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• W2012747050 abstract "In this correspondence, we report our experience using mediastinal irradiation in the treatment of a patient with esophageal carcinoma 8 years after heart transplantation. The number of heart transplantations performed appears to increase every year. The survival of these patients is reportedly improved with the use of cyclosporins for immunosuppression.1 Some of these patients are long-term survivors and the risk of treating them in oncology departments increases in time. As many as 30% of patients who undergo organ transplantation develop precancerous lesions and malignant tumors.2 If the cancer requires a radiation target-volume involving parts of a transplanted heart, a number of questions arise for the radiation oncologist.3 The tolerance of the heart for radiation has been studied previously,4, 5 but to our knowledge no sufficient data have been collected to date.3 A male patient age 52 years who had a history of chronic tobacco use and alcohol intoxication presented to the study institution. The patient had undergone a heart transplantation in 1993 for end-stage ischemic cardiomyopathy with left ventricle severe dysfunction. After the transplantation, the patient was treated with cyclosporin, azathioprin, and corticoids. In January 2002, the patient presented with dysphagia, weight loss, and impaired performance status (PS)2. Fibroscopy demonstrated stenosis and a large tumor (measuring 40 mm × 30 mm × 25 mm) situated within 30 cm of the dental arch. Biopsy was performed and demonstrated squamous cell carcinoma. There were no peritumoral lymph nodes detected on the computed tomography (CT) scan, but some mediastinal lymph nodes were found. There were no distant metastases. After discussion between physicians in multiple disciplines, Santy-Lewis surgery was performed. Finally, the tumor was classified as pT3pN2R1 (according to the TNM Staging System). There were 20 positive lymph nodes found. After a second multidisciplinary discussion, postoperative radiotherapy was proposed. Conformal radiotherapy was performed using an 18-megavolt (Mv) accelerator. A total dose of 45 grays (Gy) in 25 fractions was delivered to the reference point. Because of the higher risk to the transplanted heart, the cardiac structures were delineated in all CT slides. The heart received a median dose of 8.6 Gy (range, 0.34–43.6 Gy). Approximately 85% of the cardiac volume received < 25 Gy. A strict program of cardiac examinations (comprised of electrocardiogram, cardiac ultrasound, ejection fraction, standard blood tests, and cardiac enzymes) before, during, and after radiotherapy was established. The radiotherapy was well tolerated with Radiation Treatment Oncology Group (RTOG) Grade 2 dysphagia reported without any cardiac symptoms. A full cardiac examination was performed at 1 month, 3 months, and 6 months after irradiation and demonstrated no changes compared with pretreatment examinations (the left ventricular ejection fraction was 63%, and all cardiac enzymes were normal). Complete remission of the esophageal carcinoma was obtained. One month after last follow-up (7 months after radiotherapy), the patient died (by suicide). Mediastinal irradiation after heart transplantation is feasible and should be considered after evaluation of the risk. Conformal radiotherapy or intensity-modulated radiotherapy appears to be the most appropriate treatment." @default.
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• W2012747050 date "2003-12-04" @default.
• W2012747050 modified "2023-09-27" @default.
• W2012747050 title "Mediastinal irradiation in patients with esophageal carcinoma after heart transplantation" @default.
• W2012747050 cites W2032886991 @default.
• W2012747050 cites W2130797073 @default.
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• W2012747050 doi "https://doi.org/10.1002/cncr.11896" @default.
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