NCCC offers new heart sparing treatment for left breast cancer

Norris Cotton Cancer Center (NCCC) offers a new heart sparing treatment for left breast cancer to women concerned about radiation and increased heart disease risk. NCCC was the first tertiary academic medical center in New Hampshire to offer the technique, Deep Inspiration Breath Hold (DIBH), to patients.

Studies have shown that radiation treatment for breast cancer can increase a woman's risk of heart disease later in life, but for most women the benefit from the treatment outweighs this risk. The increased risk is small, but any additional risk can complicate a woman's decision about radiation therapy, or whether to have treatment following a successful lumpectomy.

"The important thing with left breast cancer is to do radiation carefully and avoid excessive radiation near the heart," says Lesley A. Jarvis, MD, PhD, a member of NCCC's Comprehensive Breast Cancer Program. "A deep breath pulls the diaphragm and heart down and out of the radiation beam path. Delivering radiation treatment during these deep breath holds protects the heart from exposure."

DIBH is a simple breathing technique, but making sure a patient consistently breathes deeply enough to move the heart away from the treatment area can be difficult. NCCC recently installed a real-time monitoring system that allows technicians to monitor the patient as she holds a deep breath for 20 seconds so the radiation is precisely targeted. During a DBIH treatment session three ceiling-mounted cameras on a 3-D monitoring system (Vision RT's AlignRT system) beam a red-patterned light grid onto the patient during treatment. Technicians use screens to monitor the patient's position during each breath hold and make sure the heart is positioned away from the chest wall.

Some treatment centers offering DBIH use a mouthpiece and tubes to forcibly control breathing during the radiation session. Without the Vision RT system to monitor positioning, multiple X-rays must be taken before treatment to make sure the heart is pulled away from the radiation area, adding more radiation exposure to breast cancer treatment.