Radiation therapy (RT) has demonstrated strong clinical benefit in patients with breast conservative surgery or with radical mastectomy and who are at high risk for relapse.

Unfortunately, this benefit was counterbalanced by an increased risk for death from cardiac events. Similarly, several systemic agents are associated with a cardiac toxicity or might also increase the toxicity of RT, including endocrine therapy, chemotherapy (CT) agents, or molecular targeted therapies.

This paper is a report on the current available techniques to irradiate the IMN, including promising new technology that may help limiting the risk of cardiac toxicity.

Fig. 1. Irradiation by electrons to the chest wall after mastectomy and the IMN, left side. It is shown how nicely we can spare the heart using this kind of irradiation

For years now the preferred method to decrease the doses to the heart was the use of electrons: superficial beams which slide along the irradiated volumes (Fig. 1) . Consequently, treatment planning is adapted to each patient’s morphology and practical guidelines have been implemented to improve delineation of target volumes.

Currently, new techniques as the “intensity modulated radiotherapy (IMRT)”, Tomotherapy can sculpture the isodoses and contribute to spare the heart from high dose irradiation, particularly in left-sided breast cancer patients with unfavourable cardiac anatomy. The respiratory control is also proposed in this population of patients.

Altogether, these technological improvements led to significant decrease in heart dose, suggesting but not demonstrating that cardiac toxicity could be decreased. Next step would be to explore the use of new type of beams as protons to try to deliver the dose directly to the region of IMN. The particularity of these beams is that we can stop them at the depth we want.

The future with the highly performing irradiation techniques seems better and less toxic techniques can change the long term results of the breast cancer treatment with high cancer control rates, less toxic effects and obviously better quality of life.

Publication

Irradiation of internal mammary nodes: State of the art.
Kirova YM, de Almeida CE, Fournier-Bidoz N
Cancer Radiother. 2015 Jun

Read offline:     

Related Articles:

	Does tangential radiation for breast cancer cover… Breast cancer is one of the most common cancers in women in the United States. Radiation is a very commonly used treatment modality for breast cancer: it is offered to…
	Rabbits with mammary carcinomas as a model for… Within a breeding colony of rabbits, the American pathologist Harry Greene (1904-1969) observed that mammary carcinomas were restricted to certain families. This is suggestive of a familiar predisposition as it…
	Does UV-B radiation modify gene expression? Frequently the harsh environmental conditions, such as, high temperatures, low freezing conditions, high levels of PAR and UV-B sun radiation induce remarkable adaptive reactions in plants. These responses suggest that…
	Defects in mismatch repair increase cancer risk and… Microsatellites are formed by 1-6 nucleotide base pairs that are repeated in direct order 5-50 times. Repetitive DNA including microsatellites are mainly present in non-coding DNA regions that occupy more…
	Clinically utilized nalfurafine combined with… Alcohol addiction poses massive public health costs [~15 million adult alcoholics with economic cost > $200 billion/year in the US]. Pharmacological studies in rodents have demonstrated that kappa-opioid receptor (KOR)…
	Effectiveness of infrared tympanic thermometry… Exposure to high solar radiation in the heat poses a thermoregulatory challenge and increased risks of exertional heat-related illness in workers and exercising individuals. Core temperature monitoring is important during…