A protocol for thoracic radiation therapy in patients with cardiac implantable electronic devices

Abstract

Prolonged lifespan and improved diagnostic and treatment modalities have led to significant progress in the diagnosis and treatment of cardiovascular disease and cancer. A substantial number of patients with malignancies also have cardiovascular disease at the time of cancer treatment. Per literature, over one million implantable cardiac devices are inserted annually. Ionizing radiation, especially in the thoracic area is related to cardiac implantable electronic device (CIED) damage and malfunction. Besides that, CIED can interfere with radiotherapy planning and delivery, as well as patient motivation to undergo radiotherapy treatment. Management of oncology patients, undergoing radiotherapy, for any indication, with a CIED is essential, and safe radiotherapy practice requires minimizing the risk to patients as much as possible, from pretherapy planning to posttherapy follow-up. A collaborative multidisciplinary approach, tailor-made for every single radiotherapy center is imperative to provide effective and safe radiotherapy for these patients. A collaboration of radiation oncologists, medical physicists and cardiologists from the University Clinical Center Kragujevac has created a local protocol for radiotherapy treatment and follow-up for patients receiving radiotherapy at the Center for Radiation Oncology University C linical Center Kragujevac, which provides safe and efficient delivery of an adequate radiotherapy dose to target volumes with appropriate cardiac monitoring.