Avoiding Mastectomy: Accelerated Partial Breast Irradiation for Breast Cancer Patients with Pacemakers or Defibrillators
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The objective of this study was to evaluate the safety, toxicity, and planning concerns involved in accelerated partial breast irradiation (APBI) for patients with breast cancer who have a pacemaker or an automatic implantable cardioverter-defibrillator (AICD) and who desire breast conservation.
We performed a review of prospectively obtained data for patients with early-stage breast cancer with a pacemaker or AICD treated between April 2007 and July 2010. Patients were treated with either 3D conformal external beam irradiation (3D-CRT) or high-dose rate balloon brachytherapy (HDRBB) as performed in the National Surgical Adjuvant Breast and Nowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 protocol. Device interrogation was performed after the first and last radiation treatment, with comparative cardiac monitoring performed before and after the first three treatments.
Eight patients were treated and have a mean follow-up of 6 months. Three patients received HDRBB delivering 34 Gy in 10 fractions. Mean planning target volume for evaluation (PTV_EVAL) coverage was 93.6%. The maximum radiation dose delivered to any device was 1.03 Gy, with a mean pacemaker distance to lumpectomy cavity (DLC) of 9.1 cm. Five patients received 3D-CRT consisting of 38.5 Gy in 10 fractions. The mean 90% PTV_EVAL coverage was 97.3%. Maximum dose delivered to any device was 1.68 Gy at a DLC of 9 cm. Local toxicity did not exceed grade 1, and no adverse device events were noted.
APBI in patients with pacemakers or AICDs who desire breast preservation seems to be a technically safe and reasonable application of targeted radiation therapy.
- Marbach, JR, Meoz-Menendez, RT, Huffman, JK, Hudgins, PT, Almond, PR (1978) The effects on cardiac pacemakers of ionizing radiation and electromagnetic interference from radiotherapy machines. Int J Radiat Oncol Biol Phys 4: pp. 1055-1058
- Venselaar, JLM (1985) The effects of ionizing radiation on eight cardiac pacemakers and the influence of electromagnetic interference from two linear accelerators. Radiother Oncol. 3: pp. 81-87 CrossRef
- Katzenberg, CA, Marcus, FI, Heusinkveld, RS, Mammana, RB (1982) Pacemaker failure due to radiation therapy. Pace 5: pp. 156-159
- Lee, RW, Huang, SK, Mechling, E, Bazgan, I (1986) Runaway atrioventricular sequential pacemaker after radiation therapy. Am J Med 81: pp. 883-886 CrossRef
- Goldstein, DJ, Rabkin, D, Spotnitz, HM (1999) Unconventional approaches to cardiac pacing in patients with inaccessible cardiac chambers. Ann Thorac Surg 67: pp. 952-958 CrossRef
- Maisel, WH, Moynahan, M, Zuckerman, BD (2006) Pacemaker and ICD generator malfunctions: analysis of Food and Drug Administration Annual Reports. JAMA 295: pp. 1901-1906 CrossRef
- Breast cancer statistics. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-key-statistics. Accessed 15 Feb 2011.
- Solan, AN, Solan, MJ, Bednarz, G, Goodkin, MB (2004) Treatment of patients with cardiac pacemakers and implantable cardioverter-defibrillators during radiotherapy. Int J Radiat Oncol Biol Phys 59: pp. 897-904 CrossRef
- Sundar, S, Symonds, RP, Deehan, C (2005) Radiotherapy to patients with artificial cardiac pacemakers. Cancer Treat Rev 31: pp. 474-486 CrossRef
- Frizzell, B (2009) Radiation therapy in oncology patients who have a pacemaker or implantable cardioverter-defibrillator. Commun Oncol 6: pp. 469-471
- Gossman, MS, Graves-Calhoun, AR, Wilkinson, JD (2010) Establishing radiation therapy treatment planning effects involving implantable pacemakers and implantable cardioverter-defibrillators. J Appl Clin Med Phys 11: pp. 1-13
- Marbach, JR, Sontag, MR, Dyk, J, Wolbarst, AB (1994) Management of radiation oncology patients with implanted cardiac pacemakers: report of AAPM Task Group #34. Med Phys 21: pp. 85-90 CrossRef
- Raitt, MH, Stelzer, KJ, Laramore, GE, Bardy, GH, Dolack, GL, Poole, JE, Kudenchuk, PJ (1994) Runaway pacemaker during high-energy neutron radiation therapy. Chest 106: pp. 955-957 CrossRef
- NSABP B-39/RTOG 0413 protocol. http://22.214.171.124/members/protocols/0413/0413.pdf. Accessed 7 Feb 2011.
- Rose, MA, Olivotto, I, Cady, B (1989) Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results. Arch Surg 124: pp. 153-157
- Common Terminology Criteria for Adverse Events (v4.0). http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_40. Accessed 7 Jan 2011.
- Ganz, PA, Schag, CCA, Lee, JJ, Polinsky, ML, Tan, SJ (1992) Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery?. Cancer 69: pp. 1729-1738 CrossRef
- Fisher, B, Anderson, S, Bryant, J (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Eng J Med 347: pp. 1233-1241 CrossRef
- Benitez, PR, Keisch, ME, Vicini, F (2007) Five-year results: the initial clinical trial of MammoSite® balloon brachytherapy for partial breast irradiation in early-stage breast cancer. Am J Surg 194: pp. 456-462 CrossRef
- Patel, RR, Christensen, ME, Hodge, CW, Adkinson, JB, Das, RK (2008) Clinical outcome analysis in “high-risk” versus “low-risk” patients eligible for National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 Trial: five-year results. Int J Radiat Oncol Biol Phys 70: pp. 970-973 CrossRef
- Nelson, JC, Beitsch, PD, Vicini, FA (2009) Four-year clinical update from the American Society of Breast Surgeons MammoSite Brachytherapy Trial. Am J Surg 198: pp. 83-91 CrossRef
- Polgar, C, Major, T, Fodor, J (2010) Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol 94: pp. 274-279 CrossRef
- Beitsch, P, Vicini, F, Keisch, M, Haffty, B, Shaitelman, S, Lyden, M (2010) Five-year outcome of patients classified in the “unsuitable” category using the American Society of Therapeutic Radiology and Oncology (ASTRO) Consensus Panel Guidelines for the Application of Accelerated Partial Breast Irradiation: an analysis of patients treated on the American Society of Breast Surgeons MammoSite Registry Trial. Ann Surg Oncol 17: pp. 219-225 CrossRef
- Avoiding Mastectomy: Accelerated Partial Breast Irradiation for Breast Cancer Patients with Pacemakers or Defibrillators
Annals of Surgical Oncology
Volume 18, Issue 12 , pp 3500-3505
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Human Oncology, Division of Surgical Breast Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
- 2. Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
- 3. Drexel University College of Medicine, Pittsburgh, PA, USA
- 4. National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations Office, Pittsburgh, PA, USA