% (5 yrs) but no doctor will give you firm statistics on the percentage of women that have bad side effects from the treatments.Their mission is to prevent cancer from reoccuring-the heart and lungs are another doctors concern. I know this may sound like I am anti-doctor, but I am not. I just wish their was more interest and concern about side effects and quality of life. A prone table seems like such a small investment for a hospital. I was placed on one for my sterotactic biopsy at Loudoun Innova but apparently, it is not an option in the Radiology Department down the hall. For the amount of money I am paying for their services, I would think that I could demand to have them put the table in the foyer of the White House. Let's get real, we are paying these doctors and hospitals for their services. We are trusting them with our lives. In any other business (we must remember it is their business even if we are emotionally involved) we would not accept inferior services would we? It makes me mad that I have to travel to NY to find a hospital to perform prone radiation when many studies have been published that it reduces possible damage to the heart and lungs. Read this one and you will understand why I cant let this go:

http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=70&abstractID=40365

unklezwifeonty

Sloan's satellite center in NJ uses the prone position too. I call it doggie style :-)

IHereYou

I am currently receiving radiation treatment in prone position at Swedish Medical Center in Denver, CO.  The Doctor that treats there is Dr. N. Cersonsky.  Fantastic center.  This is the only place in SouthWest Denver Metro that uses the breast board.  They have an (almost) brand new (under a year old) VARIAN State of the Art Radiology machine.  I swear it looks like it was built by NASA.   I almost did not have radiation as I had read so much about what can happen if a person  receives radiation laying  on the back. Especially if cancer is on left breast.  I have bilateral cancer- both breasts.  I saw three different radiology oncologists before I even found out that you could have radiation laying face down on a board that protects your lungs and heart.  Who knew?....   This is because supposedly the breast board is very expensive, so not many radiologists offer this method or even let you know it exists.  I do not know if the actual treatment costs more - just that the breast board used for the treatment is quite expensive.

Sloan Kettering in New York has been using this method since 1998.  Also, a medical person told me that most facilities only update their radiology machines every 10 years.  Then they try to sell the used ones to third world countries. For them, it is much better than having no machine.  The machines themselves are very expensive, and this one is somewhere around $2 Million.  It looks it too. 

I highly recommend that if there is not a facility in your area that does prone radiation, and especially if you have cancer in your left breast - then find a breast center somewhere else in the country that does offer it and find someone you can stay with there - or do whatever it takes to make it work so you can be treated in the prone position.   You must have pendulous breasts.  (Size D cup or larger). And no cancer in any of the nodes.  However I think I read they are working on ways to treat smaller breasts this way as well.   If you decide not to have radiation, and want to look at holistic or alternative cures -  look at a book on Amazon called "Outsmart your cancer".  Probably best to have radiation and also look at that book.   All of the other oncologists told me not to worry - technology is much better than it was 20 years ago, and women were not having heart and lung problems anywhere near what they used to.    Mastectomy is another option - which for many may mean - NO radiation - NO MRI's and Mamograms every year, etc.   Keep researching until you feel comfortable that you are making the right decision for YOU - the one you will be able to live with the best - for now.   Go to some stores and hold the prothesis in your hands.   The people at these places are /very/ nice and supportive.  I went to 3 stores when I thought I would be having a mastectomy....  

An old boss once told me - "Whenever you cannot make a decision - it is almost always a matter of  not having enough information..."   I have found this to be true many times in my life since - including now.   Cancer is definitely a "take one day at a time"  kind of thing - and having information is key to staying sane - keep asking questions of everyone until you feel it settle inside.   If you have breasts "that qualify" - and want to be treated in prone position but would need to go to another part of the country - then create it.  Visualize it, pray - call that center and talk to several people there and see if they have any ideas.  Write it down, and see it happen.  Post on this board what you need to have happen.  Someone here may be able to help you!   Good luck and God's speed to all of us !

DesignerMom

I have two more chemos and then am scheduled to start rads.  I like my Rads Onc very much, didn't bother with a second opinion.  Now I wonder if I should.  I am scheduled to start rads at St. Lukes Roosevelt in NYC.  I am wondering if anyone knows if they use the prone position.  I think I will need nodes done too, does that prevent the prone position? I am quite concerned as I have a strong family history of  heart stuff.  My cancer is located very close to the chest (under breast almost at bra band) on the left side, so I am concerned.  If St. Lukes doesn't do this, I could see if I could go to Sloan Kettering or NYU.  I am just wondering whether the lymph node involvement would rule it out anyway.

Omaz

Thank you for this discussion.  I found a great article comparing supine and prone positioning that I want to discuss with my rad onc.

 http://www.ncbi.nlm.nih.gov/pubmed/20561695?dopt=Citation

Lady_Madonna

*edited to add "in the supine position"

I consulted with two rads oncs, the second (who I am currently receiving treatment from) has 21 years of experience and was chief resident at Memorial Sloan Kettering...

Both doctors told me the prone position was most advantageous for women with large breasts because in this position the heart drops forward, toward the area being radiated.  While you're lying on your back, the heart drop toward your back, away from the area being radiated.  

I am doing IMRT rads on the left side, in the supine position.

DesignerMom

Lady and Omaz-  Thanks for the feedback.  Interesting point that the heart would fall backwards and further away from the radiation when you are on your back.  I'll talk to my Rad Onc about that.

Lady_Madonna

Omaz, it looks like your citation supports what I was told by the rads oncs I consulted... that unless you have large, pendulous breasts the prone position causes more harm than good because of the heart falling forward into the field of radiation in the prone position.

CTMOM1234

Highly recommend prone position for anyone with left side rads. Won't comment on breast shape, size, etc., but it's safer and I'm very happy to have had it done in that way. And thankful that it was an option at my facility, some are still behind the times.

NotAgain2015

I just completed 30 treatments (left breast) in the prone position.  I have serious asthma and was concerned about my heart and lungs.  I requested the position after doing some research and thankfully one center in my area had the prone position board.  The rad/onc agreed that it was the best option for me.  I'm a "C" cup so had enough to 'hang down" and no lymph node involvement.  I saw the plan and the beam appeared to cut through my rib cage but not my heart and lungs.  Not sure how 'scatter' impacts the close areas - no one could ever really explain that to me.  But we all have that no matter what position we choose.

Thanks for sharing that article Omaz, it confirms I made the right choice.  We have so many to make.  Glad to hear a confirmation on one of them.

whatsnext17

Does anyone have any new info about radiation in the prone position in the DC area?  Yesterday I spoke with RO at Washington Hospital Center and they now have it.  I need to learn more about how long they have been doing it but at least it has made its way to the DC area.