[Radiotherapy for XXXX and pacemaker].

@entity1 @entity5 @entity0
PURPOSE: @entity1 with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. We studied the @entity0 @entity1 who needed breast and/or chest wall and lymph node irradiation to assess the feasibility and tolerance in this population of @entity1 . @entity1 AND METHODS: From November 2008 to December 2009, more than 900 @entity1 received radiotherapy for their @entity0 in our department using megavoltage linear accelerator (X 4-6 MV and electrons). Among them, seven @entity1 were with permanent pacemaker. All @entity1 have been treated to the breast and chest wall and/or lymph nodes. Total dose to breast and/or chest wall was 50 Gy/25 fractions and 46 Gy/23 fractions to lymph nodes. @entity1 who underwent conserving surgery followed by breast irradiation were boosted when indicated to @entity5 bed with 16 Gy/8 fractions. All @entity1 were monitored everyday in presence of radiation oncologist to follow the function of their pacemaker. All pacemakers were controlled before and after radiotherapy by the @entity1 ' cardiologist. RESULTS: Seven @entity1 were referred in our department for postoperative @entity0 radiotherapy. Among them, only one @entity1 was declined for radiotherapy and underwent mastectomy without radiotherapy. In four cases the pacemaker was repositioned before the beginning of radiotherapy. Six @entity1 , aged between 48 and 84 years underwent irradiation for their @entity0 . Four @entity1 were treated with conserving surgery followed by breast radiotherapy and two with mastectomy followed by chest wall and internal mammary chain, supra- and infra-clavicular lymph node irradiation. The dose to the pacemaker generator was kept below 2 Gy. There was no pacemaker dysfunction observed during the radiotherapy. CONCLUSION: The multidisciplinary work with position change of the pacemaker before radiotherapy and everyday monitoring permitted the safe treatment of our @entity1 . Updated guidelines are definitely needed with more details about acceptable doses at the different parts of the pacemaker.
