Risk of cardiac implantable device malfunction in cancer patients receiving proton therapy: an overview

Abstract

Age is a risk factor for both cardiovascular disease and cancer, and as such radiation oncologists frequently see a number of patients with cardiac implantable electronic devices (CIEDs) receiving proton therapy (PT). CIED malfunctions induced by PT are nonnegligible and can occur in both passive scattering and pencil beam scanning modes. In the absence of an evidence-based protocol, the authors emphasise that this patient cohort should be managed differently to electron- and photon- external beam radiation therapy (EBRT) patients due to distinct properties of proton beams. Given the lack of a PT-specific guideline for managing this cohort and limited studies on this important topic; the process was initiated by evaluating all PT-related CIED malfunctions to provide a baseline for future reporting and research. In this review, different modes of PT and their interactions with a variety of CIEDs and pacing leads are discussed. Effects of PT on CIEDs were classified into a variety of hardware and software malfunctions. Apart from secondary neutrons, cumulative radiation dose, dose rate, CIED model/manufacturer, distance from CIED to proton field, and materials used in CIEDs/pacing leads were all evaluated to determine the probability of malfunctions. The importance of proton beam arrangements is highlighted in this study. Manufacturers should specify recommended dose limits for patients undergoing PT. The establishment of an international multidisciplinary team dedicated to CIED-bearing patients receiving PT may be beneficial.

A script‐enabled interactive checklist document for efficient management of electronic devices in a busy multimodality radiotherapy clinic

“…6 Although the measured neutron dose for PBS is less than both passively-scattered proton therapy and 18 MV x-ray therapy, 1,6,7 a SEU could potentially lead to catastrophic failure, in particular for CIEDs, leading to enhanced treatment guidelines in PBS proton therapy. 1,8,9 The workflow and experience in our clinic for treating CIED patients with PBS protons has been previously reported. 10 This study's purpose was to design a single clinical checklist document that was flexible to accommodate differing guidelines based on device type and treatment modality, while efficiently streamlining the quick workflow of our busy clinic.…”