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Radiotherapy-Induced Malfunction in Contemporary Cardiovascular Implantable Electronic Devices: Clinical Incidence
Jonathan D Grant1, Garrett L Jensen2, Chad Tang1
1Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston.
JAMA Oncology
|July 17, 2015
Summary
Cardiovascular implantable electronic device (CIED) malfunction during radiotherapy (RT) is linked to neutron production. Non-neutron-producing RT minimizes CIED malfunction risk, reducing the need for device relocation.
Area of Science:
- Cardiology
- Radiation Oncology
- Medical Physics
Background:
- Management of patients with cardiovascular implantable electronic devices (CIEDs) undergoing radiotherapy (RT) lacks robust data.
- Current risk stratification and management strategies for CIEDs during RT are inconsistent.
Purpose of the Study:
- To determine the incidence and predictors of CIED malfunction in patients receiving RT.
- To describe the clinical consequences associated with CIED malfunction post-RT.
Main Methods:
- Retrospective analysis of 215 patients with CIEDs who underwent 249 RT courses (photon- and electron-based) between 2005 and 2014.
- CIED malfunction events (single-event upsets, signal interference) were assessed following RT.
- RT techniques included neutron-producing (15- or 18-MV photons) and non-neutron-producing (electrons, GammaKnife, 6-MV photons) radiation.
Main Results:
- CIED malfunction occurred in 7% of RT courses (18/249), exclusively during neutron-producing RT (21% incidence).
- No malfunctions were observed during non-neutron-producing RT (0% incidence).
- Abdomen/pelvis RT increased single-event upset risk (HR 5.2); no dose-malfunction correlation was found up to 5.4 Gy.
Conclusions:
- Single-event upsets in CIEDs during RT are strongly associated with neutron production.
- Non-neutron-producing RT is recommended when clinically feasible to mitigate CIED malfunction risk.
- Minimizing invasive CIED relocation may be possible due to the lack of dose-dependent malfunction.
