Successful radiation treatment of anaplastic thyroid carcinoma metastatic to the right cardiac atrium and ventricle in a pacemaker-dependent patient

Abstract

Anaplastic thyroid carcinoma (ATC) is a rare, aggressive malignancy, which is known to metastasize to the heart. We report a case of a patient with ATC with metastatic involvement of the pacemaker leads within the right atrium and right ventricle. The patient survived external beam radiation treatment to his heart, with a radiographic response to treatment. Cardiac metastases are usually reported on autopsy; to our knowledge, this is the first report of the successful treatment of cardiac metastases encasing the leads of a pacemaker, and of cardiac metastases from ATCs, with a review of the pertinent literature.

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

“…One additional reference used 6‐MV IMRT for thyroid carcinoma metastatic to the right cardiac atrium and ventricle of an ICP‐dependent patient with the leads in the treatment field. For this research, no effects to the devices were noted . In another study that included IMRT, two partial reset events were identified, but concluded to be related to the high photon energy (16 MV) used .…”

Role of palliative radiotherapy in the management of mural cardiac metastases: who, when and how to treat? A case series of 10 patients

“…Dasgupta et al. has reported a successful treatment of a patient with cardiac metastasis involving the pacemaker leads with careful consideration of radiotherapy plan, pace maker interrogation before and after daily RT, and close cardiac monitoring during RT. Patients with CM often have positional dyspnea and may not tolerate the supine position for a long treatment delivery.…”

“…For instance, using intensity-modulated radiation therapy (IMRT) technique and contouring noninvolved cardiac structures as avoidance structures, we can deliver higher and potentially more effective RT doses to the tumor while minimizing the dose to uninvolved parts of the heart and lungs. Dasgupta et al [10] has reported a successful treatment of a patient with cardiac metastasis involving the pacemaker leads with careful consideration of radiotherapy plan, pace maker interrogation before and after daily RT, and close cardiac monitoring during RT. Patients with CM often have positional dyspnea and may not tolerate the supine position for a long treatment delivery.…”

Radiotherapy is effective for a primary lung cancer invading the left atrium

“…Improved dose-delivery techniques can also increase the utility of radiation. In fact, intensity-modulated radiotherapy was recently employed to treat a cardiac metastases from small-cell lung cancer14 and anaplastic thyroid carcinoma 24. In the latter case, the patient was also pacemaker-dependent and the use of intensity modulated radiation therapy (IMRT) allowed the pacemaker to receive a maximum dose 0.37 Gy while the tumour received a maximum dose of 43.1 Gy.…”