Clinical translation and evaluation of a novel prone crawl technique in the search for offering older women short, efficient and non-toxic adjuvant breast radiotherapy

Adjuvant radiotherapy in breast cancer improves loco-regional control and survival. Elder patients
with breast cancer are frequently undertreated leading to a strongly decreased breast cancer
specific survival. Adjuvant radiotherapy is omitted for various reasons including:
• frailty of the patient
• reduced threshold for and tolerance of toxicity
• impaired mobility, rendering optimal radiotherapy positioning more difficult
• shorter life expectancy leading to a negative cost effectiveness ratio for complex techniques
These issues call for delivering radiotherapy in a comfortable setting, using the lowest possible
number of fractions with techniques that maximally avoid toxicity and maintain efficacy. A novel
prone crawl radiotherapy technique developed at UGent seems promising regarding comfort and
avoidance of skin, lung and heart toxicity. We hypothesize that the combination of the prone crawl
technique with a highly accelerated radiotherapy schedule of 5 fractions over 10 days – designed to
have equal efficacy as the standard long schedules – might allow us to achieve the desired results
for adjuvant breast radiotherapy in older patients. This project will assess feasibility and toxicity in
the target population in a comparative setting with standard radiotherapy. The overall objective of
this project is to eliminate the reasons for depriving older patients of a highly efficient treatment,
adjuvant breast radiotherapy.