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

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.

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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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