Treatment Techniques to Reduce Cardiac Irradiation for Breast Cancer Patients Treated with Breast-Conserving Surgery and Radiation Therapy: A Review

Abstract

Thousands of women diagnosed with breast cancer each year receive breast-conserving surgery followed by adjuvant radiation therapy. For women with left-sided breast cancer, there is risk of potential cardiotoxicity from the radiation therapy. As data have become available to quantify the risk of cardiotoxicity from radiation, strategies have also developed to reduce the dose of radiation to the heart without compromising radiation dose to the breast. Several broad categories of techniques to reduce cardiac radiation doses include breath hold techniques, prone positioning, intensity-modulated radiation therapy, and accelerated partial breast irradiation, as well as many small techniques to improve traditional three-dimensional conformal radiation therapy. This review summarizes the published scientific literature on the various techniques to decrease cardiac irradiation in women treated to the left breast for breast cancer after breast-conserving surgery.

Late locoregional complications associated with adjuvant radiotherapy in the treatment of breast cancer: Systematic review and meta‐analysis

“…And although these complications present with lower frequencies, they are associated with significant morbidity and with ineffective treatment results . In addition, older RT old protocols were associated with increased risk to intrathoracic organs and a long‐term increase in the mortality rate related to cardiac causes …”

Breast cancer screening—opportunistic use of registry and linked screening data for local evaluation

“…While increased breast‐conserving therapy would generally be regarded as a screening benefit for improved body image and psychological outcomes, any side effects from exposure to radiotherapy would need to be considered (eg, potential for cardio‐toxicity from radiation to the left breast) . By comparison, mastectomy cases were more likely to receive chemotherapies and hormone therapies.…”

“…While increased breast-conserving therapy would generally be regarded as a screening benefit for improved body image and psychological outcomes, any side effects from exposure to radiotherapy would need to be considered (eg, potential for cardio-toxicity from radiation to the left breast). 35 By comparison, mastectomy cases were more likely to receive chemotherapies and hormone therapies. To the extent that these systemic therapies can have adverse effects-fatigue, nausea, weight loss, mucositis, immunosuppression, and cardio-toxicities-the reduced need for these therapies in screened cases would be regarded as a positive screening effect.…”

Evaluation of the radiobiological gamma index with motion interplay in tangential IMRT breast treatment

“…Even with small breast volumes, IMRT has improved dose distribution compared with traditional treatments [10]. Cardiac and associated left anterior descending coronary artery (LAD) toxicities are directly associated with the radiation dose [11–13]. The cardiac dose can be reduced through irradiation with a deep inspiration breath-hold technique and IMRT [14, 15].…”