Catharina Hospital Eindhoven, Department of Radiation Oncology, Eindhoven, The Netherlands.
Radiat Oncol. 2012 Nov 24;7:198. doi: 10.1186/1748-717X-7-198.
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.
目前，针对接受心脏起搏器或植入式心律转复除颤器（两者统称 CIED：心脏植入式电子设备）放疗患者的管理临床指南并未涵盖现代放疗技术，也未考虑到患者的视角。关于放疗期间 CIED 故障的频率和原因的现有数据有限，且不一致。荷兰放射治疗和肿瘤学学会（NVRO）成立了一个多学科工作组，成员包括临床物理学家、心脏病专家、放射肿瘤学家、心脏起搏器和 ICD 技术专家，旨在为 CIED 患者的管理制定循证共识指南。接受放疗的 CIED 患者应根据设备故障的可能性及其在故障情况下的临床后果进行分类。尽管没有明确的截止点，也没有明确的线性关系，但一般来说，设备故障的可能性随着剂量的增加而增加。设备故障的临床后果，如起搏丧失，对依赖起搏的患者风险最大。累积剂量和起搏依赖性已被结合起来，将患者分为低危、中危和高危组。接受 CIED 剂量小于 2Gy 的患者被归类为低危，除非此后依赖起搏，因为此时他们属于中危。在 2 到 10Gy 之间，所有患者均被归类为中危，而超过 10Gy 的患者则被归类为高危。为每个类别描述了确保患者安全的措施。该指南针对接受放疗的 CIED 患者，考虑了现代放疗技术、CIED 技术、患者视角以及安全管理这些患者所需的实际方面。该指南于 2012 年在荷兰实施，预计在荷兰以外地区也会得到临床认可。
