Adjuvant radiation in akimbo-like position in a case of post-mastectomy breast cancer - A case report

In this report, we describe the radiotherapy planning and treatment of a 72-year-old postmenopausal lady with multiple comorbidities, who was diagnosed with carcinoma of the right breast. She underwent a right modified radical mastectomy with axillary clearance and was found to have axillary nodes harboring malignant metastasis. She was planned with adjuvant radiation to the chest wall and supraclavicular region. To achieve prescribed dose distribution, the patient needs to maintain an ipsilateral arm or both arms overhead during the treatment as a standard protocol but due to shoulder movement restriction, the patient was unable to hold the position with arms overhead. We used the akimbo position for the patient's ipsilateral side and were able to achieve prescribed radiation dose distribution over the right chest wall. The patient did not have any significant side effects during and after the treatment. The akimbo position can be an acceptable alternative in select breast cancer patients for adjuvant radiation, with significant shoulder joint movement restriction.