Management of cardiac implantable devices during radiation therapy: a single centre experience.
PO-1070
Abstract
Management of cardiac implantable devices during radiation therapy: a single centre experience.
Authors: Riccardo Villa1,2, Jessica Franzetti1,2, Dario Zerini1, Chiara Lorubbio1,2, Federica Cattani3, Nicola Colombo4, Maurizio Civelli4, Giuseppina Lamantia4, Alessandro Colombo4, Giulia Bacchiani4, Carlo Ambrogio Meroni4, Barbara Alicja Jereczek-Fossa1,2
1IEO, European Institute of Oncology, IRCCS, Division of Radiation Oncology, Milan, Italy; 2University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy; 3IEO, European Institute of Oncology, IRCCS, Unit of Medical Physics, Milan, Italy; 4IEO, European Institute of Oncology, IRCCS, Division of Cardiology, Milan, Italy
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Purpose or Objective
Over the past few years, an increasing number of cardiac implantable electronic devices (CIEDs), including both pacemakers (PM), implantable cardiac defibrillators (ICD) and loop recorders (LR), has been used to manage various type of cardiac arrhythmias. Considering that the number of radiation therapy (RT) treatments is increasing, to ensure a safe management of all the devices has become mandatory. The aim of this work is to explain how CIEDs are managed in a single centre experience.
Material and Methods
We evaluated and described our activity from the end of June 2010 to September 2021; the clinical data was downloaded from a database including all the patients with CIEDs treated in our department.
Results
215 patients with CIEDs were treated in our Institute in the period in analysis: 149 patients with PM, 65 with ICD and one with LR. 40 radiation treatments were re-irradiations. Beam energy for all the therapies was X6 MV; 68 patients were treated with 3D conformal RT, 30 with intensity-modulated RT, 116 with stereotactic RT and one with brachytherapy RT. In agreement with our Cardiologists, a procedure for this kind of patients has been designed by defining probability classes for the CIEDs damage risk. On the base of the assigned risk class (low, intermediate, or high) we differently monitored the patients during the radiation delivery: 33 patients in the low-risk class were audio-visual monitored by radiation oncologists; 148 patients in the intermediate risk class were monitored with electrocardiogram (ECG) and pulse oximeter by radiation oncologists and nurses; in 34 cases, representing the high-risk class, even the presence of a cardiologist was considered necessary. During the treatments any adverse event has been registered: one patient died due to other causes.
Conclusion
Our Institute CIEDs management is based on a multidisciplinary team and on the training of the RT staff. This method appears to be safe and permits the access to the RT to all the patients with CIEDs; however, further study is deemed useful to update the current knowledge to the quick progress in technologies.