title: Management of radiation therapy patients with cardiac defibrillator or pacemaker.
abstract: The increasing growth of population with cardiac implantable electronic devices (CIEDs) such as Pacemaker (PM) and Implantable Cardiac Defibrillators (ICD), requires particular attention in management of patients needing radiation treatment. This paper updates and summarizes some recommendations from different international guidelines. Ionizing radiation and/or electromagnetic interferences could cause device failure. Current approaches to treatment in patients who have these devices vary among radiation oncology centres. We refer to the German Society of Radiation Oncology and Cardiology guidelines (ed. 2015); to the Society of Cardiology Australia and New Zealand Statement (ed. 2015); to the guidelines in force in the Netherlands (ed. 2012) and to the Italian Association of Radiation Oncology recommendations (ed. 2013) as reported in the guidelines for the treatment of breast cancer in patients with CIED. Although there is not a clear cut-off point, risk of device failure increases with increasing doses. Cumulative dose and pacing dependency have been combined to categorize patients into low-, medium- and high-risk groups. Measures to secure patient safety are described for each category. The use of energy ≤6MV is preferable and it's strongly recommended not to exceed a total dose of 2 Gy to the PM and 1 Gy for ICD. Given the dangers of device malfunction, radiation oncology departments should adopt all the measures designed to minimize the risk to patients. For this reason, a close collaboration between cardiologist, radiotherapist and physicist is necessary.
authors.affiliation: Department of Radiation Oncology, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy. fra-salerno@libero.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Salerno
authors.affiliation: Department of Radiation Oncology, Azienda Ospedaliera San Giovanni Addolorata-Roma, Via Santo Stefano Rotondo 5/A, 00184, Rome, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Gomellini
authors.affiliation: Department of Radiation Oncology, Azienda Ospedaliera San Giovanni Addolorata-Roma, Via Santo Stefano Rotondo 5/A, 00184, Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Caruso
authors.affiliation: Department of Radiation Oncology, Azienda Ospedaliera San Giovanni Addolorata-Roma, Via Santo Stefano Rotondo 5/A, 00184, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Barbara
authors.affiliation: Department of Radiation Oncology, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Musio
authors.affiliation: Department of Cardiology, Azienda Ospedaliera San Giovanni Addolorata-Roma, Via dell'Amba Aradam 9, 00184, Rome, Italy.
authors.forename: Tamara
authors.initials: T
authors.lastname: Coppi
authors.affiliation: Department of Cardiology, Azienda Ospedaliera San Giovanni Addolorata-Roma, Via dell'Amba Aradam 9, 00184, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Cardinale
authors.affiliation: Department of Radiation Oncology, Policlinico Umberto I "Sapienza", University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tombolini
authors.affiliation: Department of Radiation Oncology, Azienda Ospedaliera San Giovanni Addolorata-Roma, Via Santo Stefano Rotondo 5/A, 00184, Rome, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: de Paula
mesh_terms: D017147:Defibrillators, Implantable; D019468:Disease Management; D055590:Electromagnetic Phenomena; D004868:Equipment Failure; D006801:Humans; D010138:Pacemaker, Artificial; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D012308:Risk Management
keywords: Guidelines; Implantable cardioverter defibrillator; Ionizing radiation; Pacemaker; Pacing-dependent; Risk class