Radiation Oncology/Pacemaker

Treatment of patients with pacemakers and implantable cardioverter-defibrillators (ICDs)

AAPM Task Group 34

AAPM Report No. 45 (PDF) - "Management of Radiation Oncology Patients with Implanted Cardiac Pacemakers" (Reprinted from Medical Physics, Vol. 21, Issue 1) (1994)

Recommendations:

1. Pacemaker implanted patients should not be treated with a betatron (okay...)
2. Pacemakers should not be placed in the direct (unshielded) therapy beam. Some accelerator beams can cause transient malfunction.
3. The absorbed dose to be received by the pacemaker should be estimated before treatment.
4. If the total estimated dose to the pacemaker might > 2 Gy, the pacemaker function should be checked prior to therapy and possibly at the start of each following week of therapy. Since total and abrupt failure of pacemakers has been seen at cumulative doses between 10-30 Gy and significant functional changes have been observed between 2-10 Gy, early changes in pacemaker parameters could signal a failure in the 2-10 Gy region.
5. Although transient malfunction from electromagnetic interference is unlikely from contemporary therapy accelerators and cobalt irradiators, the patient should be closely observed during the first treatment with a linear accelerator and during subsequent treatments if magnetron or klystron misfiring (sparking) occurs.
6. Studies to date have dealt with linear accelerators, betatrons, and cobalt irradiators only. Use of other radiation therapy machines should be evaluated on an individual basis and approached with caution.

Articles

• MD Anderson, 2015
  • PMID 26181143 — "Radiotherapy-Induced Malfunction in Contemporary Cardiovascular Implantable Electronic Devices: Clinical Incidence and Predictors." Grant JD et al. JAMA Oncol. 2015 Aug;1(5):624-32.
• Netherlands, 2012
  • PMID 23176563 — "Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline in The Netherlands. Dutch Society of Radiotherapy and Oncology (NVRO)." Hurkmans CW et al. Radiat Oncol. 2012 Nov 24;7:198.
• Netherlands, 2005
  • PMID 16019095 — "Influence of radiotherapy on the latest generation of pacemakers." Hurkmans CW et al. Radiother Oncol. 2005 Jul;76(1):93-8.
  • PMID 16111598 — "Influence of radiotherapy on the latest generation of implantable cardioverter-defibrillators." Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):282-9.

• U. Pittsburgh, 2004 - PMID 15183493 — "Treatment of patients with cardiac pacemakers and implantable cardioverter-defibrillators during radiotherapy." Solan AN et al. Int J Radiat Oncol Biol Phys. 2004 Jul 1;59(3):897-904.

• Royal Marsden, 1998 - PMID 9534692 — "Radiotherapy in patients with cardiac pacemakers." Last A et al. Br J Radiol. 1998 Jan;71(841):4-10.