Curative management of a cardiac metastasis from lung cancer revealed by an electrical storm

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Oligometastatic lung adenocarcinoma with cardiac metastasis in the interventricular septum presenting with syncope and non-sustained ventricular tachycardia (n=1). Intervention: Robotic cardiac stereotactic body radiotherapy (SBRT) using CyberKnife. Primary outcome: Local tumor control and arrhythmia recurrence at 9 months.

Q: What does this research mean for the field?

Curative-intent cardiac stereotactic body radiotherapy can achieve complete local tumor response without ventricular tachycardia recurrence or atrioventricular block in patients with solitary cardiac metastasis. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Raphaël Jumeau; Maria Gabriella Vincenti; Étienne Pruvot; Juerg Schwitter; Véronique Vallet; Michele Zeverino; Raphaël Moeckli; Hasna Bouchaab; Jean Bourhis; Mahmut Özşahin

doi:10.1016/j.ctro.2019.10.005

November 3, 2019Clinical and Translational Radiation OncologyOpen Access

Curative management of a cardiac metastasis from lung cancer revealed by an electrical storm

View Full Paper

Ask AI

Bookmark

Share

Key result

Cardiac stereotactic body radiotherapy (20 Gy in 1 fraction) achieved complete local response with no ventricular tachycardia relapse or atrioventricular block at 9 months in a patient with cardiac metastasis.

Figures

Why the study?

Cardiac metastases were historically treated surgically as a palliative approach due to a lack of ablative solutions, and reports of high-precision stereotactic body radiotherapy for cardiac metastases are limited.

Key Points

To report the curative-intent delivery of stereotactic body radiotherapy for an oligometastatic lung cancer lesion in the heart causing ventricular tachycardia.
Evaluated a 66-year-old female who presented with syncope and repetitive non-sustained ventricular tachycardia, diagnosed via cardiac MRI, PET/CT, and mediastinal biopsy with lung adenocarcinoma metastatic to the interventricular septum.
Delivered a single 20 Gy fraction of cardiac stereotactic body radiotherapy (SBRT) to a planning target volume of 21 cc at the 88% isodose line, following prophylactic dual-chamber pacemaker implantation.
Administered definitive thoracic chemoradiotherapy (66 Gy in 33 fractions) one week following SBRT completion.
Treatment was well tolerated aside from an episode of febrile neutropenia after cycle two of chemotherapy; PET/CT and cardiac MRI at 3 and 6 months showed complete local response and stable left ventricular ejection fraction.
At 9 months after SBRT and 18 months after diagnosis, the patient displayed no local relapse, no ventricular tachycardia recurrence, and no atrioventricular block without ongoing oncological therapy.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 female patient, aged 66 years, with oligometastatic lung adenocarcinoma metastatic to the interventricular septum presenting with syncope and ventricular tachycardia, followed for 9 months post-SBRT (18 months post-diagnosis).

I

Intervention

Curative-intent robotic cardiac stereotactic body radiotherapy (SBRT) using CyberKnife at a single fraction of 20 Gy (prescribed at the 88% isodose line, mean PTV dose 21.2 Gy to a 21 cc target volume in a 55-minute catheter-free procedure using a preventive dual-chamber pacemaker lead for tracking), delivered after 3 cycles of carboplatin and pemetrexed chemotherapy and followed one week later by definitive thoracic chemoradiotherapy (66 Gy in 33 fractions).

O

Outcome

Local tumor response on 18-FDG PET/CT and cardiac MRI, and freedom from local relapse, ventricular tachycardia relapse, and atrioventricular block at 3, 6, and 9 months post-SBRT (18 months post-diagnosis).hard clinical

Limitations

Single-patient case report
Endomyocardial biopsy was inconclusive

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

This case report demonstrates for the first time the feasibility and 9-month efficacy of curative-intent single-fraction (20 Gy) robotic cardiac stereotactic body radiotherapy for a symptomatic interventricular septal metastasis from lung adenocarcinoma.

Abstract

Although cardiac metastases (CM) are more common than primary cardiac malignant tumors, they remain a rare localization of metastatic cancer. Until recently, CM were surgically treated as a palliative approach because of a lack of ablative solutions even for oligometastatic patients. Technological advances in radiation therapy (RT) in thoracic oncology have led to high precision delivery that enlarged the indications for stereotactic body radiotherapy (SBRT). To date, there are limited reports of cardiac SBRT for CM. Herein, we report a cardiac SBRT performed in curative intent for a lung cancer patient metastatic to the heart.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Jumeau et al. (2019) conducted a case report in Oligometastatic lung adenocarcinoma with cardiac metastasis in the interventricular septum presenting with syncope and non-sustained ventricular tachycardia (n=1). Robotic cardiac stereotactic body radiotherapy (SBRT) using CyberKnife was evaluated on Local tumor control and arrhythmia recurrence at 9 months. Cardiac stereotactic body radiotherapy (20 Gy in 1 fraction) achieved complete local response with no ventricular tachycardia relapse or atrioventricular block at 9 months in a patient with cardiac metastasis.

synapsesocial.com/papers/6a93382fe865bb6a6b78d6a1 https://doi.org/10.1016/j.ctro.2019.10.005

View Full Paper

Ask AI

Bookmark

Share

Curative management of a cardiac metastasis from lung cancer revealed by an electrical storm

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Curative management of a cardiac metastasis from lung cancer revealed by an electrical storm

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading