prone versus supine

mtnchick

I'm post right mastectomy and gearing up for radiation.  I have read that there is reduced heart/lung rads exposure in the prone position, however the research seems to be with women who have had lumpectomies as opposed to mastectomies.  Makes sense as the breast tissue hangs down and the radiation is farther from the organs.  Does anyone know if this is also the case for mastectomies?  I'm getting chest wall, internal lymph node, axillary, and supraclavicular rads.  Thanks!  

melmcbee

Thats a good question. I had cancer on the right and a bmx with expanders placed. I wasnt given the option of prone. They did mine supine. I always assumed it was because I had cancer on right side.

MsPharoah

Mtnchick, ask your ro...I am doing rads in the prone position but only because I asked for it. So my ro agreed to do the simulation both ways to see what was best and it turned out that prone was best. But I have to have my boosts supine due to where my scar is.



But...I had a lumpectomy, not mast.



My understanding is that prone is recommended when the cancer is on the left side (heart) or when the breasts are pendulous or both. I thought my breasts were pendulous and I was right. Lol.



Good luck

Otterlike

I understand that if you have positive nodes, you are out of the running as a candidate for prone (I looked into this extenstively myself).  They need to be able to get to the clavicular area, the chest wall, the armpit, etc.  I do not have positive nodes and I would be able to do prone however the only facility that does it (for Kaiser), is across the bay in Oakland.  It would make my life a living hell far more than just down to south of San Francisco every day so I had to weigh my quality of life against a likely only 0.5% reduction in possible side effects, plus, and this kind of made my mind up as well, my chest wall would NOT be getting scatter and I want full coverage thank you very much!  Sucker be gone, damnit!  It should also be noted that I have left side cancer, so I do understand the risks are a little higher for me.  But I really like and trust my radiation oncologist and he was very open and clear about the statistics and I felt far less anxious about it than I had before going in to talk to him.  Also, I think you need to have, uhm, how was it put "large, pendulous breasts", or at least that makes prone (or as I affectionally called "Boob-In-A-Board".  Which I "did" also have.  Well, still have on one side!

Annette47

I had prone, after a lumpectomy, but just thinking about the way the positioning works, I can't see how they could do it after a mastectomy as the beams kind of come at the area from the sides, so unless the area to be treated was hanging down away from the body, I don't think the beams would hit it properly.

CTMOM1234

I, too, had prone rads. following my left-side lumpectomy. I am a big fan of having left rads this way if possible to minimize heart exposure, but I did have to ask because it wasn't standard protocol. Although my hunch is that a mx would make this position unlikely, DEFINITELY ASK THE HEAD OF YOUR RAD.ONC.FACILITY.

checkers

My initial set-up was in the prone position. My RO called me before rads started and said my breast didn't fall far enough away from my heart to be in a "safety" zone. Something about the position of my heart and the shape of my breast.  I now have to go back in and get set-up in the supine position to see if that would work better. Now I'm really concerned about my heart being affect by rads!

yoga_girl

Prone Procedure

I researched (not many across the US)
before interviewing facilities.  I went
in knowing what I wanted and who I wanted. 
I was fortunate as the facility I selected had recently purchased a
second new rad machine (due to volume of patients needing treatments), 75% of
all patients treated at this location are treated in prone.  Left side with enough tissue to properly hang
in the allocated chamber and custom chest cavity form (stable the body to reduce possibility
of movement) for target area to be treated, including node range and ribs.  Patients are tested for flexibility of neck (facing
away from radiation and arms to be in same position (over your head) each day.  If flexibility is not compliant and painful,
prone will not be considered.

http://igrt.com/breast-therapy.html

Chiropractic adjustments and massage once a week or every other week during rads incorporating proper lymph flow of soft tissue.  It really helps with the pain and flexibility issues.  Oncology rehab can provide instruction sheets on correct technique. 

I waited two months after surgery to allow immune system and surgery site to heal before starting rads.  My tumor bed is one inch from my heart.

Ask for paper copies of the suggested computer model they are preparing for treatment so you know and understand the beam range for daily and boost treatments.  You can take a camera in the treatment room and photograph the computer screen details prior to your daily individual treatment (if this is something you are interested in documenting and keeping).