Cardiac Sparing Breast Radiation Techniques in Patients with Left-Sided Breast Cancers.

Patients with left-sided breast cancers in particular:
- Are candidates for cardiac sparing breast radiation techniques
Multiple techniques exist to spare cardiac dose and include:
- Active breathing coordinator techniques (ABC)
- Prone breast irradiation
- Intensity-modulated radiation therapy
- Accelerated partial breast irradiation
None however is considered superior to another and the choice of technique employed depends on multiple patient factors:
- ABC has been used consistently as a method to reduce heart dose:
  - By increasing the distance from the chest wall to the heart
- Prone breast irradiation:
  - Allows for the breast to fall away from the chest:
    - Potentially improving cardiac dose
- Intensity-modulated radiation therapy:
  - Can create segments within the beam to limit heart dose
- Accelerated partial breast irradiation:
  - Limits the volume treated to the area surrounding the lumpectomy cavity and thus spares the heart

References:
Eldredge-Hindy H, Lockamy V, Crawford A, et al. Active breathing coordinator reduces radiation dose to the heart and preserves local control in patients with left breast cancer: report of a prospective trial. Pract Radiat Oncol. 2015;5:4-10.
Mulliez T, Veldeman L, Speleers B, et al. Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother Oncol. 2015;114:79-84. Shah C, Badiyan S, Berry S, et al. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol. 2014;112:9-16.
Yim J, Suttie C, Bromley R, Morgia M, Lamoury G. Intensity modulated radiotherapy and 3D conformal radiotherapy for whole breast irradiation: a comparative dosimetric study and introduction of a novel qualitative index for plan evaluation, the normal tissue index. J Med Radiat Sci. 2015;62:184-191.

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO