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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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Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

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References

  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–iii79

    Article  PubMed  Google 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):524–548

    Article  PubMed  Google Scholar 

  3. Zaremba T, Jakobsen AR, Søgaard M et al (2015) Risk of device malfunction in cancer patients with implantable cardiac device undergoing radiotherapy: a population-based cohort study. Pacing Clin Electrophysiol 38:343–356

    Article  PubMed  Google Scholar 

  4. Hurkmans CW, Knegjens JL, Oei BS, Maas AJJ et al (2012) Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline. Neth Radiat Oncol 7:198

    Article  Google Scholar 

  5. Sundar S, Symonds RP, Deehan C (2005) Radiotherapy to patients with artificial cardiac pacemakers. Cancer Treat Rev 31:474–486

    Article  PubMed  CAS  Google Scholar 

  6. Hoecht S, Rosenthal P, Sancar D, Behrens S, Hinkelbein W, Hoeller U (2002) Implantable cardiac defibrillators may be damaged by radiation therapy. J Clin Oncol 20(8):2212–2213

    Article  PubMed  CAS  Google Scholar 

  7. Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S (2016) Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace 18:479–491

    Article  PubMed  Google 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 255:175–183

    Article  PubMed  Google Scholar 

  9. Marbach JR, Sontag MR, Van Dyk J, Wolbarst AB (1994) Management of radiation oncology patients with implanted cardiac pacemakers: report of AAPM Task Group No. 34. Med Phys 21(1):85–90

    Article  PubMed  CAS  Google Scholar 

  10. 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 59:897–904

    Article  PubMed  Google Scholar 

  11. Hudson F, Couldshed D, D’Souza E, Baker C (2010) Effect of radiation therapy on the latest generation of pacemaker and implantable cardioverter defibrillators: a systematic review. J Med Imaging Radiat Oncol 54:53–61

    Article  PubMed  CAS  Google Scholar 

  12. John J, Kaye GC (2004) Shock coil failure secondary to external irradiation in a patient with implantable cardioverter defibrillator. Pacing Clin Electrophysiol 27:690–691

    Article  PubMed  Google Scholar 

  13. Grant JD, Jensen GL, Tang C, Pollard JM, Kry SF, Krishnan S, Dougherty AH, Gomez DR, Rozner MA (2015) Radiotherapy-induced malfunction in contemporary cardiovascular implantable electronic devices: clinical incidence and predictors. JAMA Oncol 1(5):624–632

    Article  PubMed  Google Scholar 

  14. Gauter-Fleckenstein B, Israel CW, Dorenkamp M et al (2015) DEGRO/DGK guideline for radiotherapy in patients with cardiac implantable electronic devices. Strahlenther Onkol 191(5):393–404

    Article  PubMed  Google Scholar 

  15. Mouton J, Haug R, Bridier A, Dodinot B, Eschwege F (2002) Influence of high-energy photon beam irradiation on pacemaker operation. Phys Med Biol 47:2879–2893

    Article  PubMed  CAS  Google Scholar 

  16. Hurkmans CW, Scheepers E, Springorum B, Uiterwaal H (2005) Influence of radiotherapy on the latest generation on implantable cardioverter-defibrillators. Int J Radiat Oncol Biol Phys 63(1):282–289

    Article  PubMed  Google Scholar 

  17. Souliman SK, Christie J (1994) Pacemaker failure induced by radiotherapy. PACE 17:270–273

    Article  PubMed  CAS  Google Scholar 

  18. Munshi A, Agarwal JP, Pandey KC (2013) Cancer patients with cardiac pacemakers needing radiation treatment: a systematic review. J Cancer Res Ther 9(2):193–198

    Article  PubMed  Google Scholar 

  19. Riley B, Garcia J, Gurrero T (2004) The utilization of a 3-dimensional non coplanar treatment plan to avoid pacemaker complications. Med Dosim 29(2):92–96

    Article  PubMed  Google Scholar 

  20. Veronesi U, Gatti G, Luini A et al (2003) Intraoperative radiation therapy for breast cancer: technical notes. Breast J 9:106–112

    Article  PubMed  Google Scholar 

  21. Galimberti V, Ciocca M, Leonardi MC et al (2009) Is electron beam intraoperative radiotherapy (ELIOT) safe in pregnant women with early breast cancer? In vivo dosimetry to assess fetal dose. Ann Surg Oncol 16(1):100–105

    Article  PubMed  Google Scholar 

  22. Leonardi MC, Cecconi A, Luraschi R et al (2017) Electron beam intraoperative radiotherapy (ELIOT) in pregnant women with breast cancer: from in vivo dosimetry to clinical practice. Breast Care 12(6):396–400

    Article  PubMed  Google 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 35:73

    Google Scholar 

  24. Leonardi MC, Ricotti R, Dicuonzo S et al (2016) From technological advances to biological understanding: the main steps toward high-precision RT in breast cancer. Breast 29:213–222

    Article  PubMed  Google Scholar 

  25. Tseng ZH (2015) Risk of cardiovascular implantable electronic device malfunction with radiation therapy: location, dose, or energy? JAMA Intern Med 175(10):1698–1699

    Article  PubMed  Google Scholar 

  26. Croshaw R, Kim Y, Lappinen E, Julian T, Trombetta M (2011) Avoiding mastectomy: accelerated partial breast irradiation for breast cancer patients with pacemakers or defibrillators. Ann Surg Oncol 18(12):3500–3505

    Article  PubMed  Google Scholar 

  27. Kim Y, Arshoun Y, Trombetta MG (2012) Pacemaker/implantable cardioverter-defibrillator dose in balloon high-dose-rate brachytherapy for breast cancer treatment. Brachytherapy 11(5):380–386

    Article  PubMed  Google Scholar 

  28. Keshtgar MR, Eaton DJ, Reynolds C, Pigott K, Davidson T, Gauter-Fleckenstein B, Wenz F (2012) Pacemaker and radiotherapy in breast cancer: is targeted intraoperative radiotherapy the answer in this setting? Radiat Oncol 7:128

    Article  PubMed  PubMed Central  Google Scholar 

  29. Costa AM, Barbi GL, Bertucci EC et al (2010) In vivo dosimetry with thermoluminescent dosimeters in external photon beam radiotherapy. Appl Radiat Isot 68:760–762

    Article  PubMed  CAS  Google Scholar 

  30. D’Angelo L, Furetta C, Giaucola S, Iannoli D, Scacco AG (1999) Verification of treatment planning systems for therapeutic irradiations using thermoluminescence dosimeters. Radiat Prot Dosim 85:401–404

    Article  Google Scholar 

  31. Sung W, Kim S, Kim JI, Lee JG, Shin YJ, Jung JY, Ye SJ (2012) Dosimetric perturbations due to an implanted cardiac pacemaker in MammoSite(®) treatment. Med Phys 39(10):6185–6191

    Article  PubMed  Google Scholar 

  32. Makkar A, Prisciandaro J, Agarwal S et al (2012) Effect of radiation therapy on permanent pacemaker and implantable cardioverter-defibrillator function. Heart Rhythm 9(12):1964–1968

    Article  PubMed  Google Scholar 

  33. Lin JP, Chu TC, Lin SY, Liu MT (2001) The measurement of photoneutrons in the vicinity of a Siemens Primus linear accelerator. Appl Radiat Isot 55:315–321

    Article  PubMed  CAS  Google Scholar 

  34. Nath R, Meigooni AS, King CR, Smolen S, D’Errico F (1993) Superheated drop detector for determination of neutron dose equivalent to patients undergoing high-energy X-ray and electron radiotherapy. Med Phys 20:781–787

    Article  PubMed  CAS  Google Scholar 

  35. Munshi A, Wadasadawala T, Sharma PK, Sharma D, Budrukkar A, Jalali R, Dinshaw KA (2008) Radiation therapy planning of a breast cancer patient with in situ pacemaker-challenges and lessons. Acta Oncol 47(2):255–260

    Article  PubMed  Google 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):264–273

    Article  PubMed  Google Scholar 

  37. Correa C, Harris EE, Leonardi MC et al (2017) Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol 7(2):73–79

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Author notes

  1. Barbara Alicja Jereczek-Fossa and Federica Cattani have equally contributed to this study and should be considered as co-last authors.

Authors and Affiliations

  1. Medical Physics Unit, European Institute of Oncology, Milan, Italy

    Rosa Luraschi, Elena Rondi, Alessia Bazani & Federica Cattani

  2. Radiation Oncology Division, European Institute of Oncology, Milan, Italy

    Roberta Lazzari, Rosalinda Ricotti, Cristiana Fodor, Maria Cristina Leonardi & Barbara Alicja Jereczek-Fossa

  3. Molecular Senology Unit, European Institute of Oncology, Milan, Italy

    Viviana Galimberti & Giovanni Corso

  4. Cardiology Division, European Institute of Oncology, Milan, Italy

    Nicola Colombo

  5. Cardiovascular Division, Mayo Clinic, Rochester, MN, USA

    Mikolaj Winnicki

  6. Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy

    Barbara Alicja Jereczek-Fossa

Authors
  1. Rosa Luraschi
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  2. Roberta Lazzari
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  4. Elena Rondi
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  8. Rosalinda Ricotti
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  9. Cristiana Fodor
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  10. Mikolaj Winnicki
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  11. Maria Cristina Leonardi
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  12. Barbara Alicja Jereczek-Fossa
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  13. Federica Cattani
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Contributions

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.

Corresponding author

Correspondence to Maria Cristina Leonardi.

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Conflict of interest

All the authors declare that there is no actual or potential conflict of interest.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Luraschi, R., Lazzari, R., Galimberti, V. et al. Dosimetric study to assess the feasibility of intraoperative radiotherapy with electrons (ELIOT) as partial breast irradiation for patients with cardiac implantable electronic device (CIED). Breast Cancer Res Treat 171, 693–699 (2018). https://doi.org/10.1007/s10549-018-4878-8

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  • DOI: https://doi.org/10.1007/s10549-018-4878-8

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