Particle therapy using protons or carbon ions for cancer patients with cardiac implantable electronic devices (CIED): a retrospective multi-institutional study

Abstract

Purpose To evaluate the outcomes of particle therapy in cancer patients with cardiac implantable electronic devices (CIEDs). Materials and methods From April 2001 to March 2013, 19,585 patients were treated with proton beam therapy (PBT) or carbon ion therapy (CIT) at 8 institutions. Of these, 69 patients (0.4%, PBT 46, CIT 22, and PBT + CIT 1) with CIEDs (64 pacemakers, 4 implantable cardioverter defibrillators, and 1 with a cardiac resynchronization therapy defibrillator) were retrospectively reviewed. All the patients with CIEDs in this study were treated with the passive scattering type of particle beam therapy. Results Six (13%) of the 47 PBT patients, and none of the 23 CIT patients experienced CIED malfunctions (p = 0.105). Electrical resets (7) and over-sensing (3) occurred transiently in 6 patients. The distance between the edge of the irradiation field and the CIED was not associated with the incidence of malfunctions in 20 patients with lung cancer. A larger field size had a higher event rate but the test to evaluate trends as not statistically significant (p = 0.196). Conclusion Differences in the frequency of occurrence of device malfunctions for patients treated with PBT and patients treated with CIT did not reach statistical significance. The present study can be regarded as a benchmark study about the incidence of malfunctioning of CIED in passive scattering particle beam therapy and can be used as a reference for active scanning particle beam therapy.

In reply to “Comment on “Particle therapy using protons or carbon ions for cancer patients with cardiac implantable electronic devices (CIED): a retrospective multi-institutional study””

“…In the Matsubara Letter to the Editor [3], they stated that: (a) if the same physical dose is irradiated, carbon ion therapy (CIT) is safer than proton beam therapy (PBT) even without considering relative biological effectiveness (RBE), because the number of particles itself and the generated number of secondary neutrons are much smaller in CIT, (b) the reaction cross section of the neutron beam production is larger for carbon beams, CIT is still safer than PBT, however. We agree with their observation as we described: "Also, the previous dosimetric studies suggested that CIT generates fewer secondary neutrons than PBT even for the same physical absorbed dose in Gy" referring to the Matsubara et al paper in the Discussion section of the original paper [1]. However, probably due to our insufficient explanation, our phrasing seems to have been too vague to be understood correctly.…”

“…To the Editor, We are grateful for the detailed and valuable comments in response to our article [1]. We cited the report of Matsubara et al in the original paper, where they describe the probability of developing cardiac implantable electronic device (CIED) errors [2].…”

The impact of particle radiotherapy on the functioning of cardiac implantable electronic devices: a systematic review of in vitro and in vivo studies according to PICO criteria

“…15/81 (18.5%) patients with this information available were pacing-dependent. Except for one study that did not provide these data [ 33 ], dose constraints to the CIED’s power generator were maintained within the manufacturer and guidelines recommended limits by all the other studies (maximum dose of 2 Gy (RBE) or less) and the CIED was never located within the treatment field. Hashimoto et al [ 33 ] did not provide information concerning CIED checking and intrasession monitoring; in contrast, in the remaining studies, each CIED was checked in advance before the first session.…”

“…Five retrospective [29][30][31][32][33] cohort studies published between 2008 and 2021 were included. A total of 157 patients (age range between 43 and 97 years old) who underwent 161 courses or particle-beam RT were included in the studies.…”

“…The patient with ERI status underwent uneventful elective generator replacement [30]; no further details were provided by Hashimoto et al [33] concerning the patient who experienced 3 episodes of ICD oversensing, except for the fact that no permanent device malfunctions were observed. Limited sub-analyses were performed according to the radiation site (thoracic vs not thoracic), the type of device (PM vs ICD), the type of beam scattering, the type of particle (passive scattering PBT vs CIRT) and the field to generation distance.…”