Abstract
Patients with left-sided breast cancer are at risk of cardiac toxicity because of cardiac irradiation during radiotherapy with the conventional 3-dimensional conformal radiotherapy technique. In addition, many patients may receive chemotherapy prior to radiation, which may damage the myocardium and may increase the potential for late cardiac complications. New radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) may decrease the risk of cardiac toxicity because of the steep dose gradient limiting the volume of the heart irradiated to a high dose. Image-guided radiotherapy (IGRT) is a new technique of IMRT delivery with daily imaging, which may further reduce excessive cardiac irradiation. Preliminary results of IGRT for cardiac sparing in patients with left-sided breast cancer are promising and need to be investigated in future prospective clinical studies.
Highlights
CARDIAC TOXICITY FOLLOWING LEFT BREAST CANCER IRRADIATION Patients with left-sided breast cancer are at risk of long-term cardiac complications following irradiation
As randomized studies demonstrated a significant reduction of side effects during radiotherapy for breast cancer with intensitymodulated radiotherapy (IMRT) compared to 3-dimensional conformal radiotherapy technique (3D-CRT), it is quite possible that long-term cardiac complications may be reduced in the future with IMRT given its cardiac sparing properties
POTENTIAL ADVANTAGES OF image-guided radiotherapy (IGRT) FOR CARDIAC SPARING IN PATIENTS WITH LEFT-SIDED BREAST CANCER Image-guided radiotherapy is a tool that can be used in different radiotherapy treatments, including IMRT that gives the possibility of reduction of set up margins, with a better sparing of normal tissue, while promoting dose-escalation to the tumor
Summary
CARDIAC TOXICITY FOLLOWING LEFT BREAST CANCER IRRADIATION Patients with left-sided breast cancer are at risk of long-term cardiac complications following irradiation. The superiority of IMRT over 3D-CRT for left-sided breast cancer was beneficial in patients with a significant heart volume (more than 1 cm) included in the radiation fields. As randomized studies demonstrated a significant reduction of side effects during radiotherapy for breast cancer with IMRT compared to 3D-CRT, it is quite possible that long-term cardiac complications may be reduced in the future with IMRT given its cardiac sparing properties.
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