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Safavi AH, Louie AV, Elzibak AH, Warner A, Donovan EK, Detsky JS. Management of Patients with Cardiovascular Implantable Electronic Devices Undergoing Radiation Therapy: A National Survey of Canadian Multidisciplinary Radiation Oncology Professionals. Adv Radiat Oncol 2023; 8:101184. [PMID: 36874173 PMCID: PMC9975614 DOI: 10.1016/j.adro.2023.101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose This study aimed to characterize contemporary management of Canadian patients with cardiovascular implantable electronic devices (CIEDs) undergoing radiation therapy (RT) in light of updated American Association of Physicists in Medicine guidelines. Methods and Materials A 22-question web-based survey was distributed to members of the Canadian Association of Radiation Oncology, Canadian Organization of Medical Physicists, and Canadian Association of Medical Radiation Technologists from January to February 2020. Respondent demographics, knowledge, and management practices were elicited. Statistical comparisons by respondent demographics were performed using χ2 and Fisher exact tests. Results In total, 155 surveys were completed by 54 radiation oncologists, 26 medical physicists, and 75 radiation therapists in academic (51%) and community (49%) practices across all provinces. The majority of respondents (77%) had managed >10 patients with CIEDs in their career. Most respondents (70%) reported using risk-stratified institutional management protocols. Respondents used manufacturer recommendations, rather than American Association of Physicists in Medicine or institutionally recommended dose limits, when the manufacturer limit was 0 Gy (44%), 0 to 2 Gy (45%), or >2 Gy (34%). The majority of respondents (86%) reported institutional policies to refer to a cardiologist for CIED evaluation both before and after completion of RT. Cumulative dose to CIED, pacing dependence, and neutron production were considered during risk stratification by 86%, 74%, and 50% of participants, respectively. Dose and energy thresholds for high-risk management were not known by 45% and 52% of respondents, with radiation oncologists and radiation therapists significantly less likely to report thresholds than medical physicists (P < .001). Although 59% of respondents felt comfortable managing patients with CIEDs, community respondents were less likely to feel comfortable than academic respondents (P = .037). Conclusions The management of Canadian patients with CIEDs undergoing RT is characterized by variability and uncertainty. National consensus guidelines may have a role in improving provider knowledge and confidence in caring for this growing population.
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Affiliation(s)
- Amir H. Safavi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alyaa H. Elzibak
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Elysia K. Donovan
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jay S. Detsky
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Corresponding author: Jay S. Detsky, MD, PhD
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Gulletta S, Falasconi G, Cianfanelli L, Centola A, Paglino G, Cireddu M, Radinovic A, D’Angelo G, Marzi A, Sala S, Fierro N, Bisceglia C, Peretto G, Di Muzio N, Della Bella P, Vergara P, Dell’Oca I. Patients with Cardiac Implantable Electronic Device Undergoing Radiation Therapy: Insights from a Ten-Year Tertiary Center Experience. J Clin Med 2022; 11:jcm11174990. [PMID: 36078921 PMCID: PMC9457044 DOI: 10.3390/jcm11174990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The number of patients with cardiac implantable electronic devices (CIEDs) receiving radiotherapy (RT) is increasing. The management of CIED-carriers undergoing RT is challenging and requires a collaborative multidisciplinary approach. Aim: The aim of the study is to report the real-world, ten-year experience of a tertiary multidisciplinary teaching hospital. Methods: We conducted an observational, real-world, retrospective, single-center study, enrolling all CIED-carriers who underwent RT at the San Raffaele University Hospital, between June 2010 and December 2021. All devices were MRI-conditional. The devices were programmed to an asynchronous pacing mode for patients who had an intrinsic heart rate of less than 40 beats per minute. An inhibited pacing mode was used for all other patients. All tachyarrhythmia device functions were temporarily disabled. After each RT session, the CIED were reprogrammed to the original settings. Outcomes included adverse events and changes in the variables that indicate lead and device functions. Results: Between June 2010 and December 2021, 107 patients were enrolled, among which 63 (58.9%) were pacemaker carriers and 44 (41.1%) were ICD carriers. Patients were subjected to a mean of 16.4 (±10.7) RT sessions. The most represented tumors in our cohort were prostate cancer (12; 11%), breast cancer (10; 9%) and lung cancer (28; 26%). No statistically significant changes in device parameters were recorded before and after radiotherapy. Generator failures, power-on resets, changes in pacing threshold or sensing requiring system revision or programming changes, battery depletions, pacing inhibitions and inappropriate therapies did not occur in our cohort of patients during a ten-year time span period. Atrial arrhythmias were recorded during RT session in 14 patients (13.1%) and ventricular arrhythmias were observed at device interrogation in 10 patients (9.9%). Conclusions: Changes in device parameters and arrhythmia occurrence were infrequent, and none resulted in a clinically significant adverse event.
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Affiliation(s)
- Simone Gulletta
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Correspondence:
| | - Giulio Falasconi
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Lorenzo Cianfanelli
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Alice Centola
- Centro Cardiologico Monzino, Via Carlo Parea 4, 20138 Milan, Italy
| | - Gabriele Paglino
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Manuela Cireddu
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Andrea Radinovic
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Giuseppe D’Angelo
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Alessandra Marzi
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Simone Sala
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Nicolai Fierro
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Caterina Bisceglia
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Nadia Di Muzio
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Paolo Della Bella
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Pasquale Vergara
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Italo Dell’Oca
- Department of Arrhythmology and Cardiac Electrophysiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
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Zagzoog A, Wronski M, Birnie DH, Yeung C, Baranchuk A, Healey JS, Golian M, Boles U, Carrizo AG, Turner S, Hassan A, Ali E, Kumar SK, Russell S, Shurrab M, Crystal E. Assessment of Radiation-Induced Malfunction in Cardiac Implantable Electronic Devices. CJC Open 2021; 3:1438-1443. [PMID: 34993455 PMCID: PMC8712607 DOI: 10.1016/j.cjco.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/07/2021] [Indexed: 12/25/2022] Open
Abstract
Background Radiation therapy (RT) is a standard cancer treatment modality, and an increasing number of patients with cardiac implantable electronic devices (CIEDs) are being referred for RT. The goals of this study were as follows: (i) to determine the incidence of CIED malfunction following RT; (ii) to characterize the various types of malfunctions that occur; and (iii) to identify risk factors associated with CIED malfunction following RT. Methods A retrospective study of patients with CIEDs who received RT between 2007 and 2018 at 4 Canadian centres (Sunnybrook Health Sciences Centre, Kingston General Hospital, Hamilton Health Sciences Centre, and University of Ottawa Heart Institute) was conducted. Patients underwent CIED interrogation after completion of RT, to assess for late damage to the CIEDs. Data on demographics, devices, and RT were compared for the primary outcome of device malfunction. Results Of 1041 patients with CIEDs who received RT, 811 patients with complete data were included. Device malfunctions occurred in 32 of 811 patients (4%). The most common device malfunctions were reduced ventricular/atrial sensing (in 13 of 32 [41%]), an increase in lead threshold (in 9 of 32 [22%]), lead noise (in 5 of 32 [16%]), and electrical reset (in 2 of 32 [6%]). Higher beam energy (≥ 10 MV) was associated with malfunction (P < 0.0001). Radiation dose was not significantly different between the malfunction and non-malfunction groups (58.3 cGy vs 65 cGy, respectively, P = 0.71). Conclusions Although RT-induced CIED malfunctions are rare (occurring in 4% of patients with a CIED who undergo RT), collaborative efforts between radiation oncologists and cardiac rhythm device clinics to optimize CIED monitoring are needed, to detect and manage CIED malfunctions. Malfunctions are more common in patients receiving higher–beam energy (≥10MV)RT.
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Affiliation(s)
- Amin Zagzoog
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Matt Wronski
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David H. Birnie
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia Yeung
- Kingston General Hospital, Queens School of Medicine, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Kingston General Hospital, Queens School of Medicine, Kingston, Ontario, Canada
| | - Jeffrey S. Healey
- Hamilton Health Sciences and Centre, McMaster University, Hamilton, Ontario, Canada
| | - Mehrdad Golian
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Usama Boles
- Kingston General Hospital, Queens School of Medicine, Kingston, Ontario, Canada
| | - Aldo G. Carrizo
- Hamilton Health Sciences and Centre, McMaster University, Hamilton, Ontario, Canada
| | - Suzette Turner
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Hassan
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Elsayed Ali
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, Ontario, Canada
| | - Sharath K. Kumar
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steve Russell
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Shurrab
- Health Sciences North, Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Eugene Crystal
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Eugene Crystal, Division of Cardiology, Department of Medicine, D377, 2075 Bayview Ave, Toronto, Onntario M4N 3M5, Canada. Tel.: +1-416-480-6100.
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Azraai M, D'Souza D, Nadurata V. Current Clinical Practice in Patients With Cardiac Implantable Electronic Devices (CIED) Undergoing Radiotherapy (RT). Heart Lung Circ 2021; 31:327-340. [PMID: 34844904 DOI: 10.1016/j.hlc.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to ageing of the population. With newer CIEDs implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturisation of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recent updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia.
| | - Daniel D'Souza
- Department of Cardiology, Bendigo Health, Bendigo, Vic, Australia
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Azraai M, D'Souza D, Lin YH, Nadurata V. Current clinical practice in patients with cardiac implantable electronic devices undergoing radiotherapy: a literature review. Europace 2021; 24:362-374. [PMID: 34516616 DOI: 10.1093/europace/euab241] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/25/2021] [Indexed: 12/25/2022] Open
Abstract
Patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy (RT) are more common due to the ageing of the population. With newer CIEDs' implementing the complementary metal-oxide semiconductor (CMOS) technology which allows the miniaturization of CIED, it is also more susceptible to RT. Effects of RT on CIED ranges from device interference, device operational/memory errors of permanent damage. These malfunctions can cause life-threatening clinical effects. Cumulative dose is not the only component of RT that causes CIED malfunction, as neutron use and dose rate effect also affects CIEDs. The management of this patient cohort in clinical practice is inconsistent due to the lack of a consistent guideline from manufacturers and physician specialty societies. Our review will focus on the current clinical practice and the recently updated guidelines of managing patients with CIED undergoing RT. We aim to simplify the evidence and provide a simple and easy to use guide based on the recent guidelines.
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Affiliation(s)
- Meor Azraai
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Daniel D'Souza
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Yuan-Hong Lin
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health, 100 Barnard Street, Bendigo, Victoria 3550, Australia
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Gauter-Fleckenstein B, Barthel C, Büttner S, Wenz F, Borggrefe M, Tülümen E. Effectivity and applicability of the German DEGRO/DGK-guideline for radiotherapy in CIED-bearing patients. Radiother Oncol 2020; 152:208-215. [DOI: 10.1016/j.radonc.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/07/2019] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
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7
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Malavasi VL, De Marco G, Imberti JF, Placentino F, Vitolo M, Mazzeo E, Cicoria G, Casali E, Turco V, Lohr F, Boriani G. Radiotherapy-induced malfunctions of cardiac implantable electronic devices in cancer patients. Intern Emerg Med 2020; 15:967-973. [PMID: 31792775 DOI: 10.1007/s11739-019-02240-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
The number of patients with cardiac implantable electronic devices (CIEDs) requiring radiation therapy (RT) for cancer treatment is increasing. The purpose of this study is to estimate the prevalence, possible predictors, and clinical impact of RT-related CIEDs malfunctions. We retrospectively reviewed the medical records of all pacemaker (PM)/implantable cardioverter-defibrillator (ICD) patients who underwent RT in the last 14 years. One hundred and twenty-seven patients who underwent 150 separate RT courses were analysed (99 with a PM and 27 with an ICD). Of note, 21/127 (16.6%) patients were PM-dependent. Neutron-producing RT was used in 37/139 (26.6%) courses, whereas non-neutron-producing RT was used in 102/139 (73.4%) courses. The cumulative dose (Dmax) delivered to the CIED exceeded 5 Gy only in 2/132 (1.5%) cases. Device malfunctions were observed in 3/150 (2%) RT courses, but none was life-threatening or led to a major clinical event and all were resolved by CIED reprogramming. In all cases, the Dmax delivered to the CIED was < 2 Gy. Two malfunctions occurred in the 37 patients treated with neutron-producing RT (5.4%), and 1 malfunction occurred in the 102 patients treated with non-neutron-producing RT (1%) (p = 0.17). Device relocation from the RT field was performed in 2/127 (1.6%) patients. RT in patients with CIED is substantially safe if performed in an appropriately organized environment, with uncommon CIEDs malfunctions and no major clinical events. Neutron-producing energies, rather than Dmax, seem to increase the risk of malfunctions. Device interrogation on a regular basis is advised to promptly manage CIED malfunctions.
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Affiliation(s)
- Vincenzo L Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giuseppina De Marco
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Filippo Placentino
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Ercole Mazzeo
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | | | - Edoardo Casali
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Vincenzo Turco
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy
| | - Frank Lohr
- Radiotherapy Division, Department of Oncology, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Via del Pozzo, 71, 41124, Modena, Italy.
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Matsubara H, Ezura T, Hashimoto Y, Karasawa K, Nishio T, Tsuneda M. Prediction of radiation‐induced malfunction for cardiac implantable electronic devices (CIEDs). Med Phys 2020; 47:1489-1498. [DOI: 10.1002/mp.14057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/22/2019] [Accepted: 01/25/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hiroaki Matsubara
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
| | - Takatomo Ezura
- Department of Radiology Tokyo Women’s Medical University Hospital Tokyo 162‐8666Japan
| | - Yaichiro Hashimoto
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
| | - Kumiko Karasawa
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
| | - Teiji Nishio
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
| | - Masato Tsuneda
- Department of Radiation Oncology Tokyo Women’s Medical University Tokyo 162‐8666Japan
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Alitto AR, Chiesa S, Franco P, Fiore M, Marino L, Borghetti P, Desideri I, Greto D, Fiorentino A. PAIDEIA: pacemaker and implanted cardioverter defibrillator management in radiation therapy-a survey by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). LA RADIOLOGIA MEDICA 2019; 125:329-335. [PMID: 31832987 DOI: 10.1007/s11547-019-01099-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/16/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The management of patients bearing a cardiac implantable electronic device and needing a radiotherapy treatment is an important clinical scenario. The aim of this survey was to evaluate the level of awareness within the Italian Radiation Oncologist community on this topic. MATERIALS AND METHODS A survey was promoted by the Young Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) with a questionnaire made up of 22 questions allowing for multiple answers, which was administered, both online and on paper version. It was addressed to Radiation Oncologists, AIRO members, participating in the National Congress held in 2015. RESULTS A total of 113 questionnaires were collected back and analyzed (survey online: 50 respondents; paper version: 63). The answers showed a good level of awareness on the issue, but with a nonhomogeneous adherence to the different published guidelines (GL). There is a general low rate of referral for a preliminary cardiological evaluation in patients bearing PM/ICDs, in line with some published surveys; nevertheless, a focused attention to certain specific treatment factors and patient-centered point of view emerged. CONCLUSIONS A generally good awareness of this topic was shown but homogeneous application of GL was not observed, possibly due to the multiplicity of available GL. A prospective data collection could help to better clarify the shadows on this topics.
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Affiliation(s)
- Anna Rita Alitto
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Pierfrancesco Franco
- Dipartimento di Oncologia - Radioterapia Oncologica, Università di Torino - AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Michele Fiore
- Radioterapia Oncologica, Policlinico Universitario Campus Biomedico, Rome, Italy
| | | | - Paolo Borghetti
- Dipartimento di Radioterapia Oncologica, Università e ASST Spedali Civili di Brescia, Brescia, Italy
| | - Isacco Desideri
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche Mario Serio, Radioterapia Oncologica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Daniela Greto
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche Mario Serio, Radioterapia Oncologica, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alba Fiorentino
- Dipartimento di Radioterapia Oncologica, Ospedale Generale Regionale "F. Miulli", Acquaviva Delle Fonti, Bari, Italy
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Miften M, Mihailidis D, Kry SF, Reft C, Esquivel C, Farr J, Followill D, Hurkmans C, Liu A, Gayou O, Gossman M, Mahesh M, Popple R, Prisciandaro J, Wilkinson J. Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203 †. Med Phys 2019; 46:e757-e788. [PMID: 31571229 DOI: 10.1002/mp.13838] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/16/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022] Open
Abstract
Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter-defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG-34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.
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Affiliation(s)
- Moyed Miften
- Task Group 203, Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Dimitris Mihailidis
- Task Group 203, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA, 19104, USA
| | - Stephen F Kry
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chester Reft
- Department of Radiation Oncology, University of Chicago, Chicago, IL, 60637, USA
| | - Carlos Esquivel
- Department of Radiation Oncology, UT Health Sciences Center, San Antonio, TX, 78229, USA
| | - Jonathan Farr
- Division of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - David Followill
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Coen Hurkmans
- Department of Radiotherapy, Catharina Hospital, Eindhoven, the Netherlands
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Olivier Gayou
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburg, PA, 15212, USA
| | - Michael Gossman
- Department of Radiation Oncology, Tri-State Regional Cancer Center, Ashland, KY, 41101, USA
| | - Mahadevappa Mahesh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Richard Popple
- Department of Radiation Oncology, University of Alabama, Birmingham, AL, 35249, USA
| | - Joann Prisciandaro
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
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Radiotherapy of patients with cardiac implantable electronic devices according to the DEGRO/DGK guideline—is the risk of relevant errors overestimated? Strahlenther Onkol 2019; 195:1086-1093. [DOI: 10.1007/s00066-019-01502-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023]
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Radiotherapy for patients with cardiovascular implantable electronic devices: an 11-year experience. J Interv Card Electrophysiol 2019; 55:333-341. [PMID: 30603854 DOI: 10.1007/s10840-018-0506-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE As cardiovascular implantable electronic devices (CIEDs) are increasingly indicated in older patients, and the burden of cancer is rising with the aging population, the management of patients with CIEDs who require radiotherapy (RT) is a timely concern. The objective of the study was to evaluate the management of, and malfunctions in, patients with CIEDs undergoing RT. METHODS A retrospective study of patients with CIEDs receiving RT at Kingston Health Sciences Center from March 2007-April 2018 was conducted. Data on demographics, RT, devices, and management were compared for the primary outcome of device malfunction. RESULTS Of the 189 patients with CIEDs receiving a total of 297 courses of RT, 4 patients (2.1%) experienced device malfunctions. Higher beam energy was associated with a malfunction (p < 0.05). Patients with malfunctions received a lower dose of radiation per fraction (267 ± 93 cGy vs. 477 ± 282 cGy; p < 0.05) and were significantly younger (71.4 ± 2.2 years vs. 77.8 ± 9.8 years; p < 0.01) compared to patients without malfunctions. CONCLUSION RT-induced device malfunctions are rare, but given the potential complications, a better understanding of the potential predictors of malfunction and the development of evidence-based guidelines will help optimize patient safety.
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Bitterman DS, Zei PC, Mak RH. Radiation Safety and Cardiovascular Implantable Electronic Devices. Int J Radiat Oncol Biol Phys 2018; 102:243-246. [PMID: 30191855 DOI: 10.1016/j.ijrobp.2018.05.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/30/2018] [Accepted: 05/29/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Danielle S Bitterman
- Harvard Radiation Oncology Program, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul C Zei
- Department of Cardiovascular Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Raymond H Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts.
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Riva G, Alessandro O, Spoto R, Ferrari A, Garibaldi C, Cattani F, Luraschi R, Rondi E, Colombo N, Giovenzana FLF, Cipolla CM, Winnicki M, Persiani M, Castelluccia F, Fiore MS, Orecchia R, Jereczek-Fossa BA. Radiotherapy in patients with cardiac implantable electronic devices: clinical and dosimetric aspects. Med Oncol 2018; 35:73. [DOI: 10.1007/s12032-018-1126-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
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Zecchin M, Severgnini M, Fiorentino A, Malavasi VL, Menegotti L, Alongi F, Catanzariti D, Jereczek-Fossa BA, Stasi M, Russi E, Boriani G. Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: A consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM). Int J Cardiol 2017; 255:175-183. [PMID: 29310933 DOI: 10.1016/j.ijcard.2017.12.061] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/04/2017] [Accepted: 12/19/2017] [Indexed: 11/15/2022]
Abstract
The management of patients with a cardiac implanted electronic device (CIED) receiving radiotherapy (RT) is challenging and requires a structured multidisciplinary approach. A consensus document is presented as a result of a multidisciplinary working group involving cardiac electrophysiologists, radiation oncologists and physicists in order to stratify the risk of patients with CIED requiring RT and approaching RT sessions appropriately. When high radiation doses and beam energy higher than 6MV are used, CIED malfunctions can occur during treatment. In our document, we reviewed the different types of RT and CIED behavior in the presence of ionizing radiations and electromagnetic interferences, from the cardiologist's, radiation oncologist's and medical physicist's point of view. We also reviewed in vitro and in vivo literature data and other national published guidelines on this issue so far. On the basis of literature data and consensus of experts, a detailed approach based on risk stratification and appropriate management of RT patients with CIEDs is suggested, with important implications for clinical practice.
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Affiliation(s)
- Massimo Zecchin
- Struttura Complessa di Cardiologia, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Mara Severgnini
- Struttura Complessa di Fisica Sanitaria, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Alba Fiorentino
- Unità Operativa Complessa di Radioterapia Oncologica, Ospedale Sacro Cuore-Don Calabria, Cancer Care Center Negrar, Verona, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Italy
| | - Loris Menegotti
- Servizio di Fisica Sanitaria, Azienda Provinciale per i Servizi Sanitari di Trento, Italy
| | - Filippo Alongi
- Unità Operativa Complessa di Radioterapia Oncologica, Ospedale Sacro Cuore-Don Calabria, Cancer Care Center Negrar, Verona (Italy) and Università di Brescia, Brescia, Italy
| | - Domenico Catanzariti
- Unità Operativa di Cardiologia, Azienda Provinciale per i Servizi Sanitari di Trento, Italy
| | - Barbara Alicja Jereczek-Fossa
- Divisione di Radioterapia, Istituto Europeo di Oncologia, Milano (Italy) and Dipartimento di Oncologia e Emato-oncologia dell'Università degli Studi di Milano, Milan, Italy
| | - Michele Stasi
- Struttura Complessa di Fisica Sanitaria, A.O. Ordine Mauriziano di Torino, Italy
| | - Elvio Russi
- Struttura Complessa di Radioterapia, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Italy.
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Yeung C, Chacko S, Glover B, Campbell D, Crystal E, Ben-Dov N, Baranchuk A. Radiotherapy for Patients with Cardiovascular Implantable Electronic Devices: A Review. Can J Cardiol 2017; 34:244-251. [PMID: 29395701 DOI: 10.1016/j.cjca.2017.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022] Open
Abstract
Because cardiovascular implantable electronic devices are increasingly indicated in older patients, and the burden of cancer is rising with the growth and aging of the world population, the management of patients with cardiac devices who require radiotherapy for cancer treatment is a timely concern. Device malfunctions might occur in as high as 3% of radiotherapy courses, posing a substantial issue in clinical practice. A nonsystematic comprehensive review was undertaken. We searched PubMed and the MEDLINE database for randomized controlled trials, meta-analyses, systematic reviews, observational studies, in vitro/in vivo studies, and case reports. Articles were selected by 2 independent reviewers, and emphasis was given to information of interest to a general medical readership. The pathophysiology and predictors of cardiovascular implantable electronic device malfunction due to radiotherapy are reviewed, recommendations for the management of patients with such devices undergoing radiotherapy are summarized, and the clinical significance and future directions of this field are discussed. Radiotherapy-induced device malfunctions are rare, but because of the potential complications, the development of evidence-based guidelines for the management of patients with cardiovascular implantable electronic devices undergoing radiotherapy is a timely concern.
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Affiliation(s)
- Cynthia Yeung
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Benedict Glover
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Debra Campbell
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Eugene Crystal
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nissan Ben-Dov
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter-Green U, Clarke GD, Dickfeld TML, Froelich JW, Grant J, Hayes DL, Heidbuchel H, Idriss SF, Kanal E, Lampert R, Machado CE, Mandrola JM, Nazarian S, Patton KK, Rozner MA, Russo RJ, Shen WK, Shinbane JS, Teo WS, Uribe W, Verma A, Wilkoff BL, Woodard PK. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 2017; 14:e97-e153. [DOI: 10.1016/j.hrthm.2017.04.025] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/16/2022]
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Hudson FJ, Ryan EA. A review of implantable cardioverter defibrillator failures during radiation therapy in three Sydney hospitals. J Med Imaging Radiat Oncol 2017; 61:517-521. [PMID: 28256052 DOI: 10.1111/1754-9485.12578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/27/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In recent years, using radiation energies greater than 10 MV in patients with implantable cardioverter defibrillators (ICDs) has been contra-indicated due to the risk of a power on reset (POR) occurring. The ICD is often greater than 30 cm from the treatment field and subject to scatter radiation only. The aim of this study was to use recent patient cases to verify published failure rates and treatment recommendations. METHOD Five patients with ICDs who experienced a device malfunction during radiation therapy treatments were identified in three Sydney hospitals between 2008 and 2012. The types of treatments delivered during these events were assessed. Further assessment of all ICD patients at one Sydney hospital during this time was carried out to assess the rate of ICD failure during high energy treatments using 18 MV. RESULTS All ICDs that suffered malfunctions were exposed to scatter radiation only. All were exposed to partial or exclusive irradiation using 18 MV photons. Accumulated doses to the ICDs were estimated to be well below accepted dose limits found in literature. One centre reported a 22.2% rate of POR during exposure to 18 MV radiation therapy during this time frame. CONCLUSIONS Where possible, radiation therapy using energies greater than 10 MV should be avoided for ICD patients. While the use of these energies carries a risk of failure, it must be weighed against potential benefit to the patient requiring treatment if no alternatives are available. Stringent monitoring of these patients, including regular cardiac device checks and ECG monitoring is recommended if treatment is to proceed with energies greater than 10 MV.
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Affiliation(s)
- Felicity J Hudson
- Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia
| | - Elaine A Ryan
- Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
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Viganego F, Singh R, Fradley MG. Arrhythmias and Other Electrophysiology Issues in Cancer Patients Receiving Chemotherapy or Radiation. Curr Cardiol Rep 2016; 18:52. [DOI: 10.1007/s11886-016-0730-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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20
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Kotecha R, Berriochoa CA, Murphy ES, Machado AG, Chao ST, Suh JH, Stephans KL. Report of whole-brain radiation therapy in a patient with an implanted deep brain stimulator: important neurosurgical considerations and radiotherapy practice principles. J Neurosurg 2015; 124:966-70. [PMID: 26315009 DOI: 10.3171/2015.2.jns142951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with implanted neuromodulation devices present potential challenges for radiation therapy treatment planning and delivery. Although guidelines exist regarding the irradiation of cardiac pacemakers and defibrillators, fewer data and less clinical experience exist regarding the effects of radiation therapy on less frequently used devices, such as deep brain stimulators. A 79-year-old woman with a history of coarse tremors effectively managed with deep brain stimulation presented with multiple intracranial metastases from a newly diagnosed lung cancer and was referred for whole-brain radiation therapy. She was treated with a German helmet technique to a total dose of 30 Gy in 10 fractions using 6 MV photons via opposed lateral fields with the neurostimulator turned off prior to delivery of each fraction. The patient tolerated the treatment well with no acute complications and no apparent change in the functionality of her neurostimulator device or effect on her underlying neuromuscular disorder. This represents the first reported case of the safe delivery of whole-brain radiation therapy in a patient with an implanted neurostimulator device. In cases such as this, neurosurgeons and radiation oncologists should have discussions with patients about the risks of brain injury, device malfunction or failure of the device, and plans for rigorous testing of the device before and after radiation therapy.
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Affiliation(s)
- Rupesh Kotecha
- Department of Radiation Oncology, Taussig Cancer Institute
| | | | - Erin S Murphy
- Department of Radiation Oncology, Taussig Cancer Institute.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic
| | - Andre G Machado
- Center for Neurological Restoration, and ,Departments of 4 Neurological Surgery.,Neurosciences, and.,Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Samuel T Chao
- Department of Radiation Oncology, Taussig Cancer Institute.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic
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Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace 2015; 18:479-91. [PMID: 26041870 DOI: 10.1093/europace/euv135] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/16/2015] [Indexed: 11/14/2022] Open
Abstract
An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field.
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Affiliation(s)
- Tomas Zaremba
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Annette Ross Jakobsen
- Department of Medical Physics, Oncology Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark
| | - Anna Margrethe Thøgersen
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Sam Riahi
- Department of Cardiology, Center for Cardiovascular Research, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Sdr. Skovvej 15, Aalborg 9000, Denmark
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22
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Zaremba T, JAKOBSEN ANNETTEROSS, SØGAARD METTE, THØGERSEN ANNAMARGRETHE, JOHANSEN MARTINBERG, MADSEN LAERKEBRUUN, RIAHI SAM. Risk of Device Malfunction in Cancer Patients with Implantable Cardiac Device Undergoing Radiotherapy: A Population-Based Cohort Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:343-56. [DOI: 10.1111/pace.12572] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 11/30/2014] [Accepted: 12/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Tomas Zaremba
- Department of Cardiology, Center for Cardiovascular Research; Aalborg University Hospital; Aalborg Denmark
| | - ANNETTE ROSS JAKOBSEN
- Department of Medical Physics, Oncology Department; Aalborg University Hospital; Aalborg Denmark
| | - METTE SØGAARD
- Department of Clinical Epidemiology, Institute of Clinical Medicine; Aarhus University Hospital; Aarhus Denmark
| | - ANNA MARGRETHE THØGERSEN
- Department of Cardiology, Center for Cardiovascular Research; Aalborg University Hospital; Aalborg Denmark
| | - MARTIN BERG JOHANSEN
- Department of Clinical Medicine; Aalborg University and Aalborg University Hospital; Aalborg Denmark
| | - LAERKE BRUUN MADSEN
- Department of Cardiology, Center for Cardiovascular Research; Aalborg University Hospital; Aalborg Denmark
| | - SAM RIAHI
- Department of Cardiology, Center for Cardiovascular Research; Aalborg University Hospital; Aalborg Denmark
- Department of Clinical Medicine; Aalborg University and Aalborg University Hospital; Aalborg Denmark
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