Table 1 Cardiac-Sparing Modalities and Techniques in Radiation Therapy

Cardiac Displacement

Respiratory Gating

Tracking patient’s natural respiratory motion and delivering radiation precisely when the tumor is in the treatment field and farthest from the heart

Breast, Lymphoma, Lung, Esophagus

Deep Inspiration Breath Hold (DIBH)

Radiation is administered during maximal inspiration and breath hold, when the heart is pulled away from the chest wall due to flattening of the diaphragm and expansion of the lungs

Breast, Lymphoma

Prone Positioning/ Lateral Decubitus Positioning

Radiation is delivered to the tumor with patient lying prone or lateral decubitus on a specially designed table to maximally displace the heart from the treatment field

Breast

Radiation Treatment Modality/Technique

Involved Site Radiation Therapy (ISRT) and Involved Node Radiation Therapy (INRT)

Reduction in radiotherapy field size to involved-nodal tissue detected using modern imaging techniques (PET-CT/MRI), thus sparing surrounding uninvolved nodal and non-nodal anatomic structures

Lymphoma

Three-Dimensional Conformal Radiation Therapy (3D-CRT)

3D reconstruction of the tumor and surrounding structures using CT and/or MRI imaging data to guide radiation planning by beam placement. Radiation can be delivered from any angle; multiple radiation beams from different angles can be combined to deliver maximal dose to the tumor while relatively sparing normal tissue

Breast, Lymphoma, Lung, Esophagus

Intensity-Modulated Radiation Therapy (IMRT)

An advanced form of 3D-CRT that utilizes varying intensity of smaller radiation beams (beamlets) using computerized inverse planning, enabling precise delivery of radiation dose to the tumor and improving normal tissue sparing

Breast, Lymphoma, Lung, Esophagus

Volumetric-Modulated Arc Therapy (VMAT)

An extended form of IMRT, in which the radiation source is continuously rotated around the patient, allowing delivery of therapy from a full 360° beam angle, with added advantage of improved delivery of radiation dose to the target in lesser time

Breast, Lymphoma, Lung, Esophagus

Image-Guided Radiation Therapy (IGRT)

Integration of imaging prior to and during each radiation treatment, typically CT-guided and recently MRI-guided, allowing more precise localization of the tumor bed. IGRT permits significantly better sparing of normal tissue while promoting dose-escalation to the tumor when incorporated with IMRT

Breast, Lymphoma, Lung, Esophagus

Accelerated Partial Breast Irradiation

An approach that treats only the lumpectomy bed plus a 1–2 cm margin, rather than the whole breast, therefore sparing normal tissue by decreasing the target volume of radiation

Breast

Proton Beam Therapy

Proton beams have a distinct property compared to photon beams: they quickly lose energy toward the end of their range (Bragg peak), thus limiting radiation dose beyond the target

Breast, Lymphoma, Lung, Esophagus