植入永久心脏起搏器肿瘤患者的放射治疗:附4例报告

Radiotherapy of Tumor Patients Implanted with Permanent Cardiac Pacem aker:4 Cases Report

背景与目的:植入永久心脏起搏器的患者数量呈上升趋势,这其中有一部分是需要放射治疗的肿瘤患者。本文回顾性地总结了植入永久心脏起搏器的肿瘤患者接受放射治疗的经验,同时评价疗效。方法:植入永久心脏起搏器的肿瘤患者4例,其中男性2例,女性2例;年龄70～81岁。3例为Ⅲ度房室传导阻滞,被植入心室起搏器(VVI),1例为冠心病,病窦综合征,被植入双腔起搏器(DDDR)。4例患者全部经病理证实,分别为食道癌、非霍奇金淋巴瘤、非小细胞肺癌和鼻咽癌。用60Co或6～8MVX直线加速器局部放疗40～70Gy,放疗期间心电监护起搏器的情况。结果:4例患者均完成了放疗,部分缓解(PR)3例,病情稳定(SD)1例;继续接受全身化疗3例,1例复发后行二程放疗。随访10个月以上,动态心电图复查示起搏器感知良好。结论:根据照射野包括起搏器及内容物与否,来选择射线和制定照射剂量,4例肿瘤患者均能耐受放射治疗,且起搏器功能正常。

BACKGROUND &OBJECTIVE: The amount of patients implanted with perma nent cardiac pacemaker is increasing, among whom some tumor patients require rad iotherapy. This retrospective study summarized experience of the radiotherapy of tumor patients implanted with the permanent cardiac pacemaker and evaluated the results of the radiotherapy. METHODS: Four patients (2 male, 2 female; age rang e 70-81 years) implanted with permanent cardiac pacemaker were studied. Among t hem, 3 had third-degree atria ventricular block (AVB) and were implanted with V VI pacemakers, and 1 sick sinus syndrome (SSS), and was implanted with DDDR pack maker. Pathological study proved 1 esophageal carcinoma, 1 non-Hodgkins lymph oma, 1 non-small cell lung carcinoma, and 1 nasopharyngeal carcinoma. 60Co or 6-8 MV linear accelerator 40-70 Gy were used to irradiate, while the dynamic el ectrocardiogram was monitored through the radiation period. RESULTS: All 4 patie nts completed the radiotherapy. 3 cases gained PR and 1 case gained SD; 3 patien ts received continuous chemotherapy, 1 patient received a second radiotherapy. T he monitor of dynamic electrocardiogram enunciation for 10 months revealed good function of the cardiac pacemakers. CONCLUSION: With proper choice of irradiatio n energy and dose, according to irradiation field including the pacemaker and co ntents or not, 4 tumor patients implanted with permanent cardiac pacemaker could tolerate radiotherapy well, and the cardiac pacemaker could function normally.