Topics:
Radiation Oncology • Thoracic Malignancies • Stereotactic Body Radiotherapy • General Radiation Oncology • Cardiology
How do you approach treatment planning for lung SBRT in a patient with a lesion within 1 cm of a defibrillator?
The patient is not pacemaker dependent.
Answer from: Radiation Oncologist at Community Practice
V-fib requiring defibrillation poses an immediate life-threatening situation. Even if the patient doesn't regularly need their pacemaker, one would need to know that their defibrillator is functioning.
In this case, I don't think there's any choice except to move the pacemaker/defibrillator to the ...
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Answer from: Radiation Oncologist at Academic Institution
I think the safest answer is, as others have mentioned, to consider moving the pacemaker.
However, to play a bit of devil's advocate-Is the case definitive in nature? Are we talking 50-60 Gy in 3-5 Fx as Rx dose?Or, if it's palliative, could you get away with lowering the dose at the edge closest t...
Comments
Radiation Oncologist at Up Health System Marquette
Dr. @Shinde, as a learning experience for me, on t...
Dr. @Shinde, as a learning experience for me, on t...
Radiation Oncologist at Vanderbilt-Ingram Cancer Center
Sure - small correction to the dosing I mentioned ...
Sure - small correction to the dosing I mentioned ...
Radiation Oncologist at Up Health System Marquette
No, that's great! Surprising, but great! I asked o...
No, that's great! Surprising, but great! I asked o...
Radiation Oncologist at Vanderbilt-Ingram Cancer Center
Happy to help, appreciate the interest and discuss...
Happy to help, appreciate the interest and discuss...
Radiation Oncologist at Northeast Alabama Regional Medical Center
A good teaching point @Ashwin. I bet you and dosi ...
A good teaching point @Ashwin. I bet you and dosi ...
Answer from: Radiation Oncologist at Academic Institution
I agree with Dr. @Baer. Should be moved to the other side of the chest.Based on the vignette that was posted, I'm not certain as to where the lesion is located. But if it's central and the ITV and PTV would be such that the dose might spill into the contralateral lung, I'd have the dosimetrist optim...
Answer from: Radiation Oncologist at Community Practice
Dosimetrically, at only 1 cm separation, there's no way you could complete SBRT without failing to meet the dose constraint for the defibrillator. It needs to be moved to the other side of the chest wall (or rarely the abdomen), as stated above. Don't approve a poorly conformal plan that would still...
Answer from: Radiation Oncologist at Community Practice
What can be said with the different types of technology. With what I am seeing in linac-based SBRT which is coplanar, I think this is a tough case as everyone points out. I used to have a cyberknife opening infinite beams in a sphere and the plans were much better and tighter. I am a retired basical...