How should you approach treating curable laryngeal cancer with chemo-RT in a patient who had a myocardial infarction during treatment and requires CABG, given the cardiotoxicity of cisplatin and 5FU/carboplatin?
Wow - tough situation. I would largely be hesitant to give chemo to someone who requires a CABG, which also implies that stents were not placed, etc. I would also want to know if it was a STEMI or not, angiogram results, EF, etc. I think the stage of the cancer, other comorbidities, goals of the pat...
I am not completely sure if the patient had their MI during chemotherapy and radiation (and what they were receiving as chemotherapy at the time), but assuming it was during treatment, I would continue radiation without a break in therapy to avoid cell repopulation. Regarding chemotherapy, cisplatin...
If not cleared for weekly cisplatin 30 mg/M2, continue with RT alone.
We often see patients with advanced cancer and medical conditions for whom there is no standard treatment. The above treatment discussion is helpful for me who cannot present patients at a tumor board or access discussion with an oncologist from a different specialty.