Ishikawa Kazuki, Fukuda Kohei, Hanai Ryo, Kurosaki Mitsuru
Department of Radiation Therapy, Nara Prefecture General Medical Center, Nara, Japan.
Department of Radiology Division, Nara Prefecture General Medical Center, Nara, Japan.
Medicine (Baltimore). 2025 Mar 7;104(10):e41808. doi: 10.1097/MD.0000000000041808.
Stereotactic body radiotherapy (SBRT) is a precise treatment modality for lung cancer, delivering high-dose radiation to tumors while sparing surrounding organs. However, because of their intracardiac placement and proximity to the chest radiation field, leadless pacemakers (LLPMs) pose unique challenges that are not fully addressed by the existing protocols for conventional pacemakers.
In this case study, we aimed to emphasize the importance of identifying LLPMs before initiating SBRT for lung cancer and to discuss the necessary adjustments in treatment planning needed to accommodate these devices.
An 81-year-old female with stage IA adenocarcinoma in the left lower lobe of the lung underwent SBRT.
During initial planning, the presence of an LLPM implanted in the right ventricle of the heart was overlooked. According to the original rotational arc therapy plan, 5 Gy of radiation would have been delivered to the pacemaker; therefore, a revised treatment plan using a fixed-beam multiport approach was adopted to avoid exposing the device to radiation.
Pacemaker functionality was unaffected post-treatment, and the therapy was concluded without complications.
This case emphasizes the critical need for identifying LLPMs prior to treatment and the importance of tailored radiotherapy plans to prevent device malfunction. The increasing use of these devices necessitates adherence to guidelines which recommend cumulative radiation doses of <5 Gy. Consequently, a thorough patient history and meticulous imaging review are required since identifying LLPMs on computed tomography can be challenging. Furthermore, effective SBRT in patients with lung cancer and LLPMs requires careful planning to ensure safety and therapeutic success. This case provides valuable insights for radiation oncologists, advocating for diligent pretreatment evaluation and customized radiation strategies in the context of evolving cardiac implant technologies.
立体定向体部放疗（SBRT）是一种用于肺癌的精确治疗方式，可在保护周围器官的同时向肿瘤输送高剂量辐射。然而，由于无导线起搏器（LLPM）置于心腔内且靠近胸部放疗区域，会带来一些独特的挑战，现有针对传统起搏器的方案无法完全解决这些问题。
在本病例研究中，我们旨在强调在启动肺癌SBRT之前识别LLPM的重要性，并讨论为适应这些设备而在治疗计划中进行的必要调整。
一名81岁女性，左肺下叶IA期腺癌，接受了SBRT。
在初始计划阶段，植入心脏右心室的LLPM被忽视。根据原有的旋转弧形治疗计划，起搏器将接受5 Gy的辐射；因此，采用了固定束多端口方法的修订治疗计划，以避免设备受到辐射。
治疗后起搏器功能未受影响，治疗结束时无并发症。
本病例强调了治疗前识别LLPM的迫切需求以及定制放疗计划以防止设备故障的重要性。这些设备的使用日益增多，必须遵守推荐累积辐射剂量<5 Gy的指南。因此，由于在计算机断层扫描上识别LLPM具有挑战性，需要详细的患者病史和细致的影像检查。此外，肺癌合并LLPM患者的有效SBRT需要精心规划，以确保安全和治疗成功。本病例为放射肿瘤学家提供了宝贵的见解，倡导在不断发展的心脏植入技术背景下进行勤勉的预处理评估和定制放疗策略。
