Radiotherapy and devices in cancer patients: What is new in clinical practice?
Fabiana Luca1, Iris Parrini2, Laura Cipolletta3, Stefania Di Fusco4, Carmelo Massimiliano Rao1, Annamaria Iorio5, Andrea Pozzi5, Sandro Gelsomino6, Domenico Gabrielli7, Nadia Ingianni8, Massimo Zecchin9, Michele Massimo Gulizia10
1 Department of Cardiology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
2 Department of Cardiology, Ordine Mauriziano Hospital, Torino, Italy
3 Department of Cardiology, Umberto I-Lancisi-Salesi University Hospital, Ancona, Italy
4 Division of Cardiology, S. Filippo Neri Hospital, Rome, Italy
5 Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
6 Department of Cardiothoracic, Maastricht University Hospital, Maastricht, The Netherlands
7 Division of Cardiology, Augusto Murri Hospital, Fermo, Italy
8 Department of Cardiothoracic, University Hospital of Trieste, Trieste, Italy
9 Cardiology Division, Paolo Borsellino Hospital, Marsala, Italy
10 Cardiology Division, Garibaldi-Nesima Hospital, Catania; Heart Care Foundation, Florence, Italy
Dr. Fabiana Luca
Department of Cardiology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria
Source of Support: None, Conflict of Interest: None
There has been a significant increase in cancer patients with implanted electronic devices which have been exposed to the risk of malfunction when undergoing radiotherapy in the last few years. In this review, we provide a short summary of radiotherapy principles, later analyzing in vitro and in vivo data and recent recommendations, in order to present the current evidence on predictive factors, risk stratification, and management of patients with implanted electronic devices requiring radiotherapy. The risk of device failure is usually transient, seldom permanent and mainly related to patients' characteristics and cumulative doses administrated during radiotherapy. The strongest predictive factors of implanted electronic device malfunction are higher radiation doses and higher beam energy. Indeed, energy <6 MV and a total dose of 2 Gy are recommended. A close multidisciplinary collaboration involving cardiac electrophysiologists, radiotherapists, and physicists may have important consequences in clinical practice, enabling then to minimize this risk.