Malfunctions of implantable cardiac devices in patients receiving proton beam therapy: incidence and predictors.
Malfunctions of implantable cardiac devices in patients receiving proton beam therapy: incidence and predictors.
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DOI：
10.1016/j.ijrobp.2013.07.010
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发表时间：
2013-11-01
影响因子：
7
通讯作者：
Dougherty, Anne H.
中科院分区：
文献类型：
--
作者：
Gomez, Daniel R.;Poenisch, Falk;Pinnix, Chelsea C.;Sheu, Tommy;Chang, Joe Y.;Memon, Nada;Mohan, Radhe;Rozner, Marc A.;Dougherty, Anne H.
据报道，光子治疗可引起植入心脏器械的重置，但使用质子束治疗（PBT）治疗此类器械患者的临床后遗症尚不清楚。我们回顾了接受PBT的患者中器械故障的发生率。从2009年3月至2012年7月，42例植入心脏植入式电子器械（CIED）（28个起搏器和14个心律转复器-除颤器）的患者在一家机构接受了42个疗程的PBT治疗胸部（23 [55%]）、前列腺（15 [36%]）、肝脏（3[7%]）或颅底（1 [2%]）肿瘤。中位处方剂量为74戈伊（RBE）[范围46.8-87.5戈伊（RBE）]，治疗野至CIED的中位距离为10 cm（范围0.8-40 cm）。估计每个疗程的最大质子和中子剂量。在放射递送之前检查所有CIED，并在整个治疗过程中进行监测。所有患者CIED的质子和中子峰值剂量估计中位数为0.8戈伊（范围0.13-21戈伊）和346 Sv（范围11-1100 mSv）。5例患者发生6次CIED故障（2例起搏器和3例起搏器）。其中5例故障为CIED重置，1例除颤器患者（肝肿瘤患者）在治疗后出现不受辐射影响的择期更换指示器（ERI）。从质子束到CIED的平均距离是7.0 cm（范围0.9-8 cm），平均最大中子剂量是655 mSv（范围330-1100 mSv）。所有重置均发生在接受胸部PBT的患者中，并在无临床事件的情况下得到纠正。治疗后，更换了带有ERI消息的除颤器的发生器，未发生任何事件。在胸部接受PBT的患者中，CIED重置的发生率约为20%。我们建议起搏依赖性患者避免PBT，并对接受胸部PBT的任何类型CIED患者进行密切随访。
Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIEDs) (28 pacemakers and 14 cardioverter-defillibrators) underwent 42 courses of PBT for thoracic (23 [55%]), prostate (15 [36%]), liver (3[7%]), or base of skull (1 [2%]) tumors at a single institution. The median prescribed dose was 74 Gy(RBE) [range 46.8–87.5 Gy(RBE)], and the median distance from the treatment field to the CIED was 10 cm (range 0.8–40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13–21 Gy) and 346 Sv (range 11–1100 mSv). Six CIED malfunctions occurred in five patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and one patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator (ERI) after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9–8 cm), and the mean maximum neutron dose was 655 mSv (range 330–1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the ERI message was replaced uneventfully after treatment. The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving thoracic PBT be followed closely.
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DOI：
10.1186/1748-717x-7-10
发表时间：
2012-01-29
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
Hashimoto T;Isobe T;Hashii H;Kumada H;Tada H;Okumura T;Tsuboi K;Sakae T;Aonuma K;Sakurai H
通讯作者：
Sakurai H
影响因子：
1.2
作者：
Gossman, Michael S.;Nagra, Bipinpreet;Wilkinson, Jeffrey
通讯作者：
Wilkinson, Jeffrey
影响因子：
2
作者：
Soejima, Toshinori;Yoden, Eisaku;Norihisa, Yoshiki
通讯作者：
Norihisa, Yoshiki
影响因子：
5.5
作者：
Makkar, Akash;Prisciandaro, Joann;Pelosi, Frank, Jr.
通讯作者：
Pelosi, Frank, Jr.
DOI：
10.1016/j.ijrobp.2008.01.062
发表时间：
2008-11-01
影响因子：
7
作者：
Oshiro, Yoshiko;Sugahara, Shinji;Tokuuye, Koichi
通讯作者：
Tokuuye, Koichi