Video-assisted Thoracoscopic Pericardial Window Placement for Radiation Pericarditis Induced by Definitive Chemoradiotherapy in a Patient with Thoracic Esophageal Carcinoma

Katsuji Hisakura, Hideo Terashima, Kentaro Nagai, Reiji Nozaki, Yoshimasa Akashi, Sosuke Tadano and Nobuhiro Ohkohchi

Department of Gastroenterological Surgery, University of Tsukuba

We report surgical management of radiation-induced massive pericardial effusion. A 55-year-old man undergoing definitive chemoradiotherapy (CRT) for esophageal squamous cell carcinoma in the middle thorax was treated with megavoltage equipment using anterior-posterior opposed fields up to 45 Gy, including the primary tumor and regional lymphnodes. A booster dose of 25 Gy was given to the primary tumor for a total dose of 70 Gy, using bilateral oblique fields. Three years and 6 months later, he was treated with an additional 30 Gy for mediastinal lymphnode metastasis, followed by percutaneous pericardiocentesis for cardiac tamponade with massive pericardial effusion 4 times in 5 months. Because medical intervention was inadequate, he underwent pericardial effusion via video-assisted thoracoscopic pericardial window placement 4 years and 6 months after definitive CRT. Histopathological examination of the pericardial tissue specimen showed marked fibrosis but no cancer recurrence, compatible with radiation pericarditis. The postoperative course was uneventful, and pericardial effusion completely disappeared.

Key words
video-assisted thoracoscopic pericardial window, esophageal carcinoma, radiation pericarditis

Reprint requests
Katsuji Hisakura Graduate School of Comprehensive Human Sciences, University of Tsukuba
1-1-1 Tennodai, Tsukuba, 305-8577 JAPAN

Accepted
February 28, 2007

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