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PNUEUMOMEDIASTINUM AFTER CYBERKNIFE STEREOTACTIC RADIOSURGERY

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New therapeauticapprorachesforearaly stage non-small cell lung cancer. ... Lung Cancer 2003; 40:309-315. ... of Stage I Non-Small Cell Lung Cancer (NSCLC) ... – PowerPoint PPT presentation

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Title: PNUEUMOMEDIASTINUM AFTER CYBERKNIFE STEREOTACTIC RADIOSURGERY


1
PNUEUMOMEDIASTINUM AFTER CYBERKNIFE STEREOTACTIC
RADIOSURGERY Christine Turner August 10, 2006
2
  • CASE PRESENTATION
  • CW is a 51 y/o non-smoking male chemist diagnosed
    w/ Stage III colon cancer in 1999.
  • S/p hemicolectomy and adjuvant chemo
  • Liver mets in 2001 s/p partial liver resection
    and radiofrequency ablation
  • 3 lung mets in 2005 s/p multiple
    chemotherapeautic regimens
  • Lung only dz progression and referred for ESR
    (extracranial stereotactic radiosurgery)

3
  • WHAT IS ESR?
  • (EXTRACRANIAL STEREOTACTIC RADIOISURGERY)
  • Targeted high dose radiation w/ minimal
    toxicity to normal tissue
  • Traditionally for brain tumors
  • Expanded to treat intrathoracic and
    intrabdominal tumors
  • Limited by target movement/respiratory
    variation
  • Surgical resection gold standard for T1 and
    T2 lung tumors
  • ESR emerging treatment option for inoperable
    patients

4
  • CYBERKNIFE WITH THE SYNCHRONY MOTION TRACKING
    SYSTEM
  • ESR used here at GUH
  • Real-time image tracking that adjusts for resp.
    variation
  • Fiducials used as markers
  • Highly accurate with minimal damage to
    surrounding tissue

5
CYBERKNIFE SYSTEM
6
  • CASE PRESENTATION
  • Cyberknife to 3 lung lesions sequentially
  • 6 weeks later-treated for radiation pneumonitis
    w/ oral Prednisone.
  • 3 weeks later-admitted to MICU with hypoxia
  • Started on O2, empiric abx and increased
    steroid dose
  • CT showed PE-started on anticoagulation
  • Prognosis appeared poor and discharged to home
    hospice

7
  • PNEUMOMEDIASTINUM
  • 4 months after treatment, developed acute onset
    neck swelling.
  • Pneumomediastinum with subQ air and a ?small
    PTX at LUL treatment site
  • Conservative Treatment (O2, monitoring, pain
    control)
  • Discharged to Hospice
  • Resolved on imaging in 1 month
  • Condition improved, discharged from hospice

8
  • DISCUSSION/CONCLUSIONS
  • Preliminary data from ESR local tumor control
    with minimal toxicities
  • Rare complications, usually minor
  • Risk of a radiation toxicity
  • Further studies to evaluate optimal doses and
    treatment tolerance

9
  • WHY DO YOU CARE? (I.E WHAT CAN YOU LEARN?)
  • What is Cyberknife?
  • Pneumomediastinum (Signs, Sx, Dx, Tx)

10
  • PNEUMOMEDIASTINUM
  • Signs and Symptoms
  • CP
  • SOB
  • Neck swelling
  • SubQ emphysema
  • Dysphagia
  • Hoarse voice
  • Hammans sign (crunching sound w/ heart beat)
  • Dx CXR/CT

11
  • PNEUMOMEDIASTINUM
  • Spontaneous (tall, thin males) vs. secondary
  • R/o trauma, espophageal perforation, infection
    with gas producing bacteria, PTX (especially
    tension), tension pneumomediastinum
  • Risk factors steroid use, malignancy, fibrosis
    (interstitial or radiation fibrosis),
    inhalational drugs, asthma, valsalva maneuver
  • Tx Conservative (O2, monitoring, pain
    control)
  • Follow up imaging

12
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