Radioterapia pacjentow z stymulatorem serca lub kardiowerterem defibrylatorem: zasady bezpiecznego stosowania

Abstract

Author(s): Ziolkowska Ewa, Wisniewski Tomasz, Bialas Mieszko, Balcerzak Marek, Wozniak-Wisniewska Anita, Sinkiewicz Wladyslaw

Introduction: Continuous rise in the number of patients with cardiac devices as pacemakers or cardioverter- defibrillators subjected to radiotherapy is observed. The serious damage can occur during irradiation patient with cardiac pacemaker. Still is lack of detailed guidelines about radiotherapy to patients with this devices.

Material and methods: According to recommendations of the American Association of Medical Physicists and the accessible literature the algorithm of safely irradiation patients with cardiac pacemaker was created. These rules were applied at 41 patients administered to the Center of Oncology in Bydgoszcz in years 2009-2011.

Results: Among 41 patients enrolled to the study 19 persons (47%) was treated with radical intention, and 17 patients (41%) received the palliative radiotherapy. Five patients (12%) were disqualified from the radiotherapy. A most frequent kind of the cardiac device was the pacemaker (35 persons - 85%), instead 5 persons had implantable cardiac defibrillator. One patient had cardiac resynchronization therapy device. Most often the pacemaker was placed near irradiated field (19 persons - 47%), but 10 patients had pacemaker in irradiated field. From this reason one patient demanded dislocations of the pacemaker to the right subclavicular region. The pacemaker was found far from irradiated field in 12 cases (29%). The average dose received by the pulse generator was 1,43 Gy ( range: 0-22 Gy). Radiation therapy was safely delivered in all of 36 patients without any untoward effects. At 6 months of median follow-up, all patients were well with no malfunction of the pacemaker

Conclusions: Close liaison with the cardiologist and radiation oncologist is essential to ensure patient safety. The presented recommendations makes possible the treatment safely in this group of patients.

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