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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

Radiological follow-up staging after radiotherapy: a) significant reduction of tumor size and FDG-uptake in three months after radiotherapy; b) progressive disease in six months with the intrabronchial tumor propagation and increased metabolic activity.
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Fig5: Radiological follow-up staging after radiotherapy: a) significant reduction of tumor size and FDG-uptake in three months after radiotherapy; b) progressive disease in six months with the intrabronchial tumor propagation and increased metabolic activity.

Mentions: The maximal dose (Dmax) and median dose (Dmean) of the active ICD partially situated in the radiation field composed of 15.58Gy and 5.55Gy respectively. Dmax and Dmean of the CPS device and pacemaker located outside of the PTV composed of 5.38Gy/2.31Gy and 2.74Gy/1.13Gy respectively (Figure 4). Despite high radiation exposure we observed neither permanent nor temporary loss of function or inappropriate shock delivery by ICD. The implanted devices showed a non-affected function during radiation treatment and over the course of twelve months afterwards. The radiation treatment had generally no negative impact on the patient's cardiac rhythm and blood circulation parameters. The treatment response correlated with reduction of tumor size and tumor metabolic activity as demonstrated three months after radiotherapy by PET-CT (Figure 5a). Therefore, the reduction of the maximal “standardized uptake value” (SUV) in PET scans from pretreatment level of 14,8 to 6,1 was observed three months after radiation therapy. Six months post radiation treatment a progressive disease with new intrabronchial growth and enhanced metabolic activity of primary tumor by maximal SUV 12,9 was verified (Figure 5b).Figure 4


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)

Radiological follow-up staging after radiotherapy: a) significant reduction of tumor size and FDG-uptake in three months after radiotherapy; b) progressive disease in six months with the intrabronchial tumor propagation and increased metabolic activity.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig5: Radiological follow-up staging after radiotherapy: a) significant reduction of tumor size and FDG-uptake in three months after radiotherapy; b) progressive disease in six months with the intrabronchial tumor propagation and increased metabolic activity.
Mentions: The maximal dose (Dmax) and median dose (Dmean) of the active ICD partially situated in the radiation field composed of 15.58Gy and 5.55Gy respectively. Dmax and Dmean of the CPS device and pacemaker located outside of the PTV composed of 5.38Gy/2.31Gy and 2.74Gy/1.13Gy respectively (Figure 4). Despite high radiation exposure we observed neither permanent nor temporary loss of function or inappropriate shock delivery by ICD. The implanted devices showed a non-affected function during radiation treatment and over the course of twelve months afterwards. The radiation treatment had generally no negative impact on the patient's cardiac rhythm and blood circulation parameters. The treatment response correlated with reduction of tumor size and tumor metabolic activity as demonstrated three months after radiotherapy by PET-CT (Figure 5a). Therefore, the reduction of the maximal “standardized uptake value” (SUV) in PET scans from pretreatment level of 14,8 to 6,1 was observed three months after radiation therapy. Six months post radiation treatment a progressive disease with new intrabronchial growth and enhanced metabolic activity of primary tumor by maximal SUV 12,9 was verified (Figure 5b).Figure 4

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