Belbachir Mehdi, Danthez Nicolas, Rotzinger David, Panagiotis Antiochos, Pruvot Etienne, Vallet Veronique, Gondre Maude, Berthod Gregoire, Latifyan Sofia, Demicheli Rita, Schiappacasse Luis
Department of Radiation Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
Front Cardiovasc Med. 2025 Aug 15;12:1588106. doi: 10.3389/fcvm.2025.1588106. eCollection 2025.
Metastatic melanomas with prolonged survival are becoming increasingly common. We present the case of a 47-year-old man with melanoma who developed asymptomatic cardiac metastases, whose prognosis depended on their response to either systemic or focal treatment. Consequently, a CyberKnife radiotherapy treatment was performed using a pacemaker for tracking. Instead of using a pacemaker lead, we report here the successful use of a leadless pacemaker (Micra, Medtronic) as a fiducial reference for the tracking, which proved to be reproducible during all sessions. The planning target treatment volume was 161.58 cm. The radiotherapy treatment was well tolerated, and follow-up cardiac CT scans performed at 1 month and 4 months after the treatment showed an approximately 30% reduction in the lesions size. The size reduction was attributed to the focal radiotherapy treatment, as the other metastatic lesions were progressively worsening during the same period. This case report highlights the feasibility of using a leadless pacemaker as a tracking fiducial for the CyberKnife treatment of high-volume cardiac metastatic lesions.
生存期延长的转移性黑色素瘤越来越常见。我们报告了一例47岁的黑色素瘤男性患者，其出现了无症状性心脏转移，其预后取决于对全身或局部治疗的反应。因此，使用起搏器进行追踪实施了射波刀放射治疗。在此，我们报告成功使用无导线起搏器（美敦力公司的Micra）作为追踪的基准参考，而不是使用起搏器导线，结果证明在所有疗程中均可重复。计划靶区治疗体积为161.58立方厘米。放射治疗耐受性良好，治疗后1个月和4个月进行的心脏CT随访扫描显示病灶大小缩小了约30%。病灶缩小归因于局部放射治疗，因为同期其他转移病灶在逐渐恶化。本病例报告强调了使用无导线起搏器作为射波刀治疗大容量心脏转移病灶追踪基准的可行性。
