Take heart.

How much cardiac risk do standard whole breast tangents bring, really? We like to think it’s less than reported in “classic” studies on treatments from the 60s, but the problem is that really long follow-up is required to give us answers. Now we at least have long term data from a trial that started in the 90s. Across nearly 1200 women with pT1-2N0 breast cancers randomized to +/- adjuvant whole breast conventionally-fractioned radiation, the cumulative rates of cardiac mortality at 20 years was 13% with radiation versus 12.4% without. For the 157 patient with accessible CT-based 3D treatments for review (ok, so these treatments weren’t that modern), mean heart dose for left-sided treatments was 3 Gy. For comparison, that number for matched cases from 2017 was 1.5 Gy. TBL: Modern-day whole breast tangents employing deep inspiratory breath hold likely confer no appreciable cardiac risk. | Killander, Int J Radiat Oncol Biol Phys 2020