Radiotherapy for patients with cardiovascular implantable electronic device-a single institutional experience

Aim

The number of patients with cardiovascular implantable electronic devices (CIEDs) attending radiation oncology department is increasing day by day. We are writing to discuss our experience and difficulties in handling this cohort of patients and our workflow, which is enabling us to handle the situation with ease.

Methods

All the patients with CIED, treated in the past three years in our radiotherapy department were included in our analysis. The data were taken from their planning images and documentation in the case sheets. The dose to the pacemaker was recorded from the planning CT scans. The cases in which the CIEDs were not included in the planning scans had an in vivo dosimetry done using EBT3 Gaffchromic films to measure the scattered dose. The patient characteristics including their dependency on the CIEDs were also recorded from the records.

Results

We have treated 15 patients with implanted pacemakers and one patient with an ICD in the past 3 years. The dose range was between 30 Gy and 66 Gy. 5 patients had in vivo measurement of the scattered dose using Gaffchromic EBT-3 films. We did either re-planning or modification, if the dose was more than 2 Gy. For the lone patient with ICD, the sensing mode was deactivated using a magnet every day and during treatment crash cart was kept stand by.

Conclusion

Radiotherapy for patients with an implanted pacemaker or an ICD can pose difficulties in small radiotherapy facilities. None of our patients had any recordable events during and after radiotherapy. There is a need for a better understanding of the CIEDs and the possible interferences during radiotherapy.