For those holding their breath for the next advance in breast cancer treatment, it’s here.
Deep inspiration breath-hold protocol has been initiated at UPMC Hillman Cancer Center at John P. Murtha Regional Cancer Center in Johnstown.
But like most cancer treatment advances, the new technique is more like a baby step.
Breath-hold was developed to reduce radiation exposure to the heart when treating cancer in the left breast. But Murtha Center radiation oncologist Dr. David F. Stefanik said it is a small improvement.
“When you irradiate the left breast, there is a minimal radiation dose to the heart,” Stefanik said at the 337 Somerset St. cancer center. “We have always had very little radiation dose to the heart.”
Using angled fields and precise targeting, the radiation area can be limited so the vital organs are almost exclusively behind the field, he said.
The breath-hold technique was developed and honed through several research projects, including one at UPMC Whitfield Cancer Centre in Waterford, Ireland. The results of that study were published early last year in the European Journal of Medical Physics.
It followed an Australian review of deep-breath techniques published in 2015 in Journal of Medical Radiation Sciences, for the Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology.
When the cancer patient holds his or her breath for 20 to 30 seconds while radiation beam is on, the breast and cancer tumor are lifted away from the chest wall, Stefanik explained.
“This gives an extra measure of safety,” he said. “When they take a deep breath, the heart shifts a little.”
The Australian study’s scientists explained the issue in the introduction to the research paper, “Review of Deep Inspiration Breath-hold Techniques for the Treatment of Breast Cancer.”
“Radiation treatment to the left breast is associated with increased cardiac morbidity and mortality,” the researchers wrote. “The deep inspiration breath-hold technique can decrease the radiation dose delivered to the heart, and this may facilitate the treatment of the internal mammary chain nodes.”
In their conclusion, the researchers noted that breast cancer survival has greatly improved in recent years, allowing studies to focus on related issues that were not priorities in the days of higher cancer mortality.
“Radiation treatment techniques and technologies that minimize the dose to the heart are essential,” the study concluded. “The (breath-hold) technique has consistently shown to lower the dose received to the heart.”
Murtha Center radiation oncologist Dr. Subarna Hamid Eisaman applauds the advance.
“It’s a wonderful technique that furthers the goal of trying to protect normal tissue that is adjacent to the disease that’s being treated,” Eisaman said.
Cancer patient Cindy Perrone, of Northern Cambria, said she appreciated the additional measure of safety when she was having radiation therapy in September.
“Mine is going rather well,” she said.
“I hold my breath five times so my heart and my lungs are further from my tumor.”
Patients are given iPads to monitor a live display of their breathing levels during the treatment so they know they have inhaled enough.
The mobile devices don’t fit well into the simulator used to pre-target the cancer, so patients use virtual reality-type goggles to view their breathing levels in the targeting room.
Perrone said she had trouble using the goggles in the PET scanner’s tight quarters. But the Murtha Center therapists were able to get her prepared for treatment.
“You don’t need them in the actual room,” she said.