Document Detail


Malfunctions of implantable cardiac devices in patients receiving proton beam therapy: incidence and predictors.
MedLine Citation:
PMID:  24074931     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT.
METHODS AND MATERIALS: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution. The median prescribed dose was 74 Gy (relative biological effectiveness; range 46.8-87.5 Gy), and the median distance from the treatment field to the CIED was 10 cm (range 0.8-40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment.
RESULTS: Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13-21 Gy) and 346 Sv (range 11-1100 mSv). Six CIED malfunctions occurred in 5 patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and 1 patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9-8 cm), and the mean maximum neutron dose was 655 mSv (range 330-1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the elective replacement indicator message was replaced uneventfully after treatment.
CONCLUSIONS: The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving thoracic PBT be followed closely.
Authors:
Daniel R Gomez; Falk Poenisch; Chelsea C Pinnix; Tommy Sheu; Joe Y Chang; Nada Memon; Radhe Mohan; Marc A Rozner; Anne H Dougherty
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  International journal of radiation oncology, biology, physics     Volume:  87     ISSN:  1879-355X     ISO Abbreviation:  Int. J. Radiat. Oncol. Biol. Phys.     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-09-30     Completed Date:  2013-11-18     Revised Date:  2014-03-27    
Medline Journal Info:
Nlm Unique ID:  7603616     Medline TA:  Int J Radiat Oncol Biol Phys     Country:  United States    
Other Details:
Languages:  eng     Pagination:  570-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Defibrillators, Implantable*
Equipment Failure / statistics & numerical data*
Equipment Failure Analysis
Humans
Liver Neoplasms / radiotherapy
Male
Neutrons / adverse effects,  therapeutic use
Pacemaker, Artificial*
Prostatic Neoplasms / radiotherapy
Proton Therapy / contraindications*
Radiotherapy Dosage
Relative Biological Effectiveness
Retrospective Studies
Thoracic Neoplasms / radiotherapy
Grant Support
ID/Acronym/Agency:
CA016672/CA/NCI NIH HHS; P30 CA016672/CA/NCI NIH HHS
Comments/Corrections
Comment In:
Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):754   [PMID:  24521687 ]
Int J Radiat Oncol Biol Phys. 2014 Mar 1;88(3):753   [PMID:  24521686 ]

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