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18.07.2019 | Review Article

Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO)

verfasst von: Marciana-Nona Duma, René Baumann, Wilfried Budach, Jürgen Dunst, Petra Feyer, Rainer Fietkau, Wulf Haase, Wolfgang Harms, Thomas Hehr, David Krug, Marc D. Piroth, Felix Sedlmayer, Rainer Souchon, Rolf Sauer, Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 10/2019

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Abstract

Purpose

The aim of this review was to analyze the respective efficacy of various heart-sparing radiotherapy techniques.

Material and methods

Heart-sparing can be performed in three different ways in breast cancer radiotherapy: by seeking to keep the heart out of treated volumes (i.e. by prone position or specific breathing techniques such as deep inspiration breath-hold [DIBH] and/or gating), by solely irradiating a small volume around the lumpectomy cavity (partial breast irradiation, PBI), or by using modern radiation techniques like intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) or protons. This overview presents the available data on these three approaches.

Results

Studies on prone position are heterogeneous and most trials only refer to patients with large breasts; therefore, no definitive conclusion can be drawn for clinical routine. Nonetheless, there seems to be a trend toward better sparing of the left anterior descending artery in supine position even for these selected patients. The data on the use of DIBH for heart-sparing in breast cancer patients is consistent and the benefit compared to free-breathing is supported by several studies. In comparison with whole breast irradiation (WBI), PBI has an advantage in reducing the heart dose. Of note, DIBH and PBI with multicatheter brachytherapy are similar with regard to the dose reduction to heart structures. WBI by IMRT/VMAT techniques without DIBH is not an effective strategy for heart-sparing in breast cancer patients with “standard” anatomy. A combination of DIBH and IMRT may be used for internal mammary radiotherapy.

Conclusion

Based on the available findings, the DEGRO breast cancer expert panel recommends the use of DIBH as the best heart-sparing technique. Nonetheless, depending on the treatment volume and localization, other techniques may be employed or combined with DIBH when appropriate.

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Titel: Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO)
verfasst von: Marciana-Nona Duma
René Baumann
Wilfried Budach
Jürgen Dunst
Petra Feyer
Rainer Fietkau
Wulf Haase
Wolfgang Harms
Thomas Hehr
David Krug
Marc D. Piroth
Felix Sedlmayer
Rainer Souchon
Rolf Sauer
Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO)
Publikationsdatum: 18.07.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 10/2019
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-019-01495-w

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Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO)