SU-E-T-183: Managing and Assessing Patients Receiving Radiotherapy with Implantable Cardiac Devices

To assess the effectiveness of the management of patients with cardiac electronic implantable devices (CEIDS) receiving radiotherapy.

In 2005, a formal communication process was established between Radiation Oncology and Cardiac Electrophysiology (EP) for the management of patients with permanent, implantable cardiac devices receiving radiotherapy. The process requires a pre-treatment consult with EP. This information is provided to a medical physicist, who works with the primary radiation oncologist and dosimetrist. Based on the estimated dose to the device, EP and Radiation Oncology will determine the appropriate oversight required for treatment. To assess the effectiveness of this program, a retrospective analysis of patients with implantable cardiac devices receiving radiotherapy between the years 2005 and 2011 was performed.

Sixty-nine patients with CEIDs (19 implantable cardioverter defibrillators (ICDs) and 50 pacemakers) were treated in Radiation Oncology between 2005 and 2011. Patients were treated to a variety of sites, including 21 patients treated to multiple sites. Doses were estimated prior to radiotherapy, and in vivo measurements were obtained for patients near or exceeding our institutional device tolerance (ICDs = 1 Gy and ICPs = 2 Gy), or if the device was less than 10 cm from the edge of a treatment field. Of the patients evaluated, there were only two patients with ICD devices which had a partial reset of diagnostic data during their treatment. There were no major device failures of arrhythmia detection or treatment.

Our multi-disciplinary team has worked together to develop a process to manage the care of patients with permanent implantable cardiac devices. There have been few device events noted in our patient cohort. The team will continue to follow our institutional management methodology to assess the appropriate amount of EP care necessary during radiation therapy. Laura Horwood is on the speakers bureau for Medtronic. Frank Pelosi is on the advisory board for Boston Scientific Corp and St. Jude Medical, is receiving an educational grants from Medtronic, St Jude, Boston Scientific, Biotronik, and a research grants from Medtronic.