Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO) Herzschonende Strahlentherapietechniken bei Brustkrebspatientinnen: Eine Stellungnahme des Brustkrebs-Expertenpanels der Deutschen Gesellschaft für Radioonkologie (DEGRO)

Journal article
(Review article)


Publication Details

Author(s): 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
Journal: Strahlentherapie und Onkologie
Publication year: 2019
ISSN: 0179-7158
eISSN: 1439-099X


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.


FAU Authors / FAU Editors

Fietkau, Rainer Prof. Dr.
Lehrstuhl für Strahlentherapie


External institutions with authors

Marienhospital Stuttgart
Paracelsus Medizinische Privatuniversität
Private Universität Witten/Herdecke gGmbH
St. Claraspital AG
St. Marien-Krankenhaus
St. Vincentius-Kliniken gAG
Universitätsklinikum Düsseldorf
Universitätsklinikum Jena
Universitätsklinikum Schleswig-Holstein (UKSH)
Universitätsklinikum Tübingen
Vivantes - Netzwerk für Gesundheit GmbH


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) Herzschonende Strahlentherapietechniken bei Brustkrebspatientinnen: Eine Stellungnahme des Brustkrebs-Expertenpanels der Deutschen Gesellschaft für Radioonkologie (DEGRO). Strahlentherapie und Onkologie. 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) Herzschonende Strahlentherapietechniken bei Brustkrebspatientinnen: Eine Stellungnahme des Brustkrebs-Expertenpanels der Deutschen Gesellschaft für Radioonkologie (DEGRO)." Strahlentherapie und Onkologie (2019).

BibTeX: 

Last updated on 2019-01-08 at 08:53