Modern Radiation Therapy Techniques and their Toxicities for Breast Cancer

Abstract

Breast cancer (BC) is the major cause of death in women worldwide. It is a global issue with nearly 2.3 million patients diagnosed with BC and 0.685 million deaths in 2020 which greatly affects human resources as well as healthcare costs. Besides the development of systemic therapies, radiotherapy (RT) provides long life expectancy and high survival rates in breast cancer patients. With the advent of current radiotherapy planning systems, irradiation of breast cancer has undergone a drastic change. Historically, conventional fractionation techniques using tangential field protocol were considered a benchmark in RT for breast cancer. During the past 15 years, advances in treatment techniques, specifically, RT allows subsequent decline in treatment-related complications. The transition from two-dimensional to three-dimensional treatment planning has drastically decreased long-term cardiac toxicity. Herewith, it is prudent that treatment using radiations is carried out with utmost efficiency. This chapter provides practical as well as theoretical insight into the advances in radiotherapy techniques that are recently used in clinical practice. Besides three-dimensional RT planning, Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), and proton therapy are other modern treatment options. The other attractive approach which has resulted in shortened treatment duration is the hypofractionated RT technique. In addition, Accelerated Partial Breast Irradiation (APBI) and Deep Inspiration Breath Hold (DIBH) are also reasonable options for low-risk patients and maximal heart protection, respectively. Advanced techniques focus on cardiac sparing or deep breath-hold approaches which provide maximum safety and a decrease in long-term cardiac toxicity. This chapter will provide an up-to-date guide and resource for radiation oncologists, clinicians, and fellows seeking to learn and practice breast cancer radiotherapy.KeywordsRadiotherapyBreast cancerHypofractionated radiotherapyDeep Inspiration Breath-Hold RadiotherapyCardiac toxicity