UMMC Leads in Breast Cancer Radiation

University of Maryland Rounds features clinical and research updates from the University of Maryland School of Medicine and the University of Maryland Medical Center.

Intended for physicians, Rounds contains contact information to learn more about the clinical and research advances featured in each issue. It is printed three times a year and distributed monthly via email.

Designed to Protect the Heart

Reinforced by prominent research showing no amount of radiation exposure is safe for the heart, University of Maryland Medical Center (UMMC) has proactively amassed an array of technologies unique to the region benefiting breast cancer patients whose treatment includes radiation therapy.  

Since radiation treatment for breast cancer necessarily aims radiation to the area surrounding the heart, UMMC radiation oncologists have both developed and championed a bevy of radiation therapies designed to protect the heart from unnecessary radiation exposure. About 330 new breast cancer patients come to the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center for treatment each year, a significant percentage of whom undergo radiation as part or all of their care.

“Thanks to mammography and early screening, the vast majority of these women present with early-stage breast cancer, and the standards of treatment include mastectomy, breast conservation therapy where the early-stage lump is removed, and breast radiation,” explains William F. Regine, M.D., the Isadore and Fannie Schneider Foxman chairman and professor of radiation oncology. “The potential challenge is because the breast is on the chest wall. Directly beneath the chest wall, especially on the left, is the heart.”

Four Innovative Radiation Options

A large study, published in the New England Journal of Medicine in March 2013, provided strong evidence that radiation exposure to the heart is directly linked to cardiac events such as heart attack. This effect remained whether a patient was otherwise considered low- or high-risk for ischemic heart disease, and was even more pronounced for those with preexisting cardiac risk factors such as diabetes, smoking, high blood pressure or family history.

“Even lower doses of radiation to the heart are associated with an increased risk of cardiac events down the line,” Dr. Regine says. “That’s why the research and technology we bring are focused on ways of sparing the heart from additional doses of radiation.”

UMMC is the only center to offer the four leading radiation technologies designed to protect the heart. They include:

  • AlignRT with Deep Inspiration Breath Hold: The ideal time to deliver radiation to the left breast is when a patient takes a deep breath, which moves the heart posteriorly and inferiorly away from the chest wall. AlignRT helps radiation therapists know when patients are in this optimal position; it also allows the therapist to stop the radiation beam when the patient breathes. This technology brings down the amount of radiation reaching the heart to virtually nil and has been part of UMMC’s radiation treatment arsenal for about five years.
  •  Proton therapy: Compared to traditional photon radiation, proton therapy beams are more precise because they can be programmed to stop at the treatment site without penetrating deeper. Using this option in certain breast cancer patients — depending on tumor location and shape, as well as lymph node involvement — can reduce radiation exposure to the heart. The Maryland Proton Treatment Center, one of only about 20 such facilities in the country, opened in February 2016.
  • Thermal therapy: By heating tumors growing on the chest wall up to 110 degrees, this technology enhances the efficacy of radiation therapy. UMMC is the only center in the region offering thermal therapy.
  • GammaPod: The first device of its kind, this form of stereotactic radiation therapy was developed by UMMC faculty members. The machine is fully dedicated to treating early-stage breast cancer, and delivers a high dose of 36 focused radiation beams while patients are treated in a prone position, allowing the tumor to fall away from the chest wall. UMMC is currently conducting a preapproval trial on GammaPod for the Food and Drug Administration.

Optimizing Outcomes for Each Patient

With so many treatment modalities at their disposal, how do UMMC radiation oncologists decide which is optimal for each breast cancer patient? Dr. Regine says physicians both develop and follow tumor site-specific practice guidelines, using the parameters of each case to individualize treatment decisions.

“We look at the tumor in relation to the heart and lymph nodes to do the treatment planning and measure the dose of radiation,” explains Dr. Regine, also executive director of the Maryland Proton Treatment Center.

Virtually every breast cancer patient at UMMC undergoing radiation therapy benefits from AlignRT, he notes, while thermal therapy is typically reserved for patients whose malignancy has spread to the chest wall after previous radiation.

“The strength of University of Maryland is that we literally have every tool in our breast cancer-fighting toolbox, so we can offer what is truly the best option for each patient,” Dr. Regine adds. “This is personalized radiation medicine. A cancer patient’s biggest hope — beating their cancer — starts with knowing they have every possible treatment option available to them.”

Contact the team in Radiation Oncology at 410-328-6080.