Abstract
A left ventricular assist device (LVAD) is a treatment option for patients with end-stage heart failure; however, a certain number of patients on durable LVADs are diagnosed with malignancy. Radiation therapy (RT) for patients with durable LVADs has safety concerns, because RT may interfere with the device. Herein, we report a case of RT during durable LVAD management. A 48-year-old man with a durable LVAD was diagnosed with sinusitis. As his symptoms were resistant to drug therapy, endoscopic sinus surgery was performed, and extranodal NK/T-cell lymphoma, nasal type (ENKL) was pathologically detected. Since RT was the first-line treatment for ENKL, we conducted two types of irradiation experiments to determine whether RT can be safely performed in patients with durable LVADs as follows: (1) assessing the extent of the radiation levels at each site and evaluating device malfunction by irradiating the lesion sites in the patient model with the same protocol as planned, and (2) evaluating device malfunction by directly irradiating the durable LVAD equipment once at the scheduled total dose. The radiation doses at the pump, driveline, system controller, power cable, and power module of the durable LVAD reached 7.86 cGy, 6.34 cGy, 0.66 cGy, 0.38 cGy, and 0.14 cGy, respectively. In both experiments, durable LVAD malfunction or any type of alarm was not observed. We concluded that RT could be safely performed with chemotherapy in this patient and our irradiation experiments can be applied to RT for other malignancies.
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Acknowledgements
The authors are very grateful to Kuniyasu Okudaira, Yumiko Noguchi, Takayoshi Nakaya, Kazuma Sugita and Shizuka Hasegawa for their great contribution to the irradiation experiments.
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Toru Kondo received lecture fees from Otsuka, Abioemd, Abbott Medical, Otsuka, Ono Yakuhin, and Novartis. Takahiro Okumura received lecture fees from Ono Yakuhin, Medtronics, and Otsuka, and received research grants from Ono Yakuhin, Bayer, Daiichi-Sankyo, and Amgen Astellas (not in connection with the submitted work). Akihiko Usui received research grants from TERUMO, Edwards Lifesciences, JAPAN LIFELINE, Mitsubishi Tanabe, Medtronic Japan, Senko medical instrument, St. Jude Medical, Pfizer, Daiichi-Sankyo, iCorNet, Trestech, and NIPRO. Hideo Oishi, Mariko Kawamura, Kazuyuki Shimada, Masato Mutsuga, Takashi Kurokawa, Tasuku Kuwayama, Hiroaki Hiraiwa, Ryota Morimoto, Tetsuya Nishida, Hitoshi Kiyoi, Shinji Naganawa and Toyoaki Murohara have no conflict of interest.
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Oishi, H., Kondo, T., Kawamura, M. et al. Methods for confirming the safety of radiation therapy in patients with left ventricular assist device: a case of extranodal NK/T-cell lymphoma, nasal type. J Artif Organs 25, 274–278 (2022). https://doi.org/10.1007/s10047-022-01312-9
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DOI: https://doi.org/10.1007/s10047-022-01312-9