ESTRO-ACROP guideline for positioning, immobilisation and setup verification for local and loco-regional photon breast cancer irradiation
M. Mast, Aidan Leong, Stine Korreman, Grace Lee, Heidi Probst, Philipp E. Scherer, Y. Tsang
Abstract
Summary of recommendations.Tabled 1TopicRecommendationsPositioning•For most breast cancer treatments supine is the standard position. For patients with larger breasts or patients that require a higher degree of lung sparing, prone can be considered if the equipment and expertise are available.•Both arms up are considered more stable; one arm up may be considered for patients that cannot tolerate both arms up.•When using supine positioning, both flat and elevated board positions are acceptable provided collision risks are managed and the patient is appropriately stabilised.Immobilisation•There is insufficient evidence to support the adoption of any specific immobilisation device of the breast. The pro and cons of specific immobilisation devices must be weighed carefully and evaluated by the local department prior to clinical implementation.Setup•In the absence of surface guided imaging, the use of skin marking is required.•The available options for skin marking should be discussed taking into account long-term patient experience and patient preference.Position verification•Daily 2D-2D or 3D online position verification should be used where feasible.•2D online/offline position verification is appropriate with consideration of limitations.•Image matching should consider bony anatomy as well as soft tissue displacement/deformation.•SGRT should not replace standard image-guidance without local validation and particular caution to partial-breast/integrated-boost treatments. Open table in a new tab