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I have been reading the ASTRO guideline on breast cancer and they make the point that heart dose should be minimized by blocking it out of the tangent fields when treating the breast.
Interestingly a similar question was asked on the mednet and the posted reply also states the same.
It seems that people think we should do EVERYTHING possible to limit heart dose to 1-2 Gy.
I am not comfortable with that. I have several patients whose anatomy prohibits adequate coverage of the breast, if I was to totally block out the heart. We've tried prone and supine and even with DIBH it's not trivial to keep the heart completely out of the tangents, when you actually try to treat the entire breast.
The ASTRO guidelines makes the point that recurrence rates are still low when you block out the heart if the tumor wasn't situated in the blocked out part of the heart, but I am not aware of any good evidence to support this argument.
Our workaround is to use VMAT. You don't have the tangents going through the heart, yet there is still a considerable mean dose delivered by larger parts of the heart receiving (lower) doses. Our mean heart doses are usually around 2-4 Gy
How do you proceed here? Do you always block out the heart?
Interestingly a similar question was asked on the mednet and the posted reply also states the same.
It seems that people think we should do EVERYTHING possible to limit heart dose to 1-2 Gy.
I am not comfortable with that. I have several patients whose anatomy prohibits adequate coverage of the breast, if I was to totally block out the heart. We've tried prone and supine and even with DIBH it's not trivial to keep the heart completely out of the tangents, when you actually try to treat the entire breast.
The ASTRO guidelines makes the point that recurrence rates are still low when you block out the heart if the tumor wasn't situated in the blocked out part of the heart, but I am not aware of any good evidence to support this argument.
Our workaround is to use VMAT. You don't have the tangents going through the heart, yet there is still a considerable mean dose delivered by larger parts of the heart receiving (lower) doses. Our mean heart doses are usually around 2-4 Gy
How do you proceed here? Do you always block out the heart?