ESTRO 2022

Session Item

Monday

May 09

09:00 - 10:00

Mini-Oral Theatre 1

22: Mixed sites, palliation

Chair: Jon Cacicedo, Spain;

Co-Chair: Nadia Bouzid, Tunisia

Session Type: Mini-Oral

Track: Clinical

Journey:

Radiation Therapy and Cardiovascular Implanted Electronic Devices: a single center years expierence

Simone Baroni, Italy

Presentation Number: MO-0717

Abstract

Abstract Title:

Radiation Therapy and Cardiovascular Implanted Electronic Devices: a single center years expierence

Authors:

Simone Baroni¹, Simone Gulletta², Marcella Pasetti³, Pasquale Vergara⁴, Sara Broggi⁵, Roberta Tummineri³, Chiara Lucrezia Deantoni³, Flavia Zerbetto³, Andrei Fodor³, Giuseppina Mandurino¹, Ariadna Sanchez Galvan³, Nicolai Fierro⁶, Italo Dell'Oca³, Stefano Arcangeli⁷, Nadia Gisella Di Muzio⁸

¹San Raffaele Scientific Institute, Milano-Bicocca University, Radiation Oncology, Milan, Italy; ²San Raffaele Scientific Institute, Arrhitmology, MIlan, Italy; ³San Raffaele Scientific Institute, Radiation Oncology, Milan, Italy; ⁴San Raffaele Scientific Institute, Arrhitmology, Milan, Italy; ⁵San Raffaele Scientific Institute, Medical Physics, milan, Italy; ⁶San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Arrhitmology, Milan, Italy; ⁷Milano-Bicocca University, ASST Monza, Radiation Oncology, Monza, Italy; ⁸Vita-Salute San Raffaele University, San Raffaele Scientific Institute , Radiation Oncology, Milan, Italy

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Purpose or Objective

Cardiovascular Implanted Electronic Devices (CIED) are becoming more frequently implanted in oncologic patients (pts). Arrithmologist and Radiation Oncologist need to cooperate for the management of these pts. In vitro and in vivo studies demonstrated several malfunctions of CIED following direct exposure to high-energy photons beam. During the treatment planning process CIEDs must be considered as Organ at Risk with specific constraint. In 2018 AIRO (Italian Association of Radiation Oncology) and AIAC(Italian Association of Arrithmology and Cardiac Stimulation) proposed guidelines for CIED management during radiotherapy work flow. Based on CIED dependency, dose at CIED, treatment site and photon beam energy pts are classified in 3 risk groups (low, moderate and high).

Material and Methods

Since 2010, every pt with CIED was evaluated by a dedicated Arrithmologist before Radiation Therapy. During the treatment session every pt was followed by ECG/pulse-oximeter + audio-visual monitoring and magnet positioning. After the daily session, every pt was revaluated by the same Arrithmologist. The contouring of CIED and Lead was integrated into RT plan in order to avoid Maximum Dose > 2 Gy apart from some specific situation. Photon beam energy was 6 MeV for all treatments.

Results

Between 2010 and 2020, 119 CIED pts were treated in our Radiation Oncology Department. We report the data related to 75 pts (63.0%), where the CIED was included in the CT-Scan and identified as OAR. 60 pts (80%) had thorax radiotherapy, while for 15 pts (20%) RT was extra thoracic. Twenty-three (30%) pts were at high risk. Median Dmax and Maximum Doses delivered to CIED and lead were 1.23 Gy- 20.0 Gy and 17.23 Gy- 64.16 Gy respectively. 45 CIEDs (60%) received £2 Gy, 26 CIEDs (34.7%) a Dmax between 2 and 10 Gy, and 4 CIED (5.3%) received a Dmax> 10 Gy. 34 Leads (45.3%) received > 10 Gy. During CIED interrogations, no hardware failure was detected, neither in CIED, nor in Lead.

Conclusion

In our experience, CIED pts can undergo safely to radiation treatment. Even for high-risk pts, especially where Dmax at CIED was > 2 Gy no CIEDs failures were observed. To the best of our knowledge, this study is the first that included CIED and lead as distinct OAR, in order to evaluate their dose distribution. Even if Dmax of lead was high, the effect was not clinically significant.