What is your approach to left sided PMRT in patients with on-going cardiac issues (ie. cardiomyopathy, heart failure, coronary heart disease)?

In this circumstance, like for any medical intervention, we need to carefully weigh the risks and benefits of treatment. The likelihood of radiotherapy-induced cardiac injury appears to dependent on two variables:

1) Cardiac dose. This is variably defined - I think mean heart dose may be the best su...

I have these patients evaluated in our cardio-oncology department in order to more accurately assess their cardiac risk and optimize their cardiac status before any treatment. I then have a balanced discussion using this information, weighing their cardiac risk against their risk of breast cancer re...

The benefit in terms of disease free survival on MA.20 is less than the risk of serious cardiac or pulmonary side effects. MA.20 did not show difference in overall survival.

I agree with above. DIBH is good approach. Other modifications to think about: 1) would this person have been a candidate for partial breast to begin with? If so, do you really need to cover all the breast and chest wall and by omitting some it, it may allow you to omit the heart without sacrificing...