Is there additional concern for late cardiac toxicity when using ultrahypofractionated breast radiation protocols, given that the BED to the heart is higher?

Does this concern necessitate strict breath-hold protocols?

Answer from: Radiation Oncologist at Community Practice

The BED to the heart isn't actually higher in this setting.Dr. @Beriwal explained this below, but I'll just explain it another way. Imagine that you place the block edge so that it is touching the heart (i.e., the heart is completely covered by the MLCs, and there is no margin between the MLC and th...

Comments

Radiation Oncologist at Cape Oncology
Thank you for the detailed explanation. This is re...

Radiation Oncologist at Northside Hospital
Irrespective of the technique and/or fractionation...

Radiation Oncologist at Comprehensive Cancer Centers of Nevada
When I do ultra-hypofractionation, I will often tr...

Answer from: Radiation Oncologist at Community Practice

Irrespective of fractionation, this would avoid any beam going through and only the dose to the heart is from scatter or transmission, which for early-stage breast cancer is around 1 Gy. At that range and dose per fraction to the heart, the fractionation effect would be minimal.

Comments

Radiation Oncologist at Main Line Health
Agree with Sushil Beriwal, MD, MBA.

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Is there additional concern for late cardiac toxicity when using ultrahypofractionated breast radiation protocols, given that the BED to the heart is higher?

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