Left breast radiation

Maria_lucero

radiation left breast scary to damage other organs

BCat40

As about prone positioning. They are very careful to try to avoid surrounding organs and prone position can help a lot.

ruthbru

I had radiation to the left breast with no problems. It is VERY targeted. You shouldn't need to be concerned about damage to other organs.

Spookiesmom

I had left side rads after bmx. RO said they can stop the beam from getting to my heart. No problem 8 years later.

DeniseML

thanks everyone for replies regarding left side radiation. Much appreciated since I am about to begin RADS for left BC. Hard not to worry about vital organs when chest wall targeted. Helps to know of others that have been there without complications

Jewelweed

Could someone give more detail? Radiation is my next step, and since it will be my left breast, I am worried about this. How do they protect the heart and lungs?

I have heard that the prone position only works if you are large chested.

Thanks!

Messenger77

I am personally not going to get radiation on left side after chemo (this is a chest wall recurrence). Did the research and nope. I had a double mastectomy, chemotherapy and Herceptin treatment the last time and it still came back. I’ll do chemo. I cannot stand the thought of radiation, but then again I have had chemo as know what’s to expect.

I can appreciate people really looking into their treatment and asking questions. I know many people have had success while others haven’t. I don’t think there are any real guarantees in life. Keep us pisted

GreenHarbor

My tumor was in the left breast. I had the first 15 rads treatments in the prone position, and I am NOT large chested. The last 5 treatments I was face up; these were boosts to the tumor bed. They work with the dosage, angle of the beam and your position to be both effective and safe. Definitely share your concerns with the radiation treatment team; they should be able to walk you through their recommendations and answer any questions you have. I’m three years out from radiation, and have had no issues. Good luck!

ThreeTree

There is the prone position and breath holding as others here have noted, there is also proton therapy (no breath hold or prone position involved) if you can get it covered and get to a center that offers it. Proton radiation is supposed to be better than "normal" radiation (photon) for left side, as it doesn't hit the heart and lungs quite so much, etc., but my radiation oncologist (for protons) told me that photon has improved a whole lot over the years and that now the gap between proton and photon radiation isn't as wide as it was, and it is due to improvements in photon radiation. I had the proton radiation anyway, but I was able to get it covered and I live very close to a center - not something available to everyone by any means. You might want to research proton therapy also, just to see if it is a good option for you and then you can make a more wise decision about what you ultimately do.

TB90

I had radiation to left side following mx due to a remaining positive margin. I agonized over this decision as it was not even recommended. Nor was it discouraged. It was a grey area and I had only myself to make this decision. I researched so much (with Beesie’s help) that the RO was shocked with my presenting manual of research. His research assistance had the same results. I went ahead. But the real point is that it is the skill of your radiologist that matters the most. As Greenharbor mentioned above, it is the angle. Radiologists have differing levels of skill, as do surgeons, etc. Research your RO and facility. Once my BS heard who my RO was, her reluctance for me to have radiation went to enthusiasm. Now, having said that, my research also showed minimal risk for left sided radiation. Regardless. I would love to see those studies that show something different. But I am already old news with my experience being 8 years old. But my personal, therefore very limited, experience shows absolutely no indicators now that I ever even had radiation. Zero! Of course time will tell as there is a very slight risk even after many years. But I never even think about it until I read someone else’s post. Make a decision after gathering all the info you can and research and ask questions. Individual testimony, including mine, is almost irrelevant as it is such a tiny study. All the best in whatever treatment plan you choose

RatherBeSailing

Jewelweed, agree with everything said above, particularly the importance of a radiation oncologist who treats you as an individual and takes the time to plan your treatment appropriately.

Also, there is less damage if only the chest wall is being treated - adding the supraclavicular and internal mammary nodes increases the dose to the lung and heart. Whether you need those fields included depends largely on your nodal status - you can ask your RO. Even then, in addition to proton therapy, if the heart and lung doses are high they can sometimes use IMRT photon therapy to keep lung and heart doses down.

So, yes, ask questions!

Esther01

Hi Jewelweed,

I am almost finished with 33 radiation treatments to my left breast, including my axillary/lymph nodes and supraclavicular nodes at top of my chest. I only have 2 more days to go. I didn't have a prone position. They have me on my back with my arms up over my head. I am in the final week which is now the "boosts" which are much easier and faster.

After an awkward consultation with very little information given to me, I was not comfortable with the place to which I was initially referred, so I referred myself to a more modern radiology center called Cyberknife which was also on my health plan. They use 3D/IMRT which as others has mentioned is amazing technology which can curve the radiation beam and deliver very precise doses at different levels to each tissue. My RO showed me exactly where and how much the radiation was going to each area, and we could see how the rays were going to miss my heart and lungs. Once he showed me all of those 3D color images of my exact physiology in his treatment plan, and I saw that my organs were going to be protected, I was sold.

So, I would ask your RO if they have 3D/IMRT technology and also ask if they will be using DIBH (deep inspiration breath hold). When you take a deep breath and hold it, your heart moves out of the way and is away from the radiation beam. As a safeguard, if you let your breath out too soon, the radiation beam will turn off so the heart won't be damaged. There was only one tiny spot at the top of my lung where my RO showed me I might have a tiny bit of scar tissue that shows up on an xray but he said I'll never physically notice it.

I didn't have any problems at all with 6 1/2 weeks of radiation, other than very tanned/reddish skin in the treated areas, including my upper left back which I have also had to lotion. No pain, no blistering, no fatigue. Just some nipple sensitivity by treatment #25. I feel very grateful. Especially grateful for the Monthly Radiation Threads here. You may want to join the September/October group. I have been so thankful for the sweet ladies in the August Radiation group who all supported each other as we go through this together. I know you will have lots of support as you go through radiation, too. We'll all be here for you.

Love,

Esther

Augustkm

Had lumpectomy on left side. After four radiation treatments, I could barely talk or breathe. The dr told me to get anxiety meds. He said to return in two days to reset the radiation machine as "my left breast had shrunk too much". Instead I talked to my primary and was admitted to the hospital with pneumonia which the ER coded as "community acquired" rather than "radiation caused". The radiation company was in a lawsuit for using outdated machines (March 2020), anti competitive. Now they they proton.

Rubytoos

Where you are treated and by whom matters a lot. I have a personal bias for research institutes/medical schools. I met with RO's at both photon and proton centers. When I told the proton RO what the photon RO had indicated as the mean dose to my heart, she said she could not do better than that and that the cosmesis is worse with proton therapy (this was for post lumpectomy radiation). But it is well worth investigating if one's insurance will cover it. It is pretty labor intensive--they have to have a team of physicists involved to do the planning for delivering the therapy--and I definitely would not select a center based upon its proximity but rather its experience and safety record and the caliber of the medical staff.

This video was produced by UCSF Mt Zion and addresses left side radiation therapy. I got a lot of good information from it when I was researching this very issue. The title is Close to the Heart: Modern Radiation Therapy for Breast Cancer Treatment

I am editing this to add that if you go to the 10 minute mark they discuss estimates of risk by age, mean heart dose, and presence of cardiac risk factors (i.e. no cardiac risk factors or one plus). For example, if you are 40 and have two Gy of radiation to your heart, but have no other risk factors, your absolute risk of dying from a radiation related heart incident by age 80 are 0.2%. If you have at least one risk factor, the percentage rises to one half of one percent. The chart goes all the way up to age 70.

RatherBeSailing

Be aware that, while proton in theory does less damage to surrounding tissue, there is no large base of evidence to support that theory. There are enormous amounts of money invested in the proton industry, and most private insurers will not cover it without a fight. Many trials are now underway, including Radcomp for breast cancer, which I believe is still enrolling.

Regarding heart damage in general, one widely accepted study (Darby, NEJM) determined that for every one gy increase in mean dose heart exposure there is a 7.4% relative risk increase for cardiac events. So if your underlying risk is 10% for having heart damage in the next ten years, 2 gys would increase your absolute risk to 11.5%.

I only point this put to put the issue in some perspective. My 3D plan resulted in a 2.5 gy mean dose to my heart. Could proton have brought it down to 1.5 gys? Probably. But I'm not certain, in my particular case, it would have been worth it.

IMRT, by the way, usually does increase a low dose "wash" to the entire area. But most organs can easily withstand the lower doses.

I'd advise bringing your concerns to your RO, who knows all this far better than any of us do. Ask him what he expects the heart and lung doses to be.

Rubytoos

The 7.4% figure is from the Darby study which is referenced in the video I mentioned previously. That percentage was over the course of 20 years. They also noted, that for women with a mean heart dose under 2Gy, "no significantly increased event rates were seen."

Here is an excerpt from an article entitled Heart toxicity from breast cancer radiotherapy, Piroth, et al (2018):

"Even small heart doses are suspected to increase the risk of cardiac disease. Darby et al. estimated the proportional increase in the rate of major coronary events per Gray. This assumption was based on a retrospective evaluation using a population-based case–control study. Darby et al. found that the risk of major coronary events (i. e., myocardial infarction, coronary revascularization, deaths from ischemic heart disease) increased linearly with the increase in mean heart dose with no clear threshold [29]. They showed a dose–effect relationship with an increase in the relative risk of acute major coronary events of 7.4% per Gy (95% confidence interval, CI: 2.9–14.5; p < 0.001) mean heart dose within 20 years [29]. The increase started within the first 5 years after RT and continued into the third decade after RT. Although women with preexisting cardiac risk factors had greater absolute increases in the risk from RT, the proportional increase in the rate of major coronary events per Gy was similar in women with and without cardiac risk factors at the time of RT. Of note, for mean heart doses below 2 Gy, no significantly increased event rates were seen."

So as everyone has said, this needs to be discussed with a radiation oncologist and I would also encourage people to do their homework on their provider.