Safety of modern breast RT for lungs and heart

  • Modern Radiation therapy with IMRT/IGRT is much safer
  • Small risk of cardiac ds (5-6% risk at 20 years) especially for left breast cancers
  • Pneumonitis <2%

Are there radiation techniques for better heart sparing?

  1. Partial Breast Radiation
  2. Prone Treatment
  3. Use of respiratory gating- 4D RT

Gated Breast Radiation Therapy- 4D RT

  • Gating refers to 4D RT- synchronizes RT with breathing cycle
  • Pts are coached to take deep breath and then hold that level of inspiration during every radiation treatment
  • BH can increase distance between heart and target volume
  • Beam on only during breath hold in deep Inspiration
  • Its associated with lower radiation exposure to heart without compromising coverage of disease

Basic premise of BH

  • DIBH involves patient inspiring to a specific threshold and then holding that level of inspiration during every RT field
  • BH increases distance between heart/LAD and target volume- Heart gets pulled posteriorly, inferiorly and medially
  • Lung Volume increases