Safe delivery of radiation therapy in a patient with Implanted Cardiac Pacemaker - Tips and Pitfalls

Abstract

Background: There are clinical scenarios when it is required to deliver Radiotherapy (RT) to patients who have implanted pacemakers and it is challenging when treatment portals are close to pacemaker. The cumulative dose to the pacemaker needs to be less than 2 to 5 Gy as per the current recommendations.Aim and Methods: To describe the steps undertaken for safe delivery of mediastinal radiotherapy for a patient with Hodgkin’s lymphoma and implanted pacemaker. Case presentation: Sixty-year-old gentleman who had implanted dual-chamber rate adaptive (DDDR), magnetic resonance imaging (MRI) compatible, permanent pacemaker for complete heart block presented with lymphadenopathy and was diagnosed with Classical Hodgkin’s Lymphoma stage IV. He received consolidation RT (30 Gy in 15 fractions) to the mediastinum after completion of chemotherapy. An algorithm was developed based on AAPM (The American Association of Physicists) report for necessary steps to be taken at various stages of radiotherapy planning and treatment delivery. This approach made it possible to reduce cumulative dose to the pacemaker to < 2Gy.Conclusion: RT can be safely delivered to the patients with cardiac pacemakers. Close follow-up of the patients in conjunction with the Cardiologist, before, during and after radiation is essential for the patient’s safety.