Dosimetric study to assess the feasibility of intraoperative radiotherapy with electrons (ELIOT) as partial breast irradiation for patients with cardiac implantable electronic device (CIED)
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To report in-vivo dosimetry in the infraclavicular region, a potential site of a cardiac implantable electronic device (CIED) and to evaluate the absorbed dose from intraoperative radiotherapy with electrons (ELIOT).
27 non-cardiopathic breast cancer (BC) patients without CIED received quadrantectomy and ELIOT as partial breast irradiation. Before delivering ELIOT, two catheters, each containing eight thermoluminescent dosimeters (TLDs), were positioned in the infraclavicular region. TLDs internal catheter was located deep in the tumor bed while the external catheter was placed on patient’s skin.
Data were available for 24/27 patients. The absorbed doses were referred to the dose of 21 Gy. Values measured by the external catheter were low, although statistically significant higher doses were found close to the applicator (mean values 0.26–0.49 Gy). External TLD doses in proximity of the applicator were lower than those detected by their internal counterparts. Values measured by the internal catheter TLDs varied according to the distance from the applicator while no correlation with tumor site and beam energy was found. The distance from the applicator to deliver < 2 Gy to a CIED was 2 cm, while from 2.5 cm the dose measured in all the patients became negligible.
This dosimetric study provided data to support the clinical use of ELIOT in BC patients having CIEDs as long as the suggested minimum safe distance of 2.5 cm is taken from the RT field in case of ELIOT single dose of 21 Gy, in the energy range of 6–10 MeV.
KeywordsIntraoperative radiotherapy Breast cancer Cardiac devices Thermoluminescent dosimeters In vivo dosimetry
This work was partially supported by a research Grant from Accuray Inc. The sponsor did not play any role in the study design, collection, analysis and interpretation of data, nor in the writing of the manuscript, nor in the decision to submit the manuscript for publication.
All authors and the institutional Ethical Committee gave their consent for publication. Study data are in a database managed by the physicists in the Radiotherapy Division. All authors have made substantial contributions to the manuscript. In particular: RL contributed to conception, data interpretation and article draft; RL contributed to conception and design; VG and GC recruited patients; ER and AB collected data; NC and MW revised the article for important intellectual content; RR analyzed data; CF managed data; MCL contributed to design and draft the article; BAJ-F and FC gave the final approval to the publication.
Compliance with ethical standards
Conflict of interest
All the authors declare that there is no actual or potential conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The dosimetric study has been approved by the institutional Ethical Committee with the number IEO0090. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 1.Raatikainen MJ, Arnar DO, Merkely B, Camm AJ, Hindricks G (2016) Access to and clinical use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology Countries: 2016 Report from the European Heart Rhythm Association. Europace 18(Suppl 3):iii1–iii79CrossRefPubMedGoogle Scholar
- 2.Fitzmaurice C, Allen C, Barber RM et al (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol 3(4):524–548CrossRefPubMedGoogle Scholar
- 8.Zecchin M, Severgnini M, Fiorentino A, Malavasi VL, Menegotti L, Alongi F, Catanzariti D, Jereczek-Fossa BA, Stasi M, Russi E, Boriani G (2018) Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: a consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM). Int J Cardiol 255:175–183CrossRefPubMedGoogle Scholar
- 23.Riva G, Alessandro O, Spoto R et al (2018) Radiotherapy in patients with cardiac implantable electronic devices: clinical and dosimetric aspects. Int J Radiat Oncol Biol Phys 35:73Google Scholar
- 36.Polgár C, Van Limbergen E, Pötter R et al (2010) Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 94(3):264–273CrossRefPubMedGoogle Scholar