Ferrara Teresa, Baiotto Barbara, Malinverni Giuseppe, Caria Nicola, Garibaldi Elisabetta, Barboni Gilberto, Stasi Michele, Gabriele Pietro
Radiooncology Department, A Businco Oncologic Hospital, Cagliari, Italy.
Tumori. 2010 Jan-Feb;96(1):76-83. doi: 10.1177/030089161009600113.
A prospective analysis was carried out on a group of irradiated patients with pacemakers or implantable cardioverter-defibrillators to identify any relationship between the various types of devices and physical and dosimetric parameters. Cardiac toxicity of the treatment was also investigated.
Forty-five irradiated patients, implanted with pacemakers or implantable cardioverter-defibrillators, were prospectively investigated from 1999 to 2007. An analysis of radiation damage to pacemakers, depending on the geometric and dosimetric characteristics of the radiation beams, was carried out. The electric and magnetic fields of linear accelerators (LINACs) were measured to evaluate any interference. The calculation of dose received by pacemakers was evaluated by dose-volume histograms.
No dysfunction was observed in any pacemaker, nor were the substitution times negatively affected. We did not find problems with the devices due to the interaction with the electromagnetic fields. Dose-volume histograms calculated for patients treated in regions close to devices (head & neck, thorax) showed an average maximum dose equal to 2.5 Gy for the head & neck area and equal to 1.8 Gy for the thoracic area. Acute (3 cases) and late (2 cases) cardiac events were observed only in 5 patients who underwent chemoradiation treatment, but no dysfunction was observed in any pacemaker.
Our study confirms the safety of radiotherapy for patients implanted with pacemakers or implantable cardioverter-defibrillators but suggests that chemoradiation represents a probable risk factor for cardiac toxicity. Furthermore, all cardiac events were observed in patients treated in the head and'neck or left thoracic areas. A standardized protocol is advisable in order to improve patient control during the radiotherapy treatment. It is mandatory to calculate the dose received at the pacemaker/heart, even in the case of palliative treatment.
对一组植入起搏器或植入式心脏复律除颤器的放疗患者进行前瞻性分析，以确定不同类型的设备与物理和剂量学参数之间的关系。同时还研究了治疗的心脏毒性。
1999年至2007年对45例植入起搏器或植入式心脏复律除颤器的放疗患者进行前瞻性研究。根据放射束的几何和剂量学特征，对起搏器的辐射损伤进行分析。测量直线加速器（LINAC）的电场和磁场以评估是否存在干扰。通过剂量体积直方图评估起搏器接收的剂量。
未观察到任何起搏器功能障碍，更换时间也未受到负面影响。我们未发现设备因与电磁场相互作用而出现问题。对在靠近设备区域（头颈部、胸部）接受治疗的患者计算的剂量体积直方图显示，头颈部区域的平均最大剂量为2.5 Gy，胸部区域为1.8 Gy。仅在5例接受放化疗的患者中观察到急性（3例）和晚期（2例）心脏事件，但未观察到任何起搏器功能障碍。
我们的研究证实了放疗对植入起搏器或植入式心脏复律除颤器患者的安全性，但表明放化疗可能是心脏毒性的一个危险因素。此外，所有心脏事件均在头颈部或左胸部区域接受治疗的患者中观察到。为了在放疗期间改善对患者的控制，建议采用标准化方案。即使在姑息治疗的情况下，也必须计算起搏器/心脏接收的剂量。
