Ramdas Yastira, Benn Carol-Ann, Grubnik Alexandra, Mayat Yasmin, Holmes Dennis R
The Breast Care Unit, NetCare Milpark, Johannesburg, South Africa.
Department of Surgery, Glendale Adventist Medical Center, Glendale, California, USA.
Case Rep Oncol. 2020 Jul 30;13(2):916-922. doi: 10.1159/000508946. eCollection 2020 May-Aug.
Case reports detailing the effects of targeted intraoperative radiation therapy (IORT) on patients with cardiac pacemakers (PMs) are rare. This growing population sub-group requiring IORT and lack of standardized guidelines necessitate more practical published research. An 81-year-old patient with clinical stage II, T1 N0 grade III, triple-negative invasive ductal carcinoma and an implanted single-lead chamber PM (VVIR mode, model: Biotronik, type Effecta SR) received targeted intraoperative radiotherapy at the time of wide local excision and sentinel lymph node biopsy. It presents the shortest distance between the outer diameter of the PM and IORT applicator in literature. Target IORT was performed utilizing an Intrabeam device (50 kV, Carl Zeiss Surgical, Oberkochen, Germany). This case elucidates the successful use of targeted IORT for breast-conserving surgery in a patient with a single ipsilateral chamber VVIR mode PM. No device failure or malfunction was reported for the PM before, during, or after the procedure. These findings support the use of targeted IORT for patients diagnosed with early-stage breast carcinomas who have a PM implanted. However, further research is needed to understand the safety of other methods and devices for IORT patients with cardiac implantable electronic devices.
详细描述术中靶向放疗（IORT）对心脏起搏器（PM）患者影响的病例报告很少见。这个需要IORT的患者群体不断壮大，且缺乏标准化指南，因此需要更多实用的已发表研究。一名81岁的患者，临床分期为II期，T1 N0 III级，三阴性浸润性导管癌，植入了单腔单极起搏器（VVIR模式，型号：百多力，Effecta SR型），在进行局部广泛切除和前哨淋巴结活检时接受了术中靶向放疗。本文报道了文献中起搏器外径与IORT施源器之间的最短距离。使用Intrabeam装置（50 kV，德国奥伯科亨卡尔蔡司外科公司）进行靶向IORT。该病例阐明了在一名患有同侧单腔VVIR模式起搏器的患者中，靶向IORT在保乳手术中的成功应用。在手术前、手术期间或手术后，均未报告起搏器出现设备故障或失灵。这些发现支持对植入起搏器且诊断为早期乳腺癌的患者使用靶向IORT。然而，需要进一步研究以了解用于有心脏植入式电子设备的IORT患者的其他方法和设备的安全性。
