Yüksek Riskli Pacemaker Hastasında Multidisipliner Yaklaşım: Başarılı Radyoterapi Yönetimi ve Batarya Relokalizasyonu
Özet
İmplante edilebilen kardiyak elektronik cihazı (İEKEC) olan kanser hastalarında, radyoterapi (RT) uygulamaları cihaz disfonksiyonu riskini beraberinde getirmektedir. Bu bölümde, timik skuamöz hücreli karsinom nüksü ve sol taraf göğüs duvarı invazyonu nedeniyle palyatif torakal RT planlanan, atriyoventriküler (AV) tam blok nedeniyle kalıcı DDDR pacemaker bağımlılığı bulunan 74 yaşında erkek hasta sunulmuştur. Yapılan radyoterapi planlamasında cihaz bataryasının RT uygulanacak kitle ile aynı tarafta olması sebebiyle yüksek doza maruz kalacağı öngörüldüğünden, hasta Amerikan Tıbbi Fizikçiler Birliği (AAPM TG) 203 kılavuzuna göre yüksek risk grubunda sınıflandırılmıştır. Cihazın korunması amacıyla batarya cerrahi olarak sol subklavian bölgeden sağ subklavian bölgeye taşınmıştır. Relokalizasyon sonrası RT planlama süreci, batarya dozu 2 Gy sınırının altında tutularak sorunsuz tamamlamıştır. İEKEC taşıyan hastaların onkolojik tedavileri, kardiyoloji ve radyasyon onkolojisi uzmanlarının yakın multidisipliner işbirliğini gerektirmektedir.
In cancer patients with implantable cardiac electronic devices (ICEDs), radiotherapy (RT) applications carry the risk of device dysfunction. In this section, we present a 74-year-old male patient who was scheduled for palliative thoracic RT due to recurrent thymic squamous cell carcinoma and left-sided chest wall invasion, and who had permanent DDDR pacemaker dependence due to complete atrioventricular (AV) block. In the radiotherapy planning, the patient was classified in the high-risk group according to the American Association of Physicists in Medicine (AAPM TG) 203 guideline, as it was predicted that the device battery would be exposed to a high dose due to being on the same side as the mass to be treated with RT. In order to protect the device, the battery was surgically relocated from the left subclavian region to the right subclavian region. Following the relocation, the RT planning process was completed successfully, keeping the battery dose below the 2 Gy limit. Oncological treatments of patients carrying ICEDs require close multidisciplinary cooperation between cardiology and radiation oncology specialists.
Referanslar
Ohno T, Soejima T, Sekiguchi Y, Hashimoto T, Koike I, Matsubara H, et al. JASTRO/JCS Guidelines for radiotherapy in patients with cardiac implantable electronic devices. Journal of Radiation Research. 2021;62(1):172-84.
Aldaas OM, Roberge-Lacharite AS, Birgersdotter-Green U. Pacemakers. NEJM Evid. 2025;4(7):EVIDra2400323.
Matsubara H, Ezura T, Hashimoto Y, Karasawa K, Nishio T, Tsuneda M. Prediction of radiation-induced malfunction for cardiac implantable electronic devices (CIEDs). Med Phys. 2020;47(4):1489-98.
Mirzaei M, Rowshanfarzad P, Gill S, Ebert MA, Dass J. Risk of cardiac implantable device malfunction in cancer patients receiving proton therapy: an overview. Front Oncol. 2023;13:1181450.
Malavasi VL, Imberti JF, Tosetti A, Romiti GF, Vitolo M, Zecchin M, et al. A systematic review and meta-analysis on oncological radiotherapy in patients with a cardiac implantable electronic device: Prevalence and predictors of device malfunction in 3121 patients. Eur J Clin Invest. 2023;53(1):e13862.
Miften M, Mihailidis D, Kry SF, Reft C, Esquivel C, Farr J, et al. Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203(†). Med Phys. 2019;46(12):e757-e88.
Grant JD, Jensen GL, Tang C, Pollard JM, Kry SF, Krishnan S, et al. Radiotherapy-Induced Malfunction in Contemporary Cardiovascular Implantable Electronic Devices: Clinical Incidence and Predictors. JAMA Oncol. 2015;1(5):624-32.
Tseng ZH. Risk of Cardiovascular Implantable Electronic Device Malfunction With Radiation Therapy: Location, Dose, or Energy? JAMA Intern Med. 2015;175(10):1698-9.
Yeung C, Chacko S, Glover B, Campbell D, Crystal E, Ben-Dov N, et al. Radiotherapy for Patients with Cardiovascular Implantable Electronic Devices: A Review. Can J Cardiol. 2018;34(3):244-51.
Zaremba T, Jakobsen AR, Søgaard M, Thøgersen AM, Riahi S. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace. 2016;18(4):479-91.
Salerno F, Gomellini S, Caruso C, Barbara R, Musio D, Coppi T, et al. Management of radiation therapy patients with cardiac defibrillator or pacemaker. Radiol Med. 2016;121(6):515-20.
Sharifzadehgan A, Laurans M, Thuillot M, Huertas A, Baudinaud P, Narayanan K, et al. Radiotherapy in Patients With a Cardiac Implantable Electronic Device. Am J Cardiol. 2020;128:196-201.
Mori A, Kuribayashi T, Haida H, Funaishi K, Kasahara H, Harada Y, et al. Pacemaker Relocation for Radiation Against Overlapping Lung Cancer. Cureus. 2023;15(12):e49921.
