Targeted Intraoperative Radiotherapy Is a Safe Approach for Patients with Pacemakers: A Case Study and Literature Review

Abstract

Case reports detailing the effects of targeted intraoperative radiation therapy (IORT) on patients with cardiac pacemakers (PMs) are rare. This growing population subgroup requiring IORT and lack of standardized guidelines necessitate more practical published research. An 81-year-old patient with clinical stage II, T1 N0 grade III, triple-negative invasive ductal carcinoma and an implanted single-lead chamber PM (VVIR mode, model: Biotronik, type Effecta SR) received targeted intraoperative radiotherapy at the time of wide local excision and sentinel lymph node biopsy. It presents the shortest distance between the outer diameter of the PM and IORT applicator in literature. Target IORT was performed utilizing an Intrabeam device (50 kV, Carl Zeiss Surgical, Oberkochen, Germany). This case elucidates the successful use of targeted IORT for breast-conserving surgery in a patient with a single ipsilateral chamber VVIR mode PM. No device failure or malfunction was reported for the PM before, during, or after the procedure. These findings support the use of targeted IORT for patients diagnosed with early-stage breast carcinomas who have a PM implanted. However, further research is needed to understand the safety of other methods and devices for IORT patients with cardiac implantable electronic devices.

Case Report: Can Targeted Intraoperative Radiotherapy in Patients With Breast Cancer and Pacemakers be the New Standard of Care?

“…Although previous studies have evaluated the utility of IORT in patients with breast cancer, fewer have elucidated its use when associated with a presence of ipsilateral pacemaker ( 7 , 14 , 33 ). Chen et al.…”

“…Although previous studies have evaluated the utility of IORT in patients with breast cancer, fewer have elucidated its use when associated with a presence of ipsilateral pacemaker (7,14,33). Chen et al (29) assessed the dose for a patient with a pacemaker being treated in the left breast with IORT in phantom cases.…”

“…In an older population, the increasing overlap between these two groups is anticipated to contribute to an increase in the number of instances involving people with pacemaker and breast cancer ( 12 ). There is a paucity of literature looking at the use of IORT in patients with pacemakers, and the manufacturers are less likely to conduct cardiac pacemaker testing with various IORT devices due to a large number of devices available on the market for both ( 14 ). Thus, our case reports aim to highlight the applicability of IORT in breast cancer patients who also have a pacemaker on the same side.…”