Is There an Increased Risk of Local Recurrence Under the Heart Block in Patients with Left-Sided Breast Cancer?

Abstract

A heart block is a reasonable method to limit cardiac dose but should be used cautiously following a lumpectomy in patients with inferiorly located tumors. Additional study with larger numbers of patients is warranted.

Analysis of 10-year cause-specific mortality of patients with breast cancer treated in New South Wales in 1995

“…Further effort is still required to improve RT techniques to minimise the dose exposure to the heart. Techniques such as 3D conformal RT with the application of a heart block, 15 intensity‐modulated RT, 16 end‐inspiration gated RT 17 or deep inspiration breath‐hold technique 18 will result in further reductions in cardiac dose.…”

Potential Effect of Robust and Simple IMRT Approach for Left-Sided Breast Cancer on Cardiac Mortality

“…Therefore, either a significant amount of the left heart will be irradiated with the prescription dose or underdosage of some of the PTV will have to be accepted. Although partial breast RT might be an option for these patients, as long as the precise indications for partial breast RT have not been identified, it seems prudent not to compromise on whole breast coverage, if possible (17).…”

“…Although partial breast RT offers a possibility to reduce cardiac exposure, it is experimental. Also, because a reduction of the treated volume by heart blocks might result in an increased relapse risk (17), partial breast RT might not be suitable for all patients.…”

Cardiotoxicity in breast cancer patients after radiotherapy – modern methods of minimizing the dose to the heart and dilemmas of choosing critical cardiac structures for monitoring dose distribution

“…Yeboa and Evans discuss factors that need to be taken into consideration when planning and administering radiotherapy to breast cancer patients [2]. Modern heart-sparing techniques include use of heart shields, particularly for patients with clearly visible tumour bed, which however may result in insufficient irradiation of 2.8% of breast tissue on average [3]. On the other hand, no increase in local recurrence rate has been observed in patients on whom shields were used.…”