A woman with primary mediastinal diffuse large B-cell lymphoma has been through standard treatment with R-CHOP chemotherapy. After 6 days (12 Gy) of raditherapy to the upper mediastinum (roughly 25% of the heart included) she was admitted with typical signs and symptoms of acute pericarditis. Both the dose and the size of the field suggests that the risk of pericarditis should be very low. Is there anybody who has experienced this? If so what was the natural course and what treatment did you use? Was the radiotheraphy continued at some point or not?
It is not so rare complication, especially with daily doses ≥2Gy, or overall exceeding 35Gy. Look at the paper below.
http://ac.els-cdn.com/S0735109713014058/1-s2.0-S0735109713014058-main.pdf?_tid=7f342a46-fa01-11e3-b045-00000aab0f26&acdnat=1403437188_0a18289442057b4b9d14c7fdad5dda0c
Thank you. this was a nice paper. However, I am familiar with the reference litterature on this subject and the main references dates back to the 70thies when the irradiated fields were larger and the tecnique was quite diffferent (still the heart has'nt moved and mediastinal tumors are still located in the mediastinum). I was curious whether anyone had seen this complication during the last decade and during radiotherpy after only 12 Gy (in 2 Gy/fraction) for a tumor in the upper mediastinum. No one in our institution remembers a case like this.
Probably the reaction is caused by patients’ hypersensitivity to radiation. There are some tests to predict that. Seems reasonable to check this hypothesis.
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