Pacemaker Malfunction Triggered by Cybersecurity Activation During Carbon Ion Radiotherapy: A Case Report

Area of Science:

• Medical Physics
• Oncology
• Cardiology

Background:

• Carbon ion radiotherapy (CIRT) offers superior efficacy for radioresistant tumors and those near critical organs.
• Patients with cardiac implantable electronic devices (CIEDs) face unique risks during radiation therapy, including potential device malfunction.
• Neutrons generated during CIRT may interfere with CIED function, though documented cases are rare.

Observation:

• A case report details an 83-year-old male with early-stage lung cancer and a pacemaker undergoing CIRT.
• Despite meticulous planning to minimize neutron exposure, the patient's pacemaker cybersecurity function unexpectedly activated, disrupting communication.
• The malfunction occurred before the final treatment fraction, leading to CIRT discontinuation after three fractions (45 Gy RBE).

Findings:

• The pacemaker malfunction was hypothesized to be caused by high-energy neutrons from CIRT, activating its failsafe mode.
• While electrocardiogram findings remained stable, the malfunction necessitated treatment modification and raised concerns about potential future device issues.
• The patient completed a partial CIRT course and remained asymptomatic, with no subsequent device abnormalities reported.

Implications:

• This case underscores the potential for unforeseen software-related CIED malfunctions during CIRT, necessitating continuous risk assessment.
• Multidisciplinary management and standardized safety protocols, including cardiological evaluation and device monitoring, are crucial for managing CIED patients during radiation therapy.
• Future research should explore optimized treatment planning, enhanced device software robustness, and shielding strategies to improve safety for CIED patients undergoing particle therapy.