Radiation therapy in oncology patients who have a pacemaker or implantable cardioverter-defibrillator

Frizzell, Bart

doi:10.1016/s1548-5315(11)70285-6

Cited by 17 publications

(11 citation statements)

References 11 publications

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“…This audit used the AAPM guidelines and Frizzell report as the benchmark to compare UK radiotherapy departments' current CIED policies, as in the opinion of the authors, these guidelines had the most robust evidence base to support them [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…The Frizzell report recommended a lower radiotherapy tolerance dose of 0.5 Gy for ICDs and that they should be deactivated before radiotherapy by placing a magnet over the device to prevent inappropriate therapy or shock delivery as a result of accidental sensing of EMI interference [18]. Worryingly, the audit shows that only 5/45 (11%) radiotherapy departments limit the ICD dose to 0.5 Gy, 23/ 45 (51%) radiotherapy departments specify a higher ICD tolerance than recommended and 17/45 (38%) do not state a radiotherapy tolerance dose.…”

Section: Discussionmentioning

confidence: 99%

“…The AAPM and Frizzell reports recommend that all patients with CIEDs be monitored with a continuous ECG strip during their first radiotherapy treatment for any evidence of pacing disruption [17,18]. In addition, they should be monitored by an appropriately trained health professional.…”

Section: Discussionmentioning

confidence: 99%

“…The AAPM report is the basis of most of the current CIED departmental radiotherapy policies in the UK (authors' observation). Frizzell [18] published a more contemporary review and a distinction was made between pacemakers and ICDs. Both the AAPM and the Frizzell reports are widely referenced in the literature and in our opinion have the most robust evidence base to support them.…”

Section: Introductionmentioning

confidence: 99%

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A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

et al. 2014

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Aims: The number of patients with cardiac implantable electronic devices (permanent pacemakers and implantable cardioverter defibrillators) undergoing radiotherapy treatment is increasing. The aims of this audit were to establish current UK practice regarding the management of patients with implanted cardiac devices undergoing radiotherapy and to compare this practice with current 'gold standard' evidence-based guidelines. Materials and methods: All UK radiotherapy departments were contacted and asked to provide their current cardiac implantable electronic device policy or to indicate if there was no current policy. A proforma was created to analyse these polices and to compare with current best practice. Results: In total, 47/67 (70%) radiotherapy departments responded and 45 departmental policies were submitted; 31/45 (69%) policies defined the radiotherapy tolerance dose to permanent pacemakers and 14/45 (31%) defined the monitoring procedure for patients in line with current best practice. Only 5/45 (11%) policies defined the radiotherapy tolerance dose to implantable cardioverter defibrillators and 12/45 (27%) defined the monitoring procedure in line with current best practice. Conclusion: Most UK cardiac device policies do not reflect current best evidence. Policies are based on research carried out in

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

et al. 2014

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“…In case this is not known prior to consultation, the patient should be asked during the first visit to the RT facility. The patient (or patient’s legal representative) consent should be obtained in which that person is educated and notified about the potential adverse effects of RT on CIEDs and that an ICD might be deactivated during RT …”

Section: Patient Management and Recommendationsmentioning

confidence: 99%

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

et al. 2019

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Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter‐defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG‐34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.

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Management of radiation therapy patients with cardiac defibrillator or pacemaker

et al. 2015

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The increasing growth of population with cardiac implantable electronic devices (CIEDs) such as Pacemaker (PM) and Implantable Cardiac Defibrillators (ICD), requires particular attention in management of patients needing radiation treatment. This paper updates and summarizes some recommendations from different international guidelines. Ionizing radiation and/or electromagnetic interferences could cause device failure. Current approaches to treatment in patients who have these devices vary among radiation oncology centres. We refer to the German Society of Radiation Oncology and Cardiology guidelines (ed. 2015); to the Society of Cardiology Australia and New Zealand Statement (ed. 2015); to the guidelines in force in the Netherlands (ed. 2012) and to the Italian Association of Radiation Oncology recommendations (ed. 2013) as reported in the guidelines for the treatment of breast cancer in patients with CIED. Although there is not a clear cut-off point, risk of device failure increases with increasing doses. Cumulative dose and pacing dependency have been combined to categorize patients into low-, medium- and high-risk groups. Measures to secure patient safety are described for each category. The use of energy ≤6MV is preferable and it's strongly recommended not to exceed a total dose of 2 Gy to the PM and 1 Gy for ICD. Given the dangers of device malfunction, radiation oncology departments should adopt all the measures designed to minimize the risk to patients. For this reason, a close collaboration between cardiologist, radiotherapist and physicist is necessary.

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Radiation therapy in oncology patients who have a pacemaker or implantable cardioverter-defibrillator

Cited by 17 publications

References 11 publications

A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

Management of radiation therapy patients with cardiac defibrillator or pacemaker

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Radiation therapy in oncology patients who have a pacemaker or implantable cardioverter-defibrillator

Cited by 17 publications

References 11 publications

A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

A National Audit of Current Cardiac Device Policies from Radiotherapy Centres across the UK

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

Management of radiation therapy patients with cardiac defibrillator or pacemaker

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Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†