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

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.