Radiation Therapy: Reducing Long-Term Heart Complications

By Kathleen Settle, MD

Chesapeake Potomac Regional Cancer Center

. http://www.chesapeakepotomaccancer.com/

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Radiation Therapy: Reducing Long-Term Heart Complications

Radiation therapy one aspect of technology which has the potential to significantly reduce long-term heart complications in many of our cancer populations, including the breast cancer population.

Radiation therapy is a necessary course of treatment in many of our cancer populations. In the breast cancer population, it often has both local control and survival benefits. However, there is always a concern if the toxicity of treatment will negate some of the survival benefit. The most concerning toxicity is that of cardiac injury, especially in our breast cancer patient requiring treatment to their left breast or left chest wall after a mastectomy. Studies have demonstrated the radiation dose to the heart can increase a patient’s risk of cardiac events especially as that dose increases. Therefore, it is vital to reduce radiation exposure to the heart to as low a level as possible without compromise of effective cancer therapy.

Thankfully, there are a number of techniques to reduce normal tissue, and particularly heart, exposure in the breast cancer population without having to deliver a compromised and less effective course of radiation therapy.

One of the techniques commonly used is the prone position. A patient lies on her stomach with the treatment breast hanging through an opening. This allows gravity to pull the breast tissue from the chest wall further increasing the distance between the breast tissue and the heart and lung. This often results in significant avoidance of the heart and lung from the radiation beam.

However, not all patients can be treated on their stomach for a variety of reasons. Thankfully, the solution to that is treating the patient more comfortably on their back with the Deep Inspiration Breath Hold (DIBH) Technique.

DIBH is a radiation therapy technique where a patient takes in a near-maximum inspiration and holds it while the radiation is being delivered typically no longer than 30 seconds per beam. The act of taking in a deep breath results in the lungs expanding and the heart naturally moving away from the left chest wall, and thus, away from the radiation beam. With a little bit of practice, this is a technique that can easily be performed by young and old, alike.

Thankfully, improvements and advances in radiation technology and delivery over time have led to dramatic decreases in heart doses for those receiving breast cancer radiation.