Cardiopulmonary toxicity in radiotherapy of breast cancer – organs at risk and methods of limitation

Adjuvant radiotherapy is associated with improved overall survival and reduced risk of local recurrence in patients with breast cancer. But with the increase in survival, the late toxicity also appears as a result of the radiation doses in the organs at risk – the heart and the lungs. The purpose of the article is to present a review of the literature on radiation associated with the induced toxicity in women with breast cancer as well as to introduce current methods for its limitation and prevention. Deep-inspiration breath-hold irradiation technique, particularly the breath-hold technique using the active breathing coordinator (ABC), is a method which moves the heart away from the chest wall. It is a non-invasive approach that utilizes the natural physiology of the breathing cycle and enables a high dose of radiation to be delivered to the intended target (mammary gland/chest wall) while reducing the dose delivered to the heart and lungs. The dose reduction is 40–71% and the technique is reproducible and extremely precise. This determines the quality of life years after the treatment and is enshrined in the recommendations of the European Society of Cardiology.