Evaluation of a customized immobilization bra for patients with pendulous breast undergoing radiation therapy

Aim: This a feasibility study to evaluate the use of a customized immobilization bra for patients with pendulous breast undergoing radiotherapy.Methods: A total of 34 patients with large pendulous breasts were fitted with the Chabner XRT® radiation bra (CIVCO, USA) during CT simulation and treatment procedures (40Gy/15 fractions or /26Gy/5 fractions).Effects of the bra on acute skin toxicities were monitored with photo document and assessed using the Radiation Therapy Oncology Group (RTOG) skin toxicity score system during weekly reviews with the radiation oncologists.Level of positioning setup uncertainties were evaluated based on departmental imaging protocol.A mixed method questionnaire was administered to both radiation therapists (RTTs) and patients to elicit responses from end-users.Patients appraised the user-friendliness of the bra with regards to the comfort level and ease of wearing.Results: Minimal skin toxicity (grade 0-1) were observed for all patients at the end of the treatment.No broken skin or adverse skin reactions were reported throughout the course of treatment.Reproducibility of treatment position was acceptable with a median (range) setup error (isocentre) of 0.0cm (-0.6cm to 0.7cm) (left/right), -0.1cm (-0.5cm to 1.2cm) (posterior) and 0.2cm (-0.5cm to 0.9cm) (inferior) achieved based on matched field borders on skin.However, repeated setups and imaging were required for 3 patients due to large breasts size (cups D-G; size 4-5).10 RTTs completed the survey.All male RTTs (n = 4) were not confident in assisting patients with the fitting of the bra.8 RTTs agreed that although it was slightly more difficult to reproduce the breast tissue for daily treatment it has helped patient to maintain the treatment position throughout the procedure.At six-month post study, all RTTs agreed that they were more confident with fitting of the bra and daily treatment setup.27 (response rate 79.4%) patients completed the self-administered survey.Majority of the patients (n = 23) felt comfortable wearing the bra while 20 patients felt less exposed during treatment. Conclusion:This study demonstrated the feasibility of using a customized immobilization bra which provided optimal setup reproducibility while maintaining minimal skin toxicity and patient's comfort, especially the value-added modesty felt among Asian women during their breast cancer radiotherapy.Increased experience has also helped staff to overcome the initial difficulties faced in bra fitting and patient setup.