Effect of Akimbo Versus Raised Arm Positioning on Breast and Cardiopulmonary Dosimetry in Pediatric Hodgkin Lymphoma
PURPOSE: In pediatric Hodgkin lymphoma (HL), radiotherapy (RT)-related late toxicities are a prime concern during treatment planning. This is the first study to examine whether arm positioning (raised versus akimbo) result in differential cardiopulmonary and breast doses in patients undergoing media...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2016-07-01
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| Series: | Frontiers in Oncology |
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| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fonc.2016.00176/full |
| _version_ | 1811200612047519744 |
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| author | Kyle Denniston Vivek Verma Abhijeet Bhirud Nathan Bennion Chi Lin |
| author_facet | Kyle Denniston Vivek Verma Abhijeet Bhirud Nathan Bennion Chi Lin |
| author_sort | Kyle Denniston |
| collection | DOAJ |
| description | PURPOSE: In pediatric Hodgkin lymphoma (HL), radiotherapy (RT)-related late toxicities are a prime concern during treatment planning. This is the first study to examine whether arm positioning (raised versus akimbo) result in differential cardiopulmonary and breast doses in patients undergoing mediastinal RT. METHODS: Two treatment plans were made for each patient (akimbo/arms-raised); treatment was per Children’s Oncology Group AHOD0031 protocol, including AP/PA fields. The anterior midline T6-T7 disc space was used as an anatomic reference of midline. Heart/lungs were contoured for each setup. For females, breasts were also contoured and nipple positions identified. Volumetric centers of contoured organs were defined and three-dimensional distances from midline were computed. Analyzed dosimetric parameters included V5 (volume receiving ≥5 Gy), V10, V15, V20, and mean dose. Statistics were performed using the Mann-Whitney test.RESULTS: Fifteen (6 female, 9 male) pediatric HL patients treated with mediastinal RT were analyzed. The median lateral distance from the breast center/nipple to midline with arms akimbo was larger than that with arms raised (8.6 vs. 7.7cm left breast, p=0.04; 10.7 vs. 9.2cm left nipple, p=0.04; 8.7 vs. 7.0cm right breast, p=0.004; 9.9 vs. 7.9cm, p=0.007 right nipple). Raised arm position was associated with a median 2.8/3.0cm decrease in breast/nipple separation, respectively. There were no significant differences in craniocaudal breast/nipple position based on arm positioning (p>0.05). Increasing breast volume was correlated with larger arm position-related changes in breast/nipple separation (r=0.74, p=0.06 / r=0.85, p=0.02). Akimbo positioning lowered median breast V5, V10, V15, and mean dose (p<0.05), with no differences observed in patients with both mediastinal and axillary disease for any parameters (p>0.05). Arm position had no significant effect on cardiopulmonary doses.CONCLUSIONS: Akimbo arm positioning may be advantageous to decrease breast doses in female pediatric HL patients undergoing mediastinal RT, especially in the absence of axillary disease. |
| first_indexed | 2024-04-12T02:06:29Z |
| format | Article |
| id | doaj.art-1499f04a39674046bb05890b143f7a5d |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-12T02:06:29Z |
| publishDate | 2016-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-1499f04a39674046bb05890b143f7a5d2022-12-22T03:52:30ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2016-07-01610.3389/fonc.2016.00176212627Effect of Akimbo Versus Raised Arm Positioning on Breast and Cardiopulmonary Dosimetry in Pediatric Hodgkin LymphomaKyle Denniston0Vivek Verma1Abhijeet Bhirud2Nathan Bennion3Chi Lin4St. Peter's Health PartnersUniversity of Nebraska Medical CenterUniversity of Nebraska Medical CenterUniversity of Nebraska Medical CenterUniversity of Nebraska Medical CenterPURPOSE: In pediatric Hodgkin lymphoma (HL), radiotherapy (RT)-related late toxicities are a prime concern during treatment planning. This is the first study to examine whether arm positioning (raised versus akimbo) result in differential cardiopulmonary and breast doses in patients undergoing mediastinal RT. METHODS: Two treatment plans were made for each patient (akimbo/arms-raised); treatment was per Children’s Oncology Group AHOD0031 protocol, including AP/PA fields. The anterior midline T6-T7 disc space was used as an anatomic reference of midline. Heart/lungs were contoured for each setup. For females, breasts were also contoured and nipple positions identified. Volumetric centers of contoured organs were defined and three-dimensional distances from midline were computed. Analyzed dosimetric parameters included V5 (volume receiving ≥5 Gy), V10, V15, V20, and mean dose. Statistics were performed using the Mann-Whitney test.RESULTS: Fifteen (6 female, 9 male) pediatric HL patients treated with mediastinal RT were analyzed. The median lateral distance from the breast center/nipple to midline with arms akimbo was larger than that with arms raised (8.6 vs. 7.7cm left breast, p=0.04; 10.7 vs. 9.2cm left nipple, p=0.04; 8.7 vs. 7.0cm right breast, p=0.004; 9.9 vs. 7.9cm, p=0.007 right nipple). Raised arm position was associated with a median 2.8/3.0cm decrease in breast/nipple separation, respectively. There were no significant differences in craniocaudal breast/nipple position based on arm positioning (p>0.05). Increasing breast volume was correlated with larger arm position-related changes in breast/nipple separation (r=0.74, p=0.06 / r=0.85, p=0.02). Akimbo positioning lowered median breast V5, V10, V15, and mean dose (p<0.05), with no differences observed in patients with both mediastinal and axillary disease for any parameters (p>0.05). Arm position had no significant effect on cardiopulmonary doses.CONCLUSIONS: Akimbo arm positioning may be advantageous to decrease breast doses in female pediatric HL patients undergoing mediastinal RT, especially in the absence of axillary disease.http://journal.frontiersin.org/Journal/10.3389/fonc.2016.00176/fullRadiotherapypediatric cancerDosimetryHodgkin lymphomaSecondary malignancy |
| spellingShingle | Kyle Denniston Vivek Verma Abhijeet Bhirud Nathan Bennion Chi Lin Effect of Akimbo Versus Raised Arm Positioning on Breast and Cardiopulmonary Dosimetry in Pediatric Hodgkin Lymphoma Frontiers in Oncology Radiotherapy pediatric cancer Dosimetry Hodgkin lymphoma Secondary malignancy |
| title | Effect of Akimbo Versus Raised Arm Positioning on Breast and Cardiopulmonary Dosimetry in Pediatric Hodgkin Lymphoma |
| title_full | Effect of Akimbo Versus Raised Arm Positioning on Breast and Cardiopulmonary Dosimetry in Pediatric Hodgkin Lymphoma |
| title_fullStr | Effect of Akimbo Versus Raised Arm Positioning on Breast and Cardiopulmonary Dosimetry in Pediatric Hodgkin Lymphoma |
| title_full_unstemmed | Effect of Akimbo Versus Raised Arm Positioning on Breast and Cardiopulmonary Dosimetry in Pediatric Hodgkin Lymphoma |
| title_short | Effect of Akimbo Versus Raised Arm Positioning on Breast and Cardiopulmonary Dosimetry in Pediatric Hodgkin Lymphoma |
| title_sort | effect of akimbo versus raised arm positioning on breast and cardiopulmonary dosimetry in pediatric hodgkin lymphoma |
| topic | Radiotherapy pediatric cancer Dosimetry Hodgkin lymphoma Secondary malignancy |
| url | http://journal.frontiersin.org/Journal/10.3389/fonc.2016.00176/full |
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