Radiotherapy for patients with cardiovascular implantable electronic devices: an 11-year experience

Yeung, Cynthia; Hazim, Bachar; Campbell, Debra; Gooding, J.; Li, Shirley Xl; Tam, Ho Kit; Hopman, Wilma M.; Chacko, Sanoj; Redfearn, Damián P.; Simpson, Christopher S.; Abdollah, Hoshiar; Baranchuk, Adrián

doi:10.1007/s10840-018-0506-0

Cited by 15 publications

(27 citation statements)

References 32 publications

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“…This case is in line with other experiences reported in the literature demonstrating the resistance of some devices to considerably higher doses than officially recommended 4 . Modern devices with contemporary complementary metal oxide semiconductor components in the electrical circuit are more robust to damage by RT than earlier designs, which had bipolar transistor‐based technologies 5 . Furthermore, modern volumetric‐modulated arc therapy techniques leading to low scatter radiation to normal tissue may have contributed to the functional resistance of the cardiac resynchronization therapy device 3 .…”

Section: Discussionsupporting

confidence: 90%

“…On the other hand, even very low cumulative doses may lead to device malfunction such as inappropriate pacing inhibition, PM program resetting, or PM battery depletion. 5,7 In contrast, Bagur et al identified in a large population cohort that the total dose prescribed to the tumour is the only independent predictor for dysfunctions of CIEDs (7%). Furthermore, neither the radiated zone nor the cancer location side was associated with increased rates of dysfunction, and their results suggest that relocation did not protect the occurrence of malfunctions.…”

Section: Discussionmentioning

confidence: 95%

“…4 Modern devices with contemporary complementary metal oxide semiconductor components in the electrical circuit are more robust to damage by RT than earlier designs, which had bipolar transistor-based technologies. 5 Furthermore, modern volumetric-modulated arc therapy techniques leading to low scatter radiation to normal tissue may have contributed to the functional resistance of the cardiac resynchronization therapy device. 3 Expert consensus currently considers a threshold of <2 Gy as low risk, 1,6 but in the literature, this cut-off is discussed as too stringent and impractical.…”

Section: Discussionmentioning

confidence: 99%

“…8 Yeung et al proposed in his review the implementation of a clinical approval system for CIEDs exposed to RT similar to magnetic resonance conditional labeling. 5 However, the management of patients with CIEDs undergoing RT must be planned carefully in a multidisciplinary approach between radiation oncology and cardiology with a special focus on individualized risk assessment to carry out a safe and effective treatment. 3,4…”

Section: Discussionmentioning

confidence: 99%

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Safe application of extensive radiotherapy to a cardiac resynchronization device

et al. 2020

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Patients with cardiac implantable electronic devices undergoing radiotherapy (RT) are prone to the risk of device failure. Guidelines and manufacturer's instructions are lacking practical recommendations for cumulative radiation doses to pacemakers or implantable cardioverter defibrillators. The present case demonstrates the effect of RT of a Merkel cell carcinoma near the location of a cardiac resynchronization therapy pacemaker. Despite guideline recommendations, surgical relocation or de novo implantation of the device on the contralateral side was avoided to prevent the dissemination of tumour cells, inflammation, and wound healing complications. A total dose of 47.25 Gy applied in very close proximity to the cardiac resynchronization therapy pacemaker was carried out safely without jeopardizing the patient and any device malfunction during and after treatment within >1.5 years of follow-up period. The present case demonstrates that high-dose RT near to a cardiac resynchronization therapy device can be carried out safely. Special precautions during RT as well as close device follow-up interrogations are mandatory. Large-scale studies are needed for the true frequency of adverse events.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safe application of extensive radiotherapy to a cardiac resynchronization device

et al. 2020

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“…While the incidence of CIED complications due to radiotherapy is low, the rising population of patients with CIEDs requiring radiotherapy brings to attention the need for universal, evidence-based guidelines for the management of such patients [6] . A structured multidisciplinary approach involving collaboration between radiation oncology and cardiology is essential to minimize the incidence of device malfunction [11] .…”

Section: Discussionmentioning

confidence: 99%

Safe Delivery of Endoscopic Brachytherapy in a Patient with a Dual Chamber Pacemaker

Wang¹,

Yeung²,

Enríquez³

et al. 2019

Journal of Atrial Fibrillation

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In patients with advanced esophageal cancer, management of dysphagia is a challenge with significant implications on patient quality of life. Brachytherapy has been shown to be an effective and safe treatment option for symptoms related to dysphagia. The effect of endoscopic brachytherapy on patients with a cardiac implantable electronic device has not previously been described in literature. We present an 89-year-old female with a dual chamber permanent pacemaker who elected to undergo palliative brachytherapy delivered via endoscopy for treatment of dysphagia secondary to locally advanced esophageal adenocarcinoma.

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Prediction of radiation‐induced malfunction for cardiac implantable electronic devices (CIEDs)

Matsubara¹,

Ezura²,

Hashimoto³

et al. 2020

Medical Physics

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Purpose Cardiac implantable electronic devices (CIEDs) were believed to possess a tolerance dose to malfunction during radiotherapy. Although recent studies have qualitatively suggested neutrons as a cause of malfunction, numerical understanding has not been reached. The purpose of this work is to quantitatively clarify the contribution of secondary neutrons from out‐of‐field irradiation to the malfunction of CIEDs as well as to deduce the frequency of malfunctions until completion of prostate cancer treatment as a typical case. Materials and Methods Measured data were gathered from the literature and were re‐analyzed. Firstly, linear relationship for a number of malfunctions to the neutron dose was suggested by theoretical consideration. Secondly, the accumulated number of malfunctions of CIEDs gathered from the literature was compared with the prescribed dose, scattered photon dose, and secondary neutron dose for analysis of their correlation. Thirdly, the number of malfunctions during a course of prostate treatment with high‐energy X‐ray, passive proton, and passive carbon‐ion beams was calculated while assuming the same response to malfunctions, where X‐rays consisted of 6‐MV, 10‐MV, 15‐MV, and 18‐MV beams. Monte Carlo simulation assuming simple geometry was performed for the distribution of neutron dose from X‐ray beams, where normalization factors were applied to the distribution so as to reproduce the empirical values. Results Linearity between risk and neutron dose was clearly found from the measured data, as suggested by theoretical consideration. The predicted number of malfunctions until treatment completion was 0, 0.02 ± 0.01, 0.30 ± 0.08, 0.65 ± 0.17, 0.88 ± 0.50, and 0.14 ± 0.04 when 6‐MV, 10‐MV, 15‐MV, 18‐MV, passive proton, and passive carbon‐ion beams, respectively, were employed, where the single model response to a malfunction of 8.6 ± 2.1 Sv−1 was applied. Conclusions Numerical understanding of the malfunction of CIEDs has been attained for the first time. It has been clarified that neutron dose is a good scale for the risk of CIEDs in radiotherapy. Prediction of the frequency of malfunction as well as discussion of the risk to CIEDs in radiotherapy among the multiple modalities have become possible. Because the present study quantitatively clarifies the neutron contribution to malfunction, revision of clinical guidelines is suggested.

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Radiotherapy for patients with cardiovascular implantable electronic devices: an 11-year experience

Cited by 15 publications

References 32 publications

Safe application of extensive radiotherapy to a cardiac resynchronization device

Safe application of extensive radiotherapy to a cardiac resynchronization device

Safe Delivery of Endoscopic Brachytherapy in a Patient with a Dual Chamber Pacemaker

Prediction of radiation‐induced malfunction for cardiac implantable electronic devices (CIEDs)

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