Hold Your Breath to Protect Your Heart

“Women who have breast cancer on their left side present a particular challenge to radiation oncologists. Studies have shown that the risk of heart disease is higher in this group of women after radiation treatment because it can be difficult to ensure that a sufficient dose of radiation is delivered to the left breast while adequately shielding the heart from exposure. New research shows a woman who holds her breath during radiation pulses can greatly reduce radiation exposure to the heart.

” ‘Radiation therapy is commonly prescribed to patients with breast cancer following surgery as a component of first-line therapy,’ said first author Harriet Eldredge-Hindy, M.D., a Chief Resident and researcher in the Department of Radiation Oncology at Thomas Jefferson University ‘We wanted to determine how effective breath-hold could be in shielding the heart from extraneous radiation exposure during treatment of the left breast.’

“Recent studies have shown women with cancer in the left breast are at higher risk of heart disease, and that the risk increases proportionately with the dose of radiation the heart is exposed to during treatment. A number of techniques have been developed to reduce exposure to the heart including prone positioning (lying flat on the belly on a bed that only exposes the left breast), intensity-modulated radiation therapy (IMRT), and accelerated partial breast irradiation. The breath-hold technique allows doctors to monitor a patient’s breath for the position that shifts the heart out of the range of the radiation beam.”


Patients Who Have Left Breast Tumors Have Comparable OS to Those with Right Breast Tumors

“Tumor laterality (left-side vs. right-side) does not impact overall survival in breast cancer patients treated with breast-conserving surgery and adjuvant external beam radiation therapy, according to a study published in the October 1, 2014 issue of the International Journal of Radiation Oncology • Biology • Physics (Red Journal), the official scientific journal of the American Society for Radiation Oncology (ASTRO).

“Studies have shown that breast cancer patients treated with radiation therapy have improved local-regional recurrence, and breast cancer-specific survival after breast-conserving surgery and overall survival (OS) after mastectomy. Long-term follow-up of historic radiation therapy trials for breast cancer has demonstrated a potential increase in cardiac mortality. However, these studies used earlier modes of radiation therapy including Cobalt and orthovoltage radiotherapy, and did not employ CT-based planning, which allows for greater cardiac avoidance. Three recent studies suggest that cardiac mortality has not been greater for patients treated for left-sided breast cancer since the 1980s, when techniques allowing for greater cardiac avoidance became more commonplace[1-3].

“This study, ‘Breast Cancer Laterality Does Not Influence Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality,’ examines the impact of tumor laterality on overall survival in a modern cohort of patients from the National Cancer Database (NCDB). The NCDB, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, contains deidentified data from approximately 70 percent of newly diagnosed cancers in the United States. The NCBD is more than two times larger than the Surveillance, Epidemiology and End Results (SEER) database, and the NCBD contains data not found in SEER, including histopathologic data and specific treatment information such as sequencing of therapies, dose, technique (e.g., intensity modulated radiation therapy vs. brachytherapy) and target (e.g., breast only vs. breast and regional nodes).”