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Home News and Update Year 2012 Doctors Use Radiotherapy To Treat Residual Cancerous Cells

Doctors Use Radiotherapy To Treat Residual Cancerous Cells

Times of India
04 February 2012
By Umesh Isalkar
Pune India
Today Is World Cancer Day

A 39–year–old woman, who suffered from a rare malignant heart tumour, has been successfully treated with radiotherapy for residual cancerous cells (RCC). The RCC are traces of cancer cells that remain even after the tumour is surgically removed, and is a major cause of relapse. The success of this treatment is significant since heart is a soft–tissue organ and sensitive to radio waves.

According to the doctors concerned, it is for the first time that radiotherapy has been used as supplemental treatment to treat the residual cancerous cells in a patient with cardiac sarcoma. The malignant heart tumour is a rare entity and is a difficult condition to tackle. Despite relatively dismal chances of recovery, however, judicious use of multimodality treatment can help improve the outcome and quality of life, say doctors.

“Since the chances of local recurrence were very high, it was decided to treat the patient with radiotherapy. With the high–precision radiotherapy delivery techniques, it is possible now to treat partial heart with adequate dose of radiotherapy without damaging the heart’s healthier portion. This significantly reduces the chance of recurrence,” radiation oncologist Bhooshan Zade of the Ruby Hall’s Cancer Centre said.

“Heart is a radio sensitive structure. But the very fact that the tumour has recurred within a span of six months and there is a residual disease after surgery, the risk from the disease would have been very high if we had left the residual cells untreated.”

The woman, who hails from Orissa, had complications related to breathlessness and palpitations. “On evaluation with 2D–ECHO, she was found to have right ventricular tumour. She underwent surgery for the removal of the tumour in September last year. The histopathology of that tumour came out to be myxoma (benign tumour of heart) post first surgery,” said medical oncologist Minish Jain of the Ruby Hall’s Cancer Centre.

For the next six months, the patient did well. Soon after, she underwent similar complications, and this time, there was severe drop in her platelet count.

“She was evaluated again at the Asian Heart Institute, Mumbai, where she was found to have right ventricular recurrent tumour going into the right atrium damaging the tricuspid valve. She was again taken up for surgery, and removal of mass with repair of tricuspid valve. The histopathology report came out to be cardiac sarcoma, a type of cancer,” said Jain.

One month after the surgery, the patient was advised PET–CT, a type of imaging modality for evaluation. The PET scan showed a small residual disease at right side of interventricual septum — the stout wall separating the lower chambers (the ventricles) of the heart from one another.

Jain referred her to Zade for opinion regarding radiotherapy. Both the doctors discussed the case in tumour board and various national and international fora.

“Due to paucity of literature, there are no guidelines available. Eventually, after discussion with patient and family, we took the challenge of treating it with radiotherapy,” Zade said.

Heart is a structure that beats continuously. Hence, it becomes very difficult to target one particular portion of heart taking into account its movement during heartbeat and respiration. Hence, 2 DECHO was used to find the range of motion of that part of heart. The PET–CT technique was used to identify the diseased portion of heart for radiotherapy planning.

Radiotherapy planning was done at Ruby Hall’s Cancer Centre using multiple photon beams under stereotactic guidance. Radiotherapy delivery was done under Cone Beam CT image guidance (IGRT). Total dose of radiotherapy was delivered over six weeks.

“The patient responded to the treatment well. After six weeks of treatment, a PET–CT scan was repeated which showed complete resolution (disappearance) of the residual disease. Muga Scan was done for assessing her heart functions. It found them completely normal,” said Jain.

“It is six months now. Post–treatment, the patient is absolutely fine. Radiation therapy has become very safe and effective with latest state of the art modalities,” Zade said. The doctors have planned to submit the case report to an international radiation oncology journal for peer–review and publication.

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