Waiting to Exhale in Breast Cancer

Radiation oncologist Nicole L Simone, MD

Dr. Nicole Simone

Holding your breath during radiation treatment may be the best way to protect your heart.

Women who have been treated for breast cancer are living longer, making it more important than ever to make sure the treatments they receive don’t cause long-term problems. Radiation therapy is still one of the most effective ways to treat cancer. However it comes with the risk of exposing healthy tissue and organs – such as the heart – to radiation, which can be detrimental.

Currently, physicians use several methods to reduce exposure to the heart during radiation treatment for breast cancer – especially in left breast cancer, which rests over the heart – but it’s not clear which offers the best protection.

Now, researchers at Jefferson have shown that technology to monitor a patient holding their breath during administration of a pulse of radiation works best.

Simon Kramer fellow Rob Gitman

Simon Kramer fellow Rob Gitman

In a study presented in March at the 24th Annual Interdisciplinary Breast Center Conference in Las Vegas, the researchers, led by radiation oncologist Nicole Simone, MD, Associate Professor in Radiation Oncology at Thomas Jefferson University and Rob Gitman, a student at the College of Osteopathic Medicine and a Simon Kramer fellow with Dr. Simone, designed a study to test four available methods for protecting the heart during radiation treatment for breast cancer.

One method involves standard radiation planning without adding protection to the heart.

The second method involves creating a 4-dimensional map of the patient’s chest and heart to account for the motion of breathing and creating a sophisticated algorithm for the radiation beam to avoid the heart.

For a  third method, the patient lies on her belly in the prone position to shield the heart from radiation. Although this method offers good protection of the lung and heart, it doesn’t always allow the radiation oncologists to deliver enough radiation to effectively treat the entire breast.

In the fourth method, the patient holds her breath while the radiation beams are pulsed on and shut off when the patient exhales.

“In some ways, it’s not surprising that a breath hold would offer the best protection, since it’s the best way to account for a patient’s organ motion while still getting the right dose of radiation.” says Dr. Simone “Even when patients are lying still, the act of breathing in and out is enough to change how much of the chest, and heart, come into the radiation beam.”

Not all patients will be able to hold their breaths for very long, while others are not comfortable when asked to hold their breath, so the method may not be ideal for everyone. But Dr. Simone says that taking care to plan the radiation treatment for a patient, especially for young patients, is crucial to protecting patient’s health in the long-term.

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