A policy for radiotherapy in patients with implanted pacemakers

As the prevalence of implanted pacemakers increases, the likelihood that cancer requiring radiotherapy will develop in pacemaker-bearing patients increases proportionately. A management policy for pacemaker-dependent patients who require radiotherapy helps assure that they will be safely and efficiently treated with external beam radiation. Guidelines for external beam treatment have been set forth in the ASTRO Newsletter. These guidelines are the basis of the specific policy that was developed and implemented. This policy (1) requires a cardiology consultation and discussion with the manufacturer before treatment, (2) prohibits the use of a betatron, (3) suggests that attempts be made to limit the dose received by the pacemaker to 2-Gy, (4) requires that pacemaker dose be calculated, measured, and recorded in the patient chart, (5) requires cardiac monitoring in accordance with the degree of patient pacemaker dependence, and (6) requires a follow-up cardiology consultation after the patient's final treatment. Adherence to this policy is assured by use of a worksheet that is included in each pacemaker patient's chart.