Dr. Zhu on Mitigating Toxicities of Elective Nodal Irradiation in Breast Cancer

He James Zhu, MD, PhD, radiation oncologist, Tennessee Oncology, discusses potential strategies to mitigate the toxicities of elective nodal irradiation (ENI) in breast cancer.

Historically, radiation oncologists refrained from radiating regional lymph nodes to prevent additional skin and intrathoracic organ toxicity, says Zhu. Notably, ENI was not allowed in National Surgical Adjuvant Breast and Bowel Project clinical trials until the late 1990s.

As radiation therapy technology has evolved, ENI has become more widely used. Strategies such as respiratory gating and deep inspiration breath hold techniques aim to maximize tumor radiation while minimizing normal tissue exposure. Also, patients are able to receive ENI lying prone, so that the breast tissue can be treated further away from the heart, says Zhu. More recently, proton therapy has become a potential novel strategy for anatomically challenging cases, concludes Zhu.