We understand that people with cancer are worried about coronavirus. Here is the latest guidance. We will update it regularly.

Breast cancer

Affected by breast cancer? Join this group to share experiences and ask questions to people who understand what you're going through.

VMAT RT and no breath hold?

Dedalus
Posted by

My wife has been allocated for VMAT RT on the left breast.  She asked about breath-hold and was told that this was not necessary with VMAT, as the beam would be guided to avoid the heart. We are a little puzzled because there has been a fair bit of discussion about breath-hold here.

Does this mean that those performing breath-hold had a different type of RT?

Has anyone had a similar experience?

Have you had VMAT RT on the left side but still required to perform breath-hold? 

Obviously the potential for heart problems is a worry!

D

Dreamthief
Posted by

Hi

VMAT can be performed on the newer type of Linear Accelerators. Perhaps those here who have been asked to have rads using the 'Breath Hold' technique were treated on older Linac machines ?

Just thinking aloud - G n' J

HappyFeet1
Posted by

Hi , I did the breath hold and was definitely on an old machine so sounds like ’s explanation could be spot on. Do ask the team though, to put your minds at rest, horrible to have more uncertainty. HFxx

HappyFeet1 xx
Don’t be afraid to cry. It will free your mind of sorrowful thoughts. – Hopi
Dedalus
Posted by

This is an update to the breath-hold technique or rather 'no breath-hold' in my wife's case.  My wife went back to the radiotherapy unit today because of concern over a disappearing tattoo mark.  She asked again about there being no need for a 'breath-hold' with VMAT RT.  Apparently the 'no breath-hold' was not particularly related to the type of RT ie VMAT but rather down to the results from the CT scan.  The position of her heart was assessed in relation to the planned treatment beam(s).  She was told there would be no interaction with her heart and the planned treatment.

Previously they also said that doing the breath-hold could bring the lung into play.  Having read that this technique is now virtually universal, we worry.  

We also still worry over this explanation because a neighbour who had relatively recent BC requiring triple bypass heart surgery due to RT heart damage.

Has anyone else avoided the breath-hold technique due to the CT scan results? 

Jojodot
Posted by

As you know I am no expert but the prep CT must give them a great deal of info about position of area to be treated and position of organs. I did do Breath hold  technique and although most of the time I got it right sometimes my breath was too deep and sometimes  too shallow. They always directed me as apparently the radiographers were able to see from their control panel the position of my heart etc and am sure they said the machine will only work if things are in the correct position as planned.

I know you are in Scotland. I got my treatment at the Beatson in Glasgow and I felt confident in all my sessions there. I did ask the radiographers about various things and they always took time to explain. Where are you and hope you and your OH get on ok with treatment.

Jojodot

Dedalus
Posted by

Hi Jojodot

Thanks for your reply.  

It was not the Beatson, and I have read that the Beatson is considered to be a centre of excellence for cancer treatment.

I must say that the explanation and information were not as good as we would have liked, and at times it was contradictory, which does increase stress levels.  For example, when my wife initially asked about the breath-hold technique, she was told that she could attend an instruction and practice session if she wanted.  She declined in order to minimise hospital attendance.  To us, it was implicit in that offer that the b.h.t would be incorporated into the RT procedure.  However, at the CT prep session, my wife was told it was not, as the beam would be configured to avoid the heart.  Why is this not generally possible?  

Perhaps we are over-stressing but when a neighbour ended up with a triple heart bypass after radiotherapy, it does raise concerns.  When you ask questions you get a response, but not one that totally puts your mind at ease.  Then you worry if you persist that you will be categorised as being overly anxious.

peterawake
Posted by

Hi,

This discussion worries me as my BC was on the left and I had RT with no breath hold, I was advised the CT planning is so accurate and the heart would be avoided, my treatment was in Sheffield and I spoke to other ladies in the waiting room having RT to the left side and again no BHT.  Just recently their was another discussion on here regarding BHT and so I raised my concerns with my Consultant who advised the same as the RT Department had done at the planning RT stage that these days it is so accurate due to the CT planning.  I certainly hope they got it right for me.  

You are quite right Dedalus that you worry that if you persist you will be categorised as being over anxious, at times I have persisted and still not been satisfied with the response, it is very difficult, the worry goes on and on. 

Best Wishes. 

Toothtinks
Posted by

I also had LHS radiotherapy at Sheffield and didn’t do the breath hold.

Pusheen
Posted by

Hi peterawake

I was treated at Sheffield WPH. Left sided BC I had 23 sessions starting in March this year. I was advised breath hold was not required. CT planning helps plan direction of treatment very accurately and I know the expertise at that hospital is second to none and I am glad I was in their hands. 

Xxx

Dedalus
Posted by

Thanks to everyone for your experiences.  It is kind of you.

Unfortunately, we are the types who need to be fully informed and involved in our health care, and despite the 'participative' rhetoric in the hospital literature, they tend to perceive you as being in the overly anxious category, if you probe too much.  It is just another day at the office for them, but not so for us.

There is so much available on breath-holding technique, you query as to why it is no longer considered so necessary.  Has planning taken a sudden leap forward recently?  We have looked at examples of online coloured ct images where the heart is shown to have greater distancing due to the bht.  Then you are told that this technique could bring the lung into the field.

I really want my wife to be confident and comfortable with the RT.  If they would just take a little time to explain pre and post ct scan that they are taking measurements to determine whether bht is actually necessary, and give you the conclusion, but they don't do this.  You tend to find out by asking questions and teasing things out bit by bit.

Your experiences with no bht has helped to reassure my wife.  Did any of you receive VMAT RT?

peterawake
Posted by

Hi Toothtinks, 

It must be the protocol used by Weston Park with LH RT ie no breath hold.  

OscarTheCatgotmehere

Hi,

If you check Guys information on breathe holding they explain as everyone is different internally, they decide after the C.T. Scan those who will benefit and need to do it and those who the heart is not in the radiation plane.

Yvie

Dedalus
Posted by

Thanks for that link Yvie   https://www.guysandstthomas.nhs.uk/resources/patient-information/cancer/radiotherapy/dibh-central-chest.pdf

The one pertinent paragraph explains things concisely and clearly, re 'no breath hold'.

I wish all hospitals would issue explanatory information like this.  It would certainly reduce the worry.

D

Jojodot
Posted by

Thanks Yvie for sending the information re breath hold - very interesting. As Dedalus says it would set our minds at rest if we were all told more details before treatment. .It was only after asking questions during treatment that the same info was given to me but your post is still reassuring.

Jojodot

OscarTheCatgotmehere

Re N.H.S. information this is why a coordinated effort needs to be done re information given,a little leaflet or link just sets peoples minds at rest.Think of all the other issues tackled here and elsewhere,where some areas give info and others leave it to patients to find out themselves.It should follow a NICE pathway.