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Modern radiation therapy for cancer of the left breast - Precise, effective and well tolerated

Experience has shown that all patients who have undergone breast conservation surgery benefit from radiation therapy.

The purpose of irradiation is to avoid unnecessary amputation of the entire breast and still have the same assurance that the cancer in the breast will not return. Thus, the quality of life of the affected patients could be significantly improved with the same therapeutic success.

This is because the radiation kills microscopic tumor foci, which are usually hidden in the vicinity of the visible tumor (but can also be in other places in the breast).

However, one of the big challenges is the cancer of the left breast, because here the heart is close to the radiation area and one wants to avoid damage to the heart by the radiation in any case.

 

What has happened so far…

A method often used in recent years is irradiation in the phase of deep breathing with stopped air. This raises the chest and the very important distance to the heart is increased and thus the sparing is better.

However, experience has shown that this method is perceived by many patients as exhausting and the implementation is not always successful.

 

The new method…

A new method, which is very convenient for the patients, is the VMAT – modulation of the irradiation fields via a special planning software. With this very computationally intensive preparation method, the distribution of the radiation dose is very precisely adapted to the shape of the breast. As a result, the load on the heart can be optimally reduced.

In addition, in the course of this preparation, the change in shape of the breast during breathing is also taken into account. This enables stable treatment with normal breathing and makes the correct implementation of the planned therapy safe and comfortable.

Thus, a treatment session itself lasts only 5 – 10 minutes during which one lies relaxed on the treatment table and breathes normally. The treatment is painless and well tolerated.

A treatment series is carried out over a continuous sequence of 15-20 sessions. ( 1 session per day, 5 sessions per week on Mon-Fri, total 3-4 weeks in a row). The division into several sessions is necessary to make the treatment well tolerated.

Common side effect is a temporary feeling of mild fatigue and a warming and swelling of the breast at the end of the entire treatment series similar to a sunburn. All these side effects usually subside after a few days.

 

An example from practice

But what does this modern method mean concretely for the protection of the heart?

The valid recommendation for the protection of the heart [1] is that the heart should receive an average dose of less than 26 Gy in order to avoid damage (heart mean < 26 Gy).

From experience, one speaks of a good plan when the dose to the heart is less than 9 Gy (heart mean < 9 Gy) and of a very good plan when the dose is less than 3 Gy (heart mean < 3 Gy).

Now how does it look concretely with the load of the heart with the help of the new method?

 

A picture says more than 1000 words….

The graph shown here shows the dose distribution in a patient with breast cancer on the left who was treated with the modern method.

The red part shows the treatment dose in the breast, the more the color changes towards blue, the lower the dose (red 100%, blue 10%). The graph shows that the dose nestles in the shape of the breast and only a few centimeters further hardly any radiation arrives.

Source Amethyst Radiotherapy Vienna

And what about radiation exposure to the heart? Can a dose below 9 Gy or even below 3 Gy be achieved?

The answer is yes. In the case of this patient, the dose is only 1.34 Gy (heart mean = 1.34 Gy).

Source Amethyst Radiotherapy Wien

Literature

  • Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC), “Use of normal tissue complication probability models in the clinic.” (Marks LB, Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S10-9.)

Author Dr. David Kuczer, Facharzt für Radioonkologie und Strahlentherapie

 

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