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William J. Gradishar, MD, FACP, FASCO


Supine Versus Prone Breast Radiotherapy: Impact on the Skin of Women With Large Breasts

By: Vanessa A. Carter, BS
Posted: Monday, August 15, 2022

In a phase III trial, Jean-Phillippe Pignol, MD, PhD, of Dalhousie University, Halifax, Nova Scotia, Canada, and colleagues aimed to discover whether breast radiotherapy in the prone position may reduce the acute toxic effects of the skin when compared with the same therapy in the supine position among women with large breasts. Published in JAMA Oncology, the results of this trial suggest that the rates of skin toxicity are significantly decreased among patients treated in the prone position versus the supine position.

“There were fewer toxic effects of the skin in women treated with hypofractionated radiotherapy compared with extended fractionation, though it is unclear if this effect can be further reduced when women are treated in the prone position,” mentioned the study authors. “Treatment in the prone position should be considered for women with large breast size requiring adjuvant radiotherapy.”

This multicenter, single-blind trial enrolled 357 patients with large breasts who had ductal or invasive carcinoma and were referred for adjuvant radiotherapy. Participants were randomly assigned to receive breast radiotherapy in either the supine (n = 182) or prone (n = 175) position. All individuals received 50 Gy in 25 fractions with or without a boost, and the majority received a hypofractionation regimen of 42.5 Gy in 16 fractions.

Significantly higher rates of desquamation anywhere on the breast were reported among women treated in the supine position compared with the prone position (P = .002). Additionally, grade 3 desquamation was also more prevalent among those who underwent therapy in the supine position (P < .001). Other notable independent factors that appeared to increase the risk of acute cutaneous toxicities were bra size (odds ratio [OR] = 2.56; P < .001), the use of a boost (OR = 2.71; P < .001), and extended fractionation (OR = 2.85; P = .004).

Disclosure: For full disclosures of the study authors, visit

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