Cardiac Sparing Radiation for Breast Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Patients with left-sided breast cancers in particular:
    • Are candidates for cardiac sparing breast radiation techniques
  • Multiple techniques exist to reduce cardiac dose and include:
    • Active breathing coordinator techniques
    • 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
  • Active breathing coordinator techniques:
    • 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 particularly for larger breasted patients
  • 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
  • Regional nodal irradiation:
    • Would treat the axilla and / or internal mammary nodes and therefore is not cardiac sparing
  • Hypofractionated whole-breast irradiation:
    • On its own is a difference in dose regimen, not a cardiac-sparing technique
  • Abdominal compression can be used to limit respiratory motion but is not traditionally used as a cardiac sparing technique
  • 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.
    • 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(1):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(1):79-84.
    • 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(3):184-191.
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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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