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Prone Position for Breast Radiation Treatment
Oluwadamilola Oladeru M.D., discusses prone position for breast radiation treatment. She describes the benefits of prone positioning for protecting normal tissues including lungs and heart. She examines recent studies regarding prone position and she shares the factors that make a patient a good candidate for prone position or breast cancer radiation treatment.
Featuring:
Dr. Oladeru received her medical degree from the Renaissance School of Medicine at Stony Brook University. She completed her internship at NYU Winthrop Hospital, prior to completing her radiation oncology residency training at Massachusetts General Hospital/Brigham & Women’s Hospital - Harvard Radiation Oncology Program. She also earned an MBA from Johns Hopkins University, with a concentration in Healthcare Management and Leading Organizations.
Dr. Oladeru’s research has published more than 50 research papers, presentations, and book chapters. She is the recipient of numerous awards and recognitions, including the Gold Foundation for Humanism in Medicine Honor Society Award in 2015; the Research Recognition Award from Winthrop University Hospital in 2016; and the AAWR Eleanor Montague Distinguished Resident Award in Radiation Oncology in 2020.
Her research interests include technological advancements in radiation oncology, high quality radiation treatment delivery, health policy to address inequities in underserved populations, and global radiation oncology. Her clinical focus at UF Health is patient centered treatment of all types and stages of breast cancer.
Oluwadamilola (Lola) Oladeru, M.D.
Dr. Oladeru earned her bachelor’s degree in molecular, cellular and developmental biology at Yale University. She then obtained her master’s degree in African studies and medical anthropology from Yale Graduate School of Arts and Sciences with a concentration in global health from Yale Jackson Institute for Global Affairs.Dr. Oladeru received her medical degree from the Renaissance School of Medicine at Stony Brook University. She completed her internship at NYU Winthrop Hospital, prior to completing her radiation oncology residency training at Massachusetts General Hospital/Brigham & Women’s Hospital - Harvard Radiation Oncology Program. She also earned an MBA from Johns Hopkins University, with a concentration in Healthcare Management and Leading Organizations.
Dr. Oladeru’s research has published more than 50 research papers, presentations, and book chapters. She is the recipient of numerous awards and recognitions, including the Gold Foundation for Humanism in Medicine Honor Society Award in 2015; the Research Recognition Award from Winthrop University Hospital in 2016; and the AAWR Eleanor Montague Distinguished Resident Award in Radiation Oncology in 2020.
Her research interests include technological advancements in radiation oncology, high quality radiation treatment delivery, health policy to address inequities in underserved populations, and global radiation oncology. Her clinical focus at UF Health is patient centered treatment of all types and stages of breast cancer.
Transcription:
The University of Florida, College of Medicine is accredited by the accreditation council for continuing medical education, ACCME to provide continuing medical education for physicians. The University of Florida, College of Medicine designates this enduring material for a maximum of 0.25 AMA PRA category one credit physician should claim only the credit commensurate with the extent of their participation in this activity.
Melanie Cole (Host): Welcome to UF Health Med EdCast with UF Health Shands Hospital. I'm Melanie Cole. Joining me today is Dr. Lola Oladreru. She's an assistant professor in the department of radiation oncology at the University of Florida College of Medicine. She practices at UF health Shands Hospital, and she's here to highlight prone position for breast radiation treatment. Dr. Oladreru, it's a pleasure to have you join us today. Before we get into prone positioning, I'd like you to start with a bit of history of radiotherapy for breast cancer specifically. How has this evolved over the years? What have you seen change in the field? What's exciting?
Dr Oluwadamilola Oladeru: Thank you. So breast radiation has always been a part of breast cancer management and historically, before the introduction of image, guided radiation, things were done using x-ray based technique. And what this meant, for some patients who, and even physicians who trained many decades ago, they might recall seeing lots of patients report burns and scarring from the type of radiation they had during those period of time. And in fact, as a result, also a lot of side effects from radiation.
Including long fibrosis pneumonitis, heart issues, including cardiac related problems from radiation exposure to the heart, but things have changed dramatically in breast radiotherapy. We now use image guidance when we treat patients it's based on CT based planning. In fact, we have now evolved to MR based planning. We also have stereotactic ways of delivering radiation treatment to targeted areas. In some women, they are eligible to get partial breast radiation instead of whole breast radiation.
We have also evolved to be able to monitor the body internal movement, heart motion, wrong motion, when we deliver radiation to the breast. So modern techniques have really caught up to ensuring we're delivering safe, effective yet also minimizing long term risk and toxicities, for our breast cancer patients.
Melanie Cole (Host): You for that excellent description, what an exciting time to be in your field. So let's talk about the benefits of prone positioning for protecting normal tissues, including the lungs and heart during radiation. Tell us a little bit about that and really what it's like for the patient? How did this get started?
Dr Oluwadamilola Oladeru: So the standard way of treating patients is with her laying on her back with arms up over the head, slightly elevated about five to 10 degrees off the table at the head. And that's called the supine position. So the patient is facing up. The radiation is delivered to the patient's chest or breast. With prone position, the patient is lined face down. So the press that we are not treating remains flat on the table while the targeted breast is left to hang and falls down away from the chest.
And so we are able to direct the beam of the radiation to the breast and avoid the chest, reduce exposure to the heart, and reduce exposure to the lung. This is especially helpful for women with larger breasts, because we're able to focus on just the breast tissue being exposed and we're able to get adequate dose that is homogeneous throughout the breast, as opposed to treating larger breasted patients supine. Where we can have very, significant challenges with delivering homogeneous dose across the entire breast when sitting face up.
Melanie Cole (Host): So tell us a little bit then about the factors that make a patient, a candidate for this prone positioning treatment. Is it contraindicated in certain circumstances? And when is it clinically indicated?
Dr Oluwadamilola Oladeru: So it's only indicated for patients who have breast cancer that only requires radiation to the breast. So there are some women who have cancer that has gone to the nodes. If you have positive lymph nodes and you need regional nodal radiation, you can only be treated in these supine facing up position. However, if you only need the breast radiated, you don't need the node radiated, then you are the perfect candidate for a prone position.
In addition to that, a woman who is at least about a B cup would be the appropriate patient for a prone position, because you need the breast to be able to fall down a certain amount of distance away from the chest in order to be the right candidate for prone. So this is very beneficial for larger cup women, any woman whom has back pain and don't want to lay on their back while getting radiation treatment. This is the best type of position, to deliver radiation for these patients.
Melanie Cole (Host): Does weight enter this picture at all? If somebody is obese, is this kind of treatment contraindicated for them?
Dr Oluwadamilola Oladeru: It all depends on how they lay on the table. If they lay in such a position whereby laying on their belly is extremely uncomfortable or the belly fat extends forward so much that the breast cannot fall forward, then no, that patient would not be the right candidate for a prone position. However, even if you meet the weight requirements for the radiation table and we can get the breast to fall down off the table and we can also, put the patient in a patient that's comfortable for him or her, then it's a situation where we would allow for them to be put in a pro position.
Melanie Cole (Host): So have there been studies on the benefits and advantages of prone positioning for breast radiation therapy. Before we wrap up, I'd like you to speak to other providers about why this can protect vital structures and organs. When you feel it's important to refer in any studies that you would like to mention to other providers that can reiterate what we're discussing here today?
Dr Oluwadamilola Oladeru: So there have been several studies published, including very recent ones. The very first one that comes to mind was in JAMA. And that was published in 2012. And that has sort of evolved to it being adopted more in practice and people reporting their outcomes even today. In that study, they had looked at patients, who all had early stage breast cancer, and that meant they did not have positive nodes and didn't need their notes, treated.
And what they found was those who were treated, particularly those with left breast cancers facing down, the amount of heart tissue exposed to radiation reduced by 86%, the amount of lung tissue exposed to radiation reduced by 91% compared to you facing upward. In addition, whenever you treat someone who is facing up, there's no way to avoid the lungs but in patients who are facing down in the prone position, you can completely avoid their lung, in terms of getting radiation exposure to that area.
And even more so for those who have right breast, cancer, this study also showed that they reduce the amount of heart exposure to radiation to almost zero. So the benefit cannot be underestimated with this setting. It has really changed, us being worried about toxicities in the long term for patients who are undergoing, radiation therapy.
Melanie Cole (Host): Real game changer. Thank you so much, Dr. Oladreru for joining us today and to refer your patient for breast radiation treatment, or to listen to more podcasts from our experts, please visit UFhealth.org/medmatters. That concludes today's episode of UF Health Med EdCast with UF Health Shands Hospital. For updates on the latest medical advancements, breakthroughs and research. Please follow us on your social channels. I'm Melanie Cole.
The University of Florida, College of Medicine is accredited by the accreditation council for continuing medical education, ACCME to provide continuing medical education for physicians. The University of Florida, College of Medicine designates this enduring material for a maximum of 0.25 AMA PRA category one credit physician should claim only the credit commensurate with the extent of their participation in this activity.
Melanie Cole (Host): Welcome to UF Health Med EdCast with UF Health Shands Hospital. I'm Melanie Cole. Joining me today is Dr. Lola Oladreru. She's an assistant professor in the department of radiation oncology at the University of Florida College of Medicine. She practices at UF health Shands Hospital, and she's here to highlight prone position for breast radiation treatment. Dr. Oladreru, it's a pleasure to have you join us today. Before we get into prone positioning, I'd like you to start with a bit of history of radiotherapy for breast cancer specifically. How has this evolved over the years? What have you seen change in the field? What's exciting?
Dr Oluwadamilola Oladeru: Thank you. So breast radiation has always been a part of breast cancer management and historically, before the introduction of image, guided radiation, things were done using x-ray based technique. And what this meant, for some patients who, and even physicians who trained many decades ago, they might recall seeing lots of patients report burns and scarring from the type of radiation they had during those period of time. And in fact, as a result, also a lot of side effects from radiation.
Including long fibrosis pneumonitis, heart issues, including cardiac related problems from radiation exposure to the heart, but things have changed dramatically in breast radiotherapy. We now use image guidance when we treat patients it's based on CT based planning. In fact, we have now evolved to MR based planning. We also have stereotactic ways of delivering radiation treatment to targeted areas. In some women, they are eligible to get partial breast radiation instead of whole breast radiation.
We have also evolved to be able to monitor the body internal movement, heart motion, wrong motion, when we deliver radiation to the breast. So modern techniques have really caught up to ensuring we're delivering safe, effective yet also minimizing long term risk and toxicities, for our breast cancer patients.
Melanie Cole (Host): You for that excellent description, what an exciting time to be in your field. So let's talk about the benefits of prone positioning for protecting normal tissues, including the lungs and heart during radiation. Tell us a little bit about that and really what it's like for the patient? How did this get started?
Dr Oluwadamilola Oladeru: So the standard way of treating patients is with her laying on her back with arms up over the head, slightly elevated about five to 10 degrees off the table at the head. And that's called the supine position. So the patient is facing up. The radiation is delivered to the patient's chest or breast. With prone position, the patient is lined face down. So the press that we are not treating remains flat on the table while the targeted breast is left to hang and falls down away from the chest.
And so we are able to direct the beam of the radiation to the breast and avoid the chest, reduce exposure to the heart, and reduce exposure to the lung. This is especially helpful for women with larger breasts, because we're able to focus on just the breast tissue being exposed and we're able to get adequate dose that is homogeneous throughout the breast, as opposed to treating larger breasted patients supine. Where we can have very, significant challenges with delivering homogeneous dose across the entire breast when sitting face up.
Melanie Cole (Host): So tell us a little bit then about the factors that make a patient, a candidate for this prone positioning treatment. Is it contraindicated in certain circumstances? And when is it clinically indicated?
Dr Oluwadamilola Oladeru: So it's only indicated for patients who have breast cancer that only requires radiation to the breast. So there are some women who have cancer that has gone to the nodes. If you have positive lymph nodes and you need regional nodal radiation, you can only be treated in these supine facing up position. However, if you only need the breast radiated, you don't need the node radiated, then you are the perfect candidate for a prone position.
In addition to that, a woman who is at least about a B cup would be the appropriate patient for a prone position, because you need the breast to be able to fall down a certain amount of distance away from the chest in order to be the right candidate for prone. So this is very beneficial for larger cup women, any woman whom has back pain and don't want to lay on their back while getting radiation treatment. This is the best type of position, to deliver radiation for these patients.
Melanie Cole (Host): Does weight enter this picture at all? If somebody is obese, is this kind of treatment contraindicated for them?
Dr Oluwadamilola Oladeru: It all depends on how they lay on the table. If they lay in such a position whereby laying on their belly is extremely uncomfortable or the belly fat extends forward so much that the breast cannot fall forward, then no, that patient would not be the right candidate for a prone position. However, even if you meet the weight requirements for the radiation table and we can get the breast to fall down off the table and we can also, put the patient in a patient that's comfortable for him or her, then it's a situation where we would allow for them to be put in a pro position.
Melanie Cole (Host): So have there been studies on the benefits and advantages of prone positioning for breast radiation therapy. Before we wrap up, I'd like you to speak to other providers about why this can protect vital structures and organs. When you feel it's important to refer in any studies that you would like to mention to other providers that can reiterate what we're discussing here today?
Dr Oluwadamilola Oladeru: So there have been several studies published, including very recent ones. The very first one that comes to mind was in JAMA. And that was published in 2012. And that has sort of evolved to it being adopted more in practice and people reporting their outcomes even today. In that study, they had looked at patients, who all had early stage breast cancer, and that meant they did not have positive nodes and didn't need their notes, treated.
And what they found was those who were treated, particularly those with left breast cancers facing down, the amount of heart tissue exposed to radiation reduced by 86%, the amount of lung tissue exposed to radiation reduced by 91% compared to you facing upward. In addition, whenever you treat someone who is facing up, there's no way to avoid the lungs but in patients who are facing down in the prone position, you can completely avoid their lung, in terms of getting radiation exposure to that area.
And even more so for those who have right breast, cancer, this study also showed that they reduce the amount of heart exposure to radiation to almost zero. So the benefit cannot be underestimated with this setting. It has really changed, us being worried about toxicities in the long term for patients who are undergoing, radiation therapy.
Melanie Cole (Host): Real game changer. Thank you so much, Dr. Oladreru for joining us today and to refer your patient for breast radiation treatment, or to listen to more podcasts from our experts, please visit UFhealth.org/medmatters. That concludes today's episode of UF Health Med EdCast with UF Health Shands Hospital. For updates on the latest medical advancements, breakthroughs and research. Please follow us on your social channels. I'm Melanie Cole.