When do you recommend prone breast radiation?

If the plan is for whole breast radiotherapy without nodal treatment, I treat almost all women prone. The only women that are treated supine are those that have lump cavities that preclude the benefit of a prone plan (positioned posteriorly along chest wall, so tangents cut through lung/heart) or those occasional few ladies that cannot tolerate treatment.

The plans are almost always more homogeneous, and lung/rib/heart doses are very low, as compared to supine. This was seen in our internal unpublished database of hundreds of patients at my prior practice, as well as in other published series.

If you have not treated patients prone, it is worthwhile for the physician and staff to go to a training course. There, positioning, dosimetry, and the...

I treat at prone for whom I plan to treat whole breast, with no intention to cover low axilla or ipsilateral IMN. If breast hang adequately ( usually cup breast size large B & above) , I prefer prone position for dose homogeneity, less lung ( if any at all) and rib exposure.