[Lani]

which showed equal incidence of cardiotoxicity whether right or left breast irradiation was utilized. The cardiac injury from breast radiation tends to happen many years later and seems to be associated with poor blood supply to the heart muscle which causes signs and symptoms but does not seem to affect overall survival--but as you know, "knowledge" changes with time! The cardiotoxicity effect of herceptin happens much earlier and seems to be associated with damage to the mitochodria (subcellular organelles) of the heart muscles resulting in enlargement of the heart which makes it a much less efficient pump. Thus, different aspectsof the heart's functioning seems to be effected by radiation and by herceptin and in different time frames.
THAT SAID,
It seems reasonable that it should always be best to go to the most advanced available radiation therapists/radiation therapy facility with respect to equipment/technique/knowledge. Accelerated courses of radiation therapy may make this easier, as travelling far for treatment for six-seven weeks may not seem practical, but travelling for 5 days in a row may be.

Trials of APBI (accelerated partial breast irradiation) are seeming to show at LEAST as good results and SO FAR no additional toxicity. Time will tell...

The latest advances in radiation therapy often have to do with software and technique rather than machinery eg. IMRT(intensity modulated radiation therapy), but one interesting technique is intraoperative radiation therapy, where they place shields to protect tissues.

Unfortunately there is no drug company money or other "big pockets" to adequately fund trials of different types (especially shorter courses) of radiation therapy. Institutions may actually get paid less per patient because the patients have fewer treatments--there is no good mechanism in place to charge patients more for the better and more exact treatments.

Hope this helps!