Radiotherapy-induced malfunctions of cardiac implantable electronic devices in cancer patients (original) (raw)
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CIEDs (cardiac implantable electronic devices) error due to neutrons from X-ray therapy equipment
2021
Interdisciplinary collaboration is necessary for the advancement of medicine. A lack of collaboration can lead to misconceptions and a lack of theoretical understanding, which can affect the care afforded to patients. With the right collaborations between scientists in fields outside of medicine, misconceptions can be corrected and understanding improved. Assistant Professor Hiroaki Matsubara, Tokyo Women's Medical University, Japan, is a nuclear physicist who is applying his skills and expertise to advance the field of medicine. Nuclear physics is used in several key techniques and tools in medicine such as X-rays and radiotherapy. Matsubara is interested in the issues that can arise in patients with implanted cardiac devices that require radiotherapy. The radiation from radiotherapy can affect the proper functioning of cardiac implantable electronic devices (CIEDs), leading to dangerous malfunctions, even when the tumour being targeted is far from the heart. From gathering dat...
Heart Rhythm, 2015
BACKGROUND Radiation therapy (RT) may pose acute and longterm risks for patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverterdefibrillators (ICDs). However, the frequency of these problems has not been accurately defined. OBJECTIVE The purpose of this study was to determine the prevalence of CIEDs among patients requiring RT and report the common CIED-related problems when patients are managed according to a standard clinical care path. METHODS In a single tertiary-care center, we prospectively screened all patients requiring RT and identified patients with ICDs or PMs. We collected clinical data about their cancer, RT treatment plan, and CIED. Radiation dose to the device was estimated in all patients, and any device malfunction during RT was documented. RESULTS Of the 34,706 consecutive patients receiving RT, 261 patients (0.8%, mean age 77.9 Ϯ 9.4 years) had an implantable cardiac device: 54 (20.7%) ICDs and 207 (79.3%) PMs. The site of RT was head and neck (27.4%), chest (30.0%), and abdomen/pelvis (32.6%). Using our care path, 63.2% of patients required continuous cardiac monitoring, 14.6% required device reprogramming, 18.8% required magnet application during RT, and 3.4% required device repositioning to the contralateral side before RT. Four patients (1.5%) had inappropriate device function during RT: 3 experienced hemodynamically tolerated ventricular pacing at the maximum sensor rate, and 1 experienced a device power-on-reset. No patient died or suffered permanent device failure. CONCLUSION Nearly 1% of patients receiving RT in this series has a PM or ICD. However, with a systematic policy of risk assessment and patient management, significant device-related complications are rare.
Revisiting the impact of radiation therapy on cardiac implantable electronic device (CIED) function
Journal of Cardiovascular Electrophysiology, 2018
Bravo-Jaimes et al is based on a retrospective analysis of a cohort of 109 patients implanted with CIED (Cardiac Implantable Electronic Device) who underwent radiation therapy (RT), exploring device malfunction attributed to RT. [1] The authors have thoroughly evaluated various irradiation parameters that might have had an impact of CIED function, including: RT type (photon / electron beam), energy, sequence, dose and fractionation, RT site (i.e., the radiation target area) and
Clinical Oncology, 2011
Aims: To report the radiation planning dosimetric aspects and clinical outcomes of patients with implanted cardiac pacemakers. Materials and methods: Between 2005 and 2009, eight patients with in situ cardiac pacemakers of varied primary site were treated at our hospital. All patients underwent computed tomography-based treatment planning. The target volumes, organs at risk and pacemaker device were all contoured. A treatment plan optimally covering the target area and maximally sparing the pacemaker was generated. All patients were evaluated at baseline, during radiotherapy and after radiotherapy conclusion by a cardiologist as well as pacemaker company personnel. Results: The median age at presentation was 67 (range 53e77) years. There were three men with head and neck primaries, two men with lung primaries and three women with breast primaries. The prescribed dose ranged from 45 to 70 Gy in 25e35 fractions with a daily dose of 1.8e2.0 Gy. Four patients had the pacemaker implanted on the same side as the radiotherapy target. The dose ranges for the minimum, mean and maximum doses to the pacemaker were 0.06e2.0, 0.07e20.6 and 0.14e60.0 Gy, respectively. Radiation therapy was safely delivered in all patients without any untoward effects. At 5 months of median follow-up, all patients were well with no malfunction of the pacemaker. Conclusion: A series of eight patients with in situ pacemakers treated with radiotherapy is reported. Radiotherapy can be safely delivered in patients with implanted cardiac pacemakers. However, it mandates a cautious approach in planning and treatment delivery to ensure the least possible dose to the pacemaker. Close liaison with the cardiologist and a pacemaker clinic before, during and after the course of treatment is essential to ensure patient safety.
Cardiovascular Implantable Electronic Devices Dose Estimates for Radiotherapy Patient Management
Management for radiation therapy patients with Cardiovascular Implantable Electronic Devices (CIEDs) is incomplete. Manufacturers of CIEDs provide varying dose thresholds and precautions, which leads to ambiguity in planning patients’ treatments. In cases where radiotherapy patients have a CIED, an American Association of Physicists in Medicine (AAPM) task group (TG 34⁵) developed a guideline for medical physicists to follow. However, specific calculations for the CIED dose need to be performed prior to application of the guide. Radiation oncology clinics would benefit from knowing typical CIED doses received from different treatments in order to expedite risk analyses. By utilizing previous patients’ treatment plans – varying in target location and radiation delivery mode – average dose received by a CIED was measured and compared to the average recommended threshold of 2 Gy. This was done for eleven different treatment plans. Most cases showed a cumulative dose well below the recommended 2 Gy, ranging from 3-53 cGy. However, two cases showed values that would raise concern – a 3D spine with a cumulative dose of 159 cGy and a volume modulated arc therapy (VMAT) head/neck of 329 cGy. With such large doses, this indicated a higher risk of CIED malfunction leading to potential patient complications.