2007 Volume 40 Issue 9 Pages 1570-1575
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 45Gy, including the primary tumor and regional lymphnodes. A booster dose of 25Gy was given to the primary tumor for a total dose of 70Gy, using bilateral oblique fields. Three years and 6 months later, he was treated with an additional 30Gy 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.