Development of a comprehensive platform for treatment optimization in breast radiotherapy: respiratory gating, heart sparing, early detection of cardiac damage.

In the present work, I explored innovative radiotherapy (RT) techniques for treatment optimization in breast cancer patients to spare the heart from radiation exposure and obtain a better and safer treatment strategy. I have implemented a moderate deep inspiration breast hold (DIBH) radiation technique and prospectively collected data on this treatment to assess the efficacy and advantage of this procedure in left breast cancer treatment. This study applied a model-based approach to data by calculating the normal tissue complication probability (NTCP) to determine the probability of damage induced on normal tissues for given radiation doses to OAR in terms of cardiac mortality probability. The second and third parts of the thesis analyzed an alternative heart-sparing technique and a new cardiac damage detection approach. Thus, I described two ongoing trials in which I am our site PI and co-investigator, the first is about cardiac sparing technique for even more selected patients, and the second is about early detection of cardiotoxicity. In the last part, I introduced a future perspective, with my project-approved proposal on a neoadjuvant RT, a new potential cardiac sparing approach, and an unmet need in our clinical practice.