Key result
High-dose direct radiotherapy (66 Gy) to a sternal metastasis adjacent to a CRTD resulted in no device malfunction, tumor regrowth, or severe adverse events over 15 months of follow-up.
Why the study?
Because radiotherapy can cause CIED malfunction and guideline thresholds limit exposure to 2 Gy, very few cases of direct exposure of CIEDs to high-dose RT have been reported.
Does high-dose direct radiotherapy cause device malfunction in a patient with a CRTD?
Case Report (n=1)
Does high-dose direct radiotherapy cause device malfunction in a patient with a CRTD?
High-dose direct radiotherapy (up to 68.3 Gy) to a CRTD may be performed without device malfunction under careful risk assessment and safety management, challenging the widely adopted 2 Gy threshold.
Background Because radiotherapy (RT) can cause malfunction of cardiovascular implantable electronic devices (CIEDs), patients with CIEDs who receive RT require careful management. A dose threshold of 2 Gy received by CIEDs has been largely adopted in several guidelines; thus, very few cases of direct exposure of CIEDs to RT have been reported. We report a case of a cardiac resynchronization therapy defibrillator (CRTD) directly exposed to high-dose RT in a patient with sternal metastasis of thyroid papillary carcinoma. Case report The patient was a 75-year-old man who was prescribed RT to control increasing sternal bone metastasis from thyroid papillary carcinoma. A CRTD device had been implanted for treatment of chronic heart failure and ventricular tachycardia, and the device was located adjacent to the 12.2 cm sternal bone metastasis. After careful consideration of the indications by the cancer board, including cardiologists, we decided to treat the metastasis, including the CRTD device, with RT. RT was performed using 10 MV X-rays at a total dose of 66 Gy in 22 fractions. The maximum and average doses of RT received by the CRTD were 68.3 and 64.7 Gy, respectively. Implantable cardioverter defibrillator function was turned off during RT, and device checks were performed every treatment session. No device malfunction had been detected until the patient died from heart failure at 15 months after treatment. Furthermore, neither tumor regrowth nor severe adverse events were observed. Conclusion For patients with unavoidable exposure of a CIED to high-dose direct RT, careful risk assessment and appropriate safety management are important.
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Goto et al. (2024) conducted a case report in Sternal metastasis of thyroid papillary carcinoma in a patient with a CRTD (n=1). High-dose direct radiotherapy was evaluated on Device malfunction, tumor regrowth, and severe adverse events. High-dose direct radiotherapy (66 Gy) to a sternal metastasis adjacent to a CRTD resulted in no device malfunction, tumor regrowth, or severe adverse events over 15 months of follow-up.
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