safe radiotherapy in patients with implanted cardiac pacemaker

ABSTRACT

Radiotherapy to cancer patients having implanted cardiac pacemakers [ICPs] is challenging decision. The literature reported serious life threatening complications secondary to ICP malfunction. As the number of patients with ICPs requiring radiation therapy is on rise, it is recommended that cardiologist, physicist and radiation oncologist be aware of the potential risks to ICPs and their prevention. Most of radiotherapy centers do not have internal policy and procedures [IPPs] to handle cancer patients with ICP receiving radiation. This article reported three radiotherapy courses in two cancer patients with ICP treated at our center. The Pub med and cochrane database were searched for the potential hazards and effects of radiotherapy on patients having ICPs. The reviewed literature showed that modern multi-programmable pacemakers are very sensitive to radiation therapy in comparison old generation pacemakers. The radiation therapy candestroy ICP or at least can affect its function. There is no safe radiation threshold for ionizing radiation, however it is not contraindicated. Megavoltage radiation can be safely delivered to patients with cardiac pacemakers provided direct irradiation of pacemakers is avoided, adequate monitoring is required during and after irradiation and the dose to the pacemaker generator should be kept below 2 Gy. Close follow-up with cardiologists and a pacemaker clinic is essential. Radiotherapy departments should have their own protocols in place for cancer patients with ICPs