What strategies to you use for large breasted women receiving whole breast radiation?

Particularly for patients too large for prone breast treatment, do you use a breast immobilization device or bra? Do you change your fractionation? Would you consider coming off the whole breast and treating the involved breast segment or enlarged boost area? Does your skin care regimen differ for larger obese women compared to non-obese (for example, use of oral or topical antibiotics or avoiding emollients)?

Answer from: Radiation Oncologist at Community Practice

If we can't do prone, we use a styroform wedge in the inframammary region to decrease the breast fold and thus, decrease the inferior margin and amount of inframammary fold we have to treat. I would initially try hypofractionation with mixed beam with a field-in-field technique and if...

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Radiation Oncologist at Varian Medical Systems/Allegheny health network
https://www.sciencedirect.com/science/article/pii/...

Radiation Oncologist at Thomas Jefferson University
We have used a 60 cc syringe under the breast with...

Answer from: Radiation Oncologist at Academic Institution

One other comment I would make is we too routinely assume a patients needs whole breast irradiation. For larger breasted women with T1-2 (< 3 cm) N0 tumors partial breast irradiation with 40 Gy/15 fractions (IMPORT LOW) or 30 Gy/5 fractions (Livi et al) can be considered to reduce dose the remain...

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What strategies to you use for large breasted women receiving whole breast radiation?

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