nach oben

Erschienen in:

01.05.2015 | Original Article

DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices

verfasst von: Dr. med. Benjamin Gauter-Fleckenstein, MD, Carsten W. Israel, MD, Marc Dorenkamp, MD, Jürgen Dunst, MD, Mattias Roser, MD, Rainer Schimpf, MD, Volker Steil, Jörg Schäfer, MD, Ulrike Höller, MD, Frederik Wenz, MD

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 5/2015

Einloggen, um Zugang zu erhalten

Abstract

An increasing number of patients undergoing radiotherapy (RT) have cardiac implantable electronic devices [CIEDs, cardiac pacemakers (PMs) and implanted cardioverters/defibrillators (ICDs)]. Ionizing radiation can cause latent and permanent damage to CIEDs, which may result in loss of function in patients with asystole or ventricular fibrillation. Reviewing the current literature, the interdisciplinary German guideline (DEGRO/DGK) was developed reflecting patient risk according to type of CIED, cardiac condition, and estimated radiation dose to the CIED. Planning for RT should consider the CIED specifications as well as patient-related characteristics (pacing-dependent, previous ventricular tachycardia/fibrillation). Antitachyarrhythmia therapy should be suspended in patients with ICDs, who should be under electrocardiographic monitoring with an external defibrillator on stand-by. The beam energy should be limited to 6 (to 10) MV CIEDs should never be located in the beam, and the cumulative scatter radiation dose should be limited to 2 Gy. Personnel must be able to respond adequately in the case of a cardiac emergency and initiate basic life support, while an emergency team capable of advanced life support should be available within 5 min. CIEDs need to be interrogated 1, 3, and 6 months after the last RT due to the risk of latent damage.

Berg RA, Hemphill R, Abella BS et al (2010) Part 5: adult basic life support: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122:685–705CrossRef

Biotronik (2011) Strahlentherapie und Biotronik CRM-Implantate – Herzschrittmacher (IPG), Defibrillatoren (ICD) und CRT-Geräte. Berlin: Biotronik SE & Co. KG, Global Technical Service

Blamires NG, Myatt J (1982) X-ray effects on pacemaker type circuits. Pacing Clin Electrophysiol 5:151–155CrossRefPubMed

Boston Scientific (2012) Therapeutic radiation and implantable device systems. http://www.bostonscientific.com/content/dam/bostonscientific/quality/educationresources/english/ACL_Therapeutic_Radiation_20120925.pdf

Croshaw R, Kim Y, Lappinen E et al (2011) Avoiding mastectomy: accelerated partial breast irradiation for breast cancer patients with pacemakers or defibrillators. Ann Surg Oncol 18:3500–3505CrossRefPubMed

Dasgupta T, Barani IJ, Roach M 3rd (2011) Successful radiation treatment of anaplastic thyroid carcinoma metastatic to the right cardiac atrium and ventricle in a pacemaker-dependent patient. Radiat Oncol 6:16CrossRefPubMedCentralPubMed

Dorenkamp M, Roser M, Hamm B et al (2012) Magnetic resonance imaging and implantable cardiac devices. Current status and future perspectives of MR-compatible systems. Herz 37:136–145CrossRefPubMed

Elders J, Kunze-Busch M, Jan Smeenk R et al (2013) High incidence of implantable cardioverter defibrillator malfunctions during radiation therapy: neutrons as a probable cause of soft errors. Europace 15:60–65CrossRefPubMed

Ferrara T, Baiotto B, Malinverni G et al (2010) Irradiation of pacemakers and cardio-defibrillators in patients submitted to radiotherapy: a clinical experience. Tumori 96:76–83PubMed

10.

Franco L, Gomez F, Iglesias A et al (2005) SEUs on commercial SRAM induced by low energy neutrons produced at a clinical linac facility. RADECS Proceedings, 2005

11.

Frantz S, Wagner J, Langenfeld H (2003) Radiation-induced pacemaker malfunction. Z Kardiol 92:415–417CrossRefPubMed

12.

Gelblum DY, Amols H (2009) Implanted cardiac defibrillator care in radiation oncology patient population. Int J Radiat Oncol Biol Phys 73:1525–1531CrossRefPubMed

13.

Gomez DR, Poenisch F, Pinnix CC et al (2013) Malfunctions of implantable cardiac devices in patients receiving proton beam therapy: incidence and predictors. Int J Radiat Oncol Biol Phys 87:570–575CrossRefPubMedCentralPubMed

14.

Hashii H, Hashimoto T, Okawa A et al (2013) Comparison of the effects of high-energy photon beam irradiation (10 and 18 MV) on 2 types of implantable cardioverter-defibrillators. Int J Radiat Oncol Biol Phys 85:840–845CrossRefPubMed

15.

Hashimoto T, Isobe T, Hashii H et al (2012) Influence of secondary neutrons induced by proton radiotherapy for cancer patients with implantable cardioverter defibrillators. Radiat Oncol 7:10CrossRefPubMedCentralPubMed

16.

Hirose M, Tachikawa K, Ozaki M et al (2010) X-ray radiation causes electromagnetic interference in implantable cardiac pacemakers. Pacing Clin Electrophysiol 33:1174–1181CrossRefPubMed

17.

Hoecht S, Rosenthal P, Sancar D et al (2002) Implantable cardiac defibrillators may be damaged by radiation therapy. J Clin Oncol 20:2212–2213PubMed

18.

Hudson F, Coulshed D, DʼSouza E et al (2010) Effect of radiation therapy on the latest generation of pacemakers and implantable cardioverter defibrillators: A systematic review. J Med Imaging Radiat Oncol 54:53–61CrossRefPubMed

19.

Hurkmans CW, Knegjens JL, Oei BS et al (2012) Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline in The Netherlands. Radiat Oncol 7:198CrossRefPubMedCentralPubMed

20.

Hurkmans CW, Scheepers E, Springorum BG et al (2005) Influence of radiotherapy on the latest generation of implantable cardioverter-defibrillators. Int J Radiat Oncol Biol Phys 63:282–289CrossRefPubMed

21.

Hurkmans CW, Scheepers E, Springorum BG et al (2005) Influence of radiotherapy on the latest generation of pacemakers. Radiother Oncol 76:93–98CrossRefPubMed

22.

John J, Kaye GC (2004) Shock coil failure secondary to external irradiation in a patient with implantable cardioverter defibrillator. Pacing Clin Electrophysiol 27:690–691CrossRefPubMed

23.

St. Jude Medical (2014) http://www.sjm.de/media/2/D14051912/2410103808/Roentgenbestrahlung_therapeutisch.pdf

24.

Kapa S, Fong L, Blackwell CR et al (2008) Effects of scatter radiation on ICD and CRT function. Pacing Clin Electrophysiol 31:727–732CrossRefPubMed

25.

Kesek M, Nyholm T, Asklund T (2012) Radiotherapy and pacemaker: 80 Gy to target close to the device may be feasible. Europace 14:1595CrossRefPubMed

26.

Keshtgar MR, Eaton DJ, Reynolds C et al (2012) Pacemaker and radiotherapy in breast cancer: is targeted intraoperative radiotherapy the answer in this setting? Radiat Oncol 7:128CrossRefPubMedCentralPubMed

27.

Kim Y, Arshoun Y, Trombetta MG (2012) Pacemaker/implantable cardioverter-defibrillator dose in balloon high-dose-rate brachytherapy for breast cancer treatment. Brachytherapy 11:380–386CrossRefPubMed

28.

Kirova YM, Menard J, Chargari C et al (2012) Case study thoracic radiotherapy in an elderly patient with pacemaker: the issue of pacing leads. Med Dosim 37:192–194CrossRefPubMed

29.

Lambert P, Da Costa A, Marcy PY et al (2011) Pacemaker, implanted cardiac defibrillator and irradiation: management proposal in 2010 depending on the type of cardiac stimulator and prognosis and location of cancer. Cancer Radiother 15:238–249; quiz 57CrossRefPubMed

30.

Last A (1998) Radiotherapy in patients with cardiac pacemakers. Br J Radiol 71:4–10CrossRefPubMed

31.

Lau DH, Wilson L, Stiles MK et al (2008) Defibrillator reset by radiotherapy. Int J Cardiol 130:e37–38CrossRefPubMed

32.

Lester JF, Evans LM, Yousef Z et al (2014) A national audit of current cardiac device policies from radiotherapy centres across the UK. Clin Oncol (R Coll Radiol) 26:45–50CrossRef

33.

Link MS, Atkins DL, Passman RS et al (2010) Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122:706–719CrossRef

34.

Little FA (1994) Pacemakers in radiotherapy. Clin Oncol (R Coll Radiol) 6:211–212CrossRef

35.

Lohr F, Baus W, Vorwerk H et al (2012) Rules and regulations applying to incidents in radiotherapy. Strahlenther Onkol 188:545–550CrossRefPubMed

36.

Makkar A, Prisciandaro J, Agarwal S et al (2012) Effect of radiation therapy on permanent pacemaker and implantable cardioverter-defibrillator function. Heart Rhythm 9:1964–1968CrossRefPubMed

37.

Manegold JC, Israel CW, Ehrlich JR et al (2007) External cardioversion of atrial fibrillation in patients with implanted pacemaker or cardioverter-defibrillator systems: a randomized comparison of monophasic and biphasic shock energy application. Eur Heart J 28:1731–1738CrossRefPubMed

38.

Marbach JR, Sontag MR, Van Dyk J et al (1994) Management of radiation oncology patients with implanted cardiac pacemakers: report of AAPM Task Group No. 34. American association of physicists in medicine. Med Phys 21:85–90CrossRefPubMed

39.

McCollough CH, Zhang J, Primak AN et al (2007) Effects of CT irradiation on implantable cardiac rhythm management devices. Radiology 243:766–774CrossRefPubMed

40.

Medtronic (2013) Therapeutic radiation. http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@corp/documents/documents/crdm_sl_radiation.pdf

41.

Menard J, Campana F, Kirov KM et al (2011) Radiotherapy for breast cancer and pacemaker. Cancer Radiother 15:197–201CrossRefPubMed

42.

Mitra D, Ghosh K, Gupta P et al (2006) Radiation dose monitoring in a lung cancer patient with a pacemaker—a case report. Indian J Radiol Imaging 16:857–877CrossRef

43.

Mouton J, Haug R, Bridier A et al (2002) Influence of high-energy photon beam irradiation on pacemaker operation. Phys Med Biol 47:2879–2893CrossRefPubMed

44.

Munshi A, Wadasadawala T, Sharma PK et al (2008) Radiation therapy planning of a breast cancer patient with in situ pacemaker–challenges and lessons. Acta Oncol 47:255–260CrossRefPubMed

45.

Nemec J (2007) Runaway implantable defibrillator–a rare complication of radiation therapy. Pacing Clin Electrophysiol 30:716–718CrossRefPubMed

46.

Nibhanupudy JR, de Jesus MA, Fujita M et al (2001) Radiation dose monitoring in a breast cancer patient with a pacemaker: a case report. J Natl Med Assoc 93:278–281PubMedCentralPubMed

47.

Niehaus M, Tebbenjohanns J (2001) Electromagnetic interference in patients with implanted pacemakers or cardioverter-defibrillators. Heart 86:246–248PubMedCentralPubMed

48.

Oshiro Y, Sugahara S, Noma M et al (2008) Proton beam therapy interference with implanted cardiac pacemakers. Int J Radiat Oncol Biol Phys 72:723–727CrossRefPubMed

49.

Raitt MH, Stelzer KJ, Laramore GE et al (1994) Runaway pacemaker during high-energy neutron radiation therapy. Chest 106:955–957CrossRefPubMed

50.

Rothig H, Herrmann T, Kopcsek H (1995) Experience in dealing with artificial pacemaker patients during therapy with ionizing radiation. Strahlenther Onkol 171:398–402PubMed

51.

Schlaff CD, Krauze A, Belard A et al (2014) Bringing the heavy: carbon ion therapy in the radiobiological and clinical context. Radiat Oncol 9:88CrossRefPubMedCentralPubMed

52.

Sepe S, Schaffer P, Krimmel K et al (2007) Irradiation treatment of laryngeal cancer in a patient with an implantable cardioverter-defibrillator (ICD). Onkologie 30:378–380CrossRefPubMed

53.

Snow JS, Kalenderian D, Colasacco JA et al (1995) Implanted devices and electromagnetic interference: case presentations and review. J Invasive Cardiol 7:25–32PubMed

54.

Soejima T, Yoden E, Y NI et al (2011) Radiation therapy in patients with implanted cardiac pacemakers and implantable cardioverter defibrillators: a prospective survey in Japan. J Radiat Res 52:516–521CrossRefPubMed

55.

Solan AN, Solan MJ, Bednarz G et al (2004) Treatment of patients with cardiac pacemakers and implantable cardioverter-defibrillators during radiotherapy. Int J Radiat Oncol Biol Phys 59:897–904CrossRefPubMed

56.

Souliman SK, Christie J (1994) Pacemaker failure induced by radiotherapy. Pacing Clin Electrophysiol 17:270–273CrossRefPubMed

57.

Sundar S, Symonds RP, Deehan C (2005) Radiotherapy to patients with artificial cardiac pacemakers. Cancer Treat Rev 31:474–486CrossRefPubMed

58.

TheTask Force on cardiac pacing, resynchronization therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association, Brignole M et al (2014) 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Rev Esp Cardiol 67:58PubMed

59.

Thomas D, Becker R, Katus HA et al (2004) Radiation therapy-induced electrical reset of an implantable cardioverter defibrillator device located outside the irradiation field. J Electrocardiol 37:73–74CrossRefPubMed

60.

Tondato F, Ng DW, Srivathsan K et al (2009) Radiotherapy-induced pacemaker and implantable cardioverter defibrillator malfunction. Expert Rev Med Devices 6:243–249CrossRefPubMed

61.

Tsekos A, Momm F, Brunner M et al (2000) The cardiac pacemaker patient–might the pacer be directly irradiated? Acta Oncol 39:881–883CrossRefPubMed

62.

Uiterwaal GJ, Springorum BGF, Scheepers E et al (2006) Interference detection in implantable defibrillators induced by therapeutic radiation therapy. Neth Heart J 14:330–334PubMedCentralPubMed

63.

Kuck KH, Hindricks G, Padeletti L, et al (2014) The EHRA white book. The current status of cardiac electrophysiology in ESC Member countries. http://www.escardio.org/communities/EHRA/publications/Documents/ehra-white-book-2014.pdf

64.

Wadasadawala T, Pandey A, Agarwal JP et al (2011) Radiation therapy with implanted cardiac pacemaker devices: a clinical and dosimetric analysis of patients and proposed precautions. Clin Oncol (R Coll Radiol) 23:79–85CrossRef

65.

Wilkinson JD, Bounds C, Brown T et al (2005) Cancer-Radiotherapy equipment as a cause of soft errors in electronic equipment. IEEE transactions device and materials reliability 5:449–451

66.

Wilm M, Kronholz HL, Schutz J et al (1994) The modification of programmable pacemakers by therapeutic irradiation. Strahlenther Onkol 170:225–231PubMed

67.

Zaremba T, Jakobsen AR, Thogersen AM et al (2014) The effect of radiotherapy beam energy on modern cardiac devices: an in vitro study. Europace 16:612–616CrossRefPubMed

68.

Zaremba T, Thogersen AM, Eschen O et al (2010) High-dose radiotherapy exposure to cardiac pacemakers may be safe in selected patients. Radiother Oncol 95:133–134CrossRefPubMed

69.

Zweng A, Schuster R, Hawlicek R et al (2009) Life-threatening pacemaker dysfunction associated with therapeutic radiation: a case report. Angiology 60:509–512CrossRefPubMed

Titel: DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices
verfasst von: Dr. med. Benjamin Gauter-Fleckenstein, MD
Carsten W. Israel, MD
Marc Dorenkamp, MD
Jürgen Dunst, MD
Mattias Roser, MD
Rainer Schimpf, MD
Volker Steil
Jörg Schäfer, MD
Ulrike Höller, MD
Frederik Wenz, MD
Publikationsdatum: 01.05.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 5/2015
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-015-0817-3

Neu im Fachgebiet Onkologie

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Springer Medizin

DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices

Abstract

Neu im Fachgebiet Onkologie

Umsetzung der POMGAT-Leitlinie läuft

CUP-Syndrom: Künstliche Intelligenz kann Primärtumor finden

Sind Frauen die fähigeren Ärzte?

Adjuvante Immuntherapie verlängert Leben bei RCC

Update Onkologie

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2015

The SS x-ray unit as an instrument for “total registration” and “race selection”

CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma

Hepatotoxicity after liver irradiation in children and adolescents

Successful radiation treatment of chylous ascites following pancreaticoduodenectomy

Zu empfehlende Dauer der hormonablativen Therapie des lokalisierten Prostatakarzinoms vor Strahlentherapie weiterhin unklar

Linearity of patient positioning detection

Neu im Fachgebiet Onkologie

Umsetzung der POMGAT-Leitlinie läuft

CUP-Syndrom: Künstliche Intelligenz kann Primärtumor finden

Sind Frauen die fähigeren Ärzte?

Adjuvante Immuntherapie verlängert Leben bei RCC

Update Onkologie