Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Radiation Oncology

Lieselot van Erven⁵  Marleen MJ Ploegmakers⁴  Arnoud J van der Borden³  GJ Uiterwaal²  Ad JJ Maas²  Bing S Oei¹  Joost L Knegjens¹  Coen W Hurkmans¹ 

[1] Dutch Society of Radiotherapy and Oncology (NVRO), Utrecht, The Netherlands;Dutch Society of Specialists in Invasive Heart Stimulation (VITHaS), Utrecht, The Netherlands;Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands;Order of Medical Specialists (OMS), Utrecht, The Netherlands;Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

关键词: Risk management;    CIED;    Guideline;    Implantable cardioverter defibrillator;    Pacemaker;   

Others  :  1155020
DOI  :  10.1186/1748-717X-7-198

 received in 2012-07-24, accepted in 2012-11-21,  发布年份 2012

【 摘 要 】

Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.

【 授权许可】

   
2012 Hurkmans et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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