Interaction between CIEDs and modern radiotherapy techniques

• Verfasst von: Gauter-Fleckenstein, Benjamin [VerfasserIn]
• Verfasst von: Nguyen, Julia [VerfasserIn]
• Verfasst von: Jahnke, Lennart [VerfasserIn]
• Verfasst von: Gaiser, Timo [VerfasserIn]
• Verfasst von: Rudic, Boris [VerfasserIn]
• Verfasst von: Büttner, Sylvia [VerfasserIn]
• Verfasst von: Wenz, Frederik [VerfasserIn]
• Verfasst von: Borggrefe, Martin [VerfasserIn]
• Verfasst von: Tueluemen, Erol [VerfasserIn]
• Titel: Interaction between CIEDs and modern radiotherapy techniques
• Titelzusatz: flattening filter free-VMAT, dose-rate effects, scatter radiation, and neutron-generating energies
• Verf.angabe: Benjamin Gauter-Fleckenstein, Julia Nguyen, Lennart Jahnke, Timo Gaiser, Boris Rudic, Sylvia Büttner, Frederik Wenz, Martin Borggrefe, Erol Tülümen
• E-Jahr: 2020
• Jahr: November 2020
• Umfang: 7 S.
• Fussnoten: Gesehen am 31.05.2023
• Titel Quelle: Enthalten in: Radiotherapy and oncology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1983
• Jahr Quelle: 2020
• Band/Heft Quelle: 152(2020) vom: Nov., Seite 196-202
• ISSN Quelle: 1879-0887
• DOI: doi:10.1016/j.radonc.2019.12.007
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Cardiac pacemaker
• Sach-SW: Dose-rate effects
• Sach-SW: Flattening filter free-VMAT
• Sach-SW: Implantable cardioverter-defibrillator
• Sach-SW: Neutron-generating energies
• Sach-SW: Scatter radiation
• K10plus-PPN: 1890393711

Abstract

Background and purpose - Providing evidence for radiotherapy (RT)-induced effects on cardiac implantable electric devices (CIEDs) with focus on flattening filter free-volumetric modulated arc therapy (FFF-VMAT) at 6 and 10 MV as well as 3D-conformal radiotherapy (3D-CRT) at 18 MV. - Materials and methods - 68 CIEDs (64 implantable cardioverter-defibrillators (ICDs) and 4 cardiac pacemakers (PMs)) were located on the left chest position on a slab phantom and irradiated under telemetrical surveillance either directly, or distant to 3D-CRT or FFF-VMAT, dose-rate 2500 cGy/min, and target dose of 150 Gy. Devices were placed within, close by (2.5 cm and 5 cm), and distant (35 cm) to the radiation field. Scatter radiation (SR) and photon neutrons (PN) were recorded. CIEDs were investigated in following groups: 1a) 18 MV 3D-CRT − 4 ICDs/4 PMs out of radiation field, 1b) 18 MV open field − 4 ICDs/4 PMs within radiation field, 2) 6 MV FFF-VMAT, 15 ICDs in 35 cm distance to VMAT, 3) 10 MV-FFF VMAT, 15 ICDs in 35 cm distance to VMAT, 4) 6 MV FFF-VMAT, 15 ICDs in 2.5 cm distance to VMAT, 5) 10 MV FFF-VMAT, 15 ICDs in 2.5 cm distance to VMAT. - Results - No incidents occurred at 6 MV FFF. 10 MV FFF-VMAT and 18 MV 3D-CRT resulted in data loss, reset, and erroneous sensing with inhibition of pacing (leading to inadequate defibrillation) in 8/34 ICDs and 2/4 PMs which were not located within radiation. Direct radiation triggered instantaneous defibrillation in 3/4 ICDs. - Conclusions - 6 MV FFF-VMAT is safe even at high dose-rates of 2500 cGy/min, regardless whether CIEDs are located close (2.5 cm) or distant (35 cm) to the radiation beam. CIEDs should never be placed within radiation and energy should always be limited to 6 MV. At 6 MV, VMAT at high dose-rates can be used to treat tumors, which are located close to CIEDs.