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

Duma MN, Baumann R, Budach W, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Krug D, Piroth MD, Sedlmayer F, Souchon R, Sauer R (2019)

Publication Type: Journal article, Review article

Publication year: 2019

Journal

Strahlentherapie und Onkologie Urban & Vogel

Book Volume: 195

Pages Range: 861-871

Journal Issue: 10

DOI: 10.1007/s00066-019-01495-w

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.

Authors with CRIS profile

Rainer Fietkau Lehrstuhl für Strahlentherapie

Involved external institutions

St. Claraspital AG CH Switzerland (CH) St. Vincentius-Kliniken / ViDia Kliniken DE Germany (DE) Universitätsklinikum Düsseldorf DE Germany (DE) Vivantes - Netzwerk für Gesundheit GmbH DE Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) DE Germany (DE) Universitätsklinikum Jena DE Germany (DE) Universitätsklinikum Tübingen DE Germany (DE) Marienhospital Stuttgart DE Germany (DE) Paracelsus Medizinische Privatuniversität AT Austria (AT) St. Marien-Krankenhaus DE Germany (DE) Universität Witten/Herdecke DE Germany (DE)

How to cite

APA:

Duma, M.N., Baumann, R., Budach, W., Dunst, J., Feyer, P., Fietkau, R.,... Sauer, R. (2019). Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlentherapie und Onkologie, 195(10), 861-871. https://dx.doi.org/10.1007/s00066-019-01495-w

MLA:

Duma, Marciana Nona, et al. "Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO)." Strahlentherapie und Onkologie 195.10 (2019): 861-871.

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