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A case of radiotherapy for an advanced bronchial carcinoma patient with implanted cardiac rhythm machines as well as heart assist device.

Scobioala S, Ernst I, Moustakis C, Haverkamp U, Martens S, Eich HT - Radiat Oncol (2015)

Bottom Line: Despite partial localization of the active ICD in the radiation field, the tumor was treated without inappropriate shock delivery during radiation treatment and over twelve months afterwards.The reduced tumor size as well as tumor metabolic activity were observed by PET-CT three months after radiation treatment.The reduced dyspnea and cough over the first four months after treatment were observed.In conclusion, tumor shrinkage and temporary clinical improvement of the patient as well as no technical complications of implanted cardiac devices were achieved by the radiation treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy and Radiooncology, University Hospital of Muenster, Muenster, 48149, Germany. Sergiu.Scobioala@ukmuenster.de.

ABSTRACT
We present a case of radiotherapy for a 66-year-old patient with squamous cell carcinoma on the left main bronchus undergoing implantation of pacemaker, implantable cardioverter defibrillator (ICD) as well as cardiopulmonary support (CPS) device. The radiation area was determined according to 4D List Mode positron emission tomography-computed tomography (PET-CT) data. Planning Target Volume (PTV) included a part of the active ICD. For the optimal tumor coverage and sparing of both the implantable cardiac devices and organs at risk, we combined the conformal radiotherapy with stereotactic body radiotherapy (SBRT) using helical tomotherapy. The prescription dose of 25.2Gy was applied by conventional radiotherapy. SBRT was performed hypofractionated with a prescription dose of 35Gy in 5 fractions. A dynamic electrocardiogram was performed during every radiation fraction. The implanted aggregates were checked three times a week. Despite partial localization of the active ICD in the radiation field, the tumor was treated without inappropriate shock delivery during radiation treatment and over twelve months afterwards. The reduced tumor size as well as tumor metabolic activity were observed by PET-CT three months after radiation treatment. The patient exhibited no signs of pneumonitis on the last radiological follow-up examination six months after radiotherapy. The reduced dyspnea and cough over the first four months after treatment were observed.In conclusion, tumor shrinkage and temporary clinical improvement of the patient as well as no technical complications of implanted cardiac devices were achieved by the radiation treatment.

No MeSH data available.


Related in: MedlinePlus

Planning-PET-CT imaging by use of “fludeoxyglucose F 18” tracer. Hypermetabolic activity of bronchial carcinoma on the left main bronchus with restriction of those.
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Fig1: Planning-PET-CT imaging by use of “fludeoxyglucose F 18” tracer. Hypermetabolic activity of bronchial carcinoma on the left main bronchus with restriction of those.

Mentions: A 66-year-old patient with squamous cell carcinoma, Grade II, on the left main bronchus, cT3 (5 cm) cN0 cM0 (Figure 1). A complete occlusion of the left upper lobe and partial involvement of the left lower lobe were detected by video-bronchoscopy. The general health condition was complicated with a mild dyspnea at rest and productive cough. The patient had initially undergone implantation of the CMOS-based cardiac pacemaker due to clinical relevant bradycardia developing on the basis of ischemic cardiomyopathy. The implanted cardiac pacemaker belongs to the “Accent” family pacemakers produced from St.-Jude Medical GmbH® (professional.sjm.com/products/crm). Six months later an implantation of the cardiac defibrillator was performed due to the first attack of the ventricular tachyarrhythmia. The ICD was activated shortly before radiation therapy due to a new attack of the tachyarrhythmia. The implanted ICD model – Atlas II VR SN – is the dual-chamber devices with automatic vector switching algorithm and algorithms for protection against inappropriate shock delivery (http://matesa.com.sv/manuales/atlasIIVR.pdf). A heart assist device, namely left ventricular assist devices (LVAD), was implanted two years later due to development of left heart failure NYHA III. The CPS device belongs to the long-term intracorporeal assisted system from company “Novacor” [16,17].Figure 1


A case of radiotherapy for an advanced bronchial carcinoma patient with implanted cardiac rhythm machines as well as heart assist device.

Scobioala S, Ernst I, Moustakis C, Haverkamp U, Martens S, Eich HT - Radiat Oncol (2015)

Planning-PET-CT imaging by use of “fludeoxyglucose F 18” tracer. Hypermetabolic activity of bronchial carcinoma on the left main bronchus with restriction of those.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389884&req=5

Fig1: Planning-PET-CT imaging by use of “fludeoxyglucose F 18” tracer. Hypermetabolic activity of bronchial carcinoma on the left main bronchus with restriction of those.
Mentions: A 66-year-old patient with squamous cell carcinoma, Grade II, on the left main bronchus, cT3 (5 cm) cN0 cM0 (Figure 1). A complete occlusion of the left upper lobe and partial involvement of the left lower lobe were detected by video-bronchoscopy. The general health condition was complicated with a mild dyspnea at rest and productive cough. The patient had initially undergone implantation of the CMOS-based cardiac pacemaker due to clinical relevant bradycardia developing on the basis of ischemic cardiomyopathy. The implanted cardiac pacemaker belongs to the “Accent” family pacemakers produced from St.-Jude Medical GmbH® (professional.sjm.com/products/crm). Six months later an implantation of the cardiac defibrillator was performed due to the first attack of the ventricular tachyarrhythmia. The ICD was activated shortly before radiation therapy due to a new attack of the tachyarrhythmia. The implanted ICD model – Atlas II VR SN – is the dual-chamber devices with automatic vector switching algorithm and algorithms for protection against inappropriate shock delivery (http://matesa.com.sv/manuales/atlasIIVR.pdf). A heart assist device, namely left ventricular assist devices (LVAD), was implanted two years later due to development of left heart failure NYHA III. The CPS device belongs to the long-term intracorporeal assisted system from company “Novacor” [16,17].Figure 1

Bottom Line: Despite partial localization of the active ICD in the radiation field, the tumor was treated without inappropriate shock delivery during radiation treatment and over twelve months afterwards.The reduced tumor size as well as tumor metabolic activity were observed by PET-CT three months after radiation treatment.The reduced dyspnea and cough over the first four months after treatment were observed.In conclusion, tumor shrinkage and temporary clinical improvement of the patient as well as no technical complications of implanted cardiac devices were achieved by the radiation treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy and Radiooncology, University Hospital of Muenster, Muenster, 48149, Germany. Sergiu.Scobioala@ukmuenster.de.

ABSTRACT
We present a case of radiotherapy for a 66-year-old patient with squamous cell carcinoma on the left main bronchus undergoing implantation of pacemaker, implantable cardioverter defibrillator (ICD) as well as cardiopulmonary support (CPS) device. The radiation area was determined according to 4D List Mode positron emission tomography-computed tomography (PET-CT) data. Planning Target Volume (PTV) included a part of the active ICD. For the optimal tumor coverage and sparing of both the implantable cardiac devices and organs at risk, we combined the conformal radiotherapy with stereotactic body radiotherapy (SBRT) using helical tomotherapy. The prescription dose of 25.2Gy was applied by conventional radiotherapy. SBRT was performed hypofractionated with a prescription dose of 35Gy in 5 fractions. A dynamic electrocardiogram was performed during every radiation fraction. The implanted aggregates were checked three times a week. Despite partial localization of the active ICD in the radiation field, the tumor was treated without inappropriate shock delivery during radiation treatment and over twelve months afterwards. The reduced tumor size as well as tumor metabolic activity were observed by PET-CT three months after radiation treatment. The patient exhibited no signs of pneumonitis on the last radiological follow-up examination six months after radiotherapy. The reduced dyspnea and cough over the first four months after treatment were observed.In conclusion, tumor shrinkage and temporary clinical improvement of the patient as well as no technical complications of implanted cardiac devices were achieved by the radiation treatment.

No MeSH data available.


Related in: MedlinePlus