Cardiac Toxicity after Radiotherapy for Breast Cancer: Myths and Facts

Nitsche, Mirko; Pahl, René; Eilf, Kirsten; Dunst, Juergen

doi:10.1159/000376560

Cited by 14 publications

(11 citation statements)

References 32 publications

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“…Another promising technique for breast only RT is prone-positioned breast irradiation, especially in patients with large breasts [50]. This technique exploits gravity to elongate the treated breast away from the heart and lung.…”

Section: Modern Radiotherapy Techniques Heart Sparing Techniques In Bmentioning

confidence: 99%

Recent advances in radiotherapy of breast cancer

et al. 2020

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Radiation therapy is an integral part of the multidisciplinary management of breast cancer. Regional lymph node irradiation in younger trials seems to provide superior target coverage as well as a reduction in long-term toxicity resulting in a small benefit in the overall survival rate. For partial breast irradiation there are now two large trials available which support the role of partial breast irradiation in low risk breast cancer patients. Multiple randomized trials have established that a sequentially applied dose to the tumor bed improves local control with the cost of worse cosmetic results.

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Section: Modern Radiotherapy Techniques Heart Sparing Techniques In Bmentioning

confidence: 99%

Recent advances in radiotherapy of breast cancer

et al. 2020

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“…Cardiac toxicity after breast cancer [16,34,48,52], lung cancer [53,54] and mediastinal lymphoma [49,50,59] is the most reported radiation-induced complication [51]. The common clinical complications are asymptomatic pericarditis, congestive heart failure, and heart infarction.…”

Section: Discussionmentioning

confidence: 99%

5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

Steffal

Schratter-Sehn

Brinda-Raitmayr

et al. 2020

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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Background Radiation treatment to the left breast is associated with increased cardiac morbidity as well as mortality. Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) could have dosimetric advantages over the free breathing technique (NB, normal breathing) in cardiac (heart and LAD) and ipsilateral lung sparing in patients with left-sided breast cancer after surgery. Therefore this technique was implemented in 2013 at the institute of radiooncology at the KFJ/SMZ-South – Hospital Vienna. Methods From Oct 2013 – December 2018 548 patients were referred to radiotherapy following conservative operation of left-sided invasive breast cancer. All patients gave their informed consent and underwent training sessions for the DIBH-technique independent of age or breathing activity or respiratory disorders. Patients who turned out to be unfit for DIBH were enrolled for NB. The relative reduction in Dmean heart and left lung dose was compared between the two cohorts. Acute radiation induced side effects were classified according to the Radiation Therapy Oncology Group/The European Organisation for Research (RTOG) 37; late toxicity rates according to the Common Terminology Criteria for Adverse Events (CTCAE Version 4.03) Results The median age of the DIBH-patients was 58 years (27–90), of the NB-patients 65 (30–80) years. Follow-up was obtained until June 2019. The median follow-up was 52 months (range 7–73 m). The average coverage of Dmean left lung was 6.91 Gy (1.44 Gy – 12.4 Gy). The average coverage of Dmean heart was 1.17 Gy (0.12 Gy – 3.19 Gy) in the DIBH-cohort. The NB – plans had a Dmean of 8.92 Gy (5.23–16.9 Gy) at the ipsilateral lung and a Dmean of 2.31 Gy (0.71–4.21 Gy) at the heart. This shows that the DIBH-technique halved the Dmean of the heart. The amount of acute side effects was comparable between the two groups: RTOG 1: 70.8 % vs. 64 %, RTOG 3 6.6 % vs. 5.6 %, no reaction 3.2 % vs. 1.4 %. There were more CTCAE 1-late events in the NB-group (51.6 % vs. 12.67 %). Conclusion Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) is a rather simple, reproducable method with a high acceptance of the patients who can actively participate in the whole treatment process. The mean dose at the heart and the left lung can be reduced, at the heart even by as much as 50 %.

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“…Since most radiotherapy-associated cardiac side effects occur after 15 years or more, currently available results must be assessed with caution, especially in women with a long life expectancy and an unhealthy lifestyle. However, no significant cardiotoxicity has been observed in modern normofractionated radiotherapy for breast cancer with current radiotherapy techniques making it now safer than in the past [18]. Recently, Chan et al [19 ]reported a 15-year follow-up of cardiac injury, comparing hypofractionation versus normofractionation in left-sided early-stage breast cancer patients.…”

Section: Ongoing Controversies Concerning the Hypofractionated Treatmmentioning

confidence: 99%