Reducing Radiation Doses to Adjacent Organs

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • During a breath-hold:
  • The distance between the tangential radiation beam edge and heart typically increases:
    • Reducing cardiac dose
  • Intensity modulated radiation therapy (IMRT):
    • Utilizes a computerized multi-leaf collimator to control the dose distribution throughout the radiation beam:
      • This helps conform the dose to the target breast (and lymph node regions, as appropriate) and away from organs at risk, such as the heart and lung
  • Treatment in the prone position:
    • Is generally less useful for small breasts, because large, pendulous breasts fall away from the chest wall, thus increasing the distance between the majority of the target breast tissue and the heart and lungs
    • Treatment planning studies suggest that heart doses are reduced when treating women with large breasts but not reduced (and even increased) when treating women with small breasts
    • Additionally, axillary lymph node coverage may be compromised when treating in the prone position
  • Accelerated partial breast irradiation targets the tumor bed with a limited margin of surrounding breast tissue and may decrease integral dose to the heart and lungs in select women, but is not suitable for women with node-positive breast cancer
  • References
    • Shah C, Badiyan S, Berry S, et al. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol. 2014;112(1):9-16.
    • 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(1):79-84.
    • Osa EO, DeWyngaert K, Roses D, et al. Prone breast intensity modulated radiation therapy: 5-year results. Int J Radiat Oncol Biol Phys. 2014;89(4):899-906.
    • Mulliez T, Speleers B, Mahjoubi K, et al. Prone left-sided whole-breast irradiation: significant heart dose reduction using end-inspiratory versus end-expiratory gating. Cancer Radiother. 2014;18(7):672-677.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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