Avoiding Mastectomy: Accelerated Partial Breast Irradiation for Breast Cancer Patients with Pacemakers or Defibrillators

Croshaw, Randal; Kim, Yongbok; Lappinen, Erik; Julian, Thomas B.; Trombetta, Mark

doi:10.1245/s10434-011-1784-2

Cited by 27 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The lower energy spectrum of gamma brachytherapy implies a larger relative contribution of the photo-electric effect due to high Z materials in the CIED, and thus a localized higher dose to the CIED might be anticipated than the usually reported dose to water in surrounding tissue. However, as reports about brachytherapy use in this patient population did not reports any CIED problems yet, it was considered that this treatment modality could be handled equivalent to external beam photon therapy until more data will become available in the literature [14,15]. The specific influence of imaging techniques like CT, EPID and CBCT on CIED dose have not been described in detail within this guideline.…”

Section: Methodsmentioning

confidence: 99%

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

et al. 2012

View full text Add to dashboard Cite

Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.

show abstract

Section: Methodsmentioning

confidence: 99%

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

et al. 2012

View full text Add to dashboard Cite

show abstract

“…While the dose to the device has been measured to be low from clinical procedures including coronary artery brachytherapy, the dose may also exceed 1 Gy . For example, the Mammosite® (Hologic, Inc., Marlborough, MA, USA) system can deliver 1 Gy at 15 cm from the source (for a prescription dose of 34 Gy), although Croshaw et al, reported a maximum dose of 1.03 Gy from a balloon breast applicator with an average distance to device of 9.1 cm from three patients (with no adverse event) . Optimization flexibility may allow for dose reduction during multilumen treatment for partial breast irradiation …”

Section: Malfunction Risk Associated With Clinical Proceduresmentioning

confidence: 99%

“…95 For example, the Mammositeâ (Hologic, Inc., Marlborough, MA, USA) system can deliver 1 Gy at 15 cm from the source (for a prescription dose of 34 Gy), although Croshaw et al, reported a maximum dose of 1.03 Gy from a balloon breast applicator with an average distance to device of 9.1 cm from three patients (with no adverse event). 96 Optimization flexibility may allow for dose reduction during multilumen treatment for partial breast irradiation. 97 A recent study 98 made use of a simple method of estimating the maximal dose to the implanted CIED from an HDR spherical breast applicator surface.…”

Section: B2 Brachytherapymentioning

confidence: 99%

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

“…Till date, the largest clinical study with regards to radiotherapy treatment in patients with in situ PM has been done by Ferrara et al [16] Forty-five irradiated patients, implanted with pacemakers or implantable cardioverter-defibrillators were prospectively investigated from 1999 to 2007. The authors carried out an analysis of radiation damage to pacemakers, depending on the geometric and dosimetric characteristics of the radiation beams.…”

Section: In Vivo; Case Series and Case Reports In Literaturementioning

confidence: 99%

Cancer patients with cardiac pacemakers needing radiation treatment: A systematic review

2013

View full text Add to dashboard Cite

With improving average life expectancy of individuals in most countries, there has been increase in the incidence of cardiovascular diseases and cancers. Radiation oncologists therefore are likely to encounter an increasing number of cancer patients with in situ cardiac pacemaker devices needing radiation treatments. Pacemaker technology has advanced rapidly in recent years. As a result, the potential interactions of these devices with radiation therapy have changed since American Association of Physicists in Medicine (AAPM) issued guidelines in 1994. Current approaches to treatment in patients who have these devices vary among radiation oncology centers. Furthermore, the recommendations given by the devices' manufacturers differ considerably. Common knowledge about pacemaker in radiation oncology community is vital as radiation management needs to be tailored to individual patients in accordance to the information of available for the device. Some general practical guidelines can be gleaned from the literature. It is felt that more robust information is required using web based database sharing to develop total safe practice guidelines in such patients. This article reviews the information available to help create such guidelines and presents recommendations for treatment in this increasingly common clinical situation.

show abstract

Avoiding Mastectomy: Accelerated Partial Breast Irradiation for Breast Cancer Patients with Pacemakers or Defibrillators

Abstract: APBI in patients with pacemakers or AICDs who desire breast preservation seems to be a technically safe and reasonable application of targeted radiation therapy.

Cited by 27 publications

References 20 publications

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

Cancer patients with cardiac pacemakers needing radiation treatment: A systematic review

Contact Info

Product

Resources

About

Avoiding Mastectomy: Accelerated Partial Breast Irradiation for Breast Cancer Patients with Pacemakers or Defibrillators

Abstract: APBI in patients with pacemakers or AICDs who desire breast preservation seems to be a technically safe and reasonable application of targeted radiation therapy.

Cited by 27 publications

References 20 publications

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

Cancer patients with cardiac pacemakers needing radiation treatment: A systematic review

Contact Info

Product

Resources

About

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†