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Management of radiation oncology patients with a pacemaker or ICD: A new comprehensive practical guideline in The Netherlands

Coen W Hurkmans18*, Joost L Knegjens28, Bing S Oei38, Ad JJ Maas1049, GJ Uiterwaal59, Arnoud J van der Borden106, Marleen MJ Ploegmakers11 and Lieselot van Erven127

Author Affiliations

1 Catharina Hospital Eindhoven, Department of Radiation Oncology, Eindhoven, The Netherlands

2 Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Radiation Oncology, Amsterdam, The Netherlands

3 Verbeeten Instituut, Department of Radiation Oncology, Tilburg, The Netherlands

4 Jeroen Bosch Ziekenhuis, department of clinical physics, Hertogenbosch, The Netherlands

5 Flevoziekenhuis, Department of Cardiology, Almere, The Netherlands

6 Department of Radiation Oncology, University Medical Centre Groningen, Groningen, The Netherlands

7 Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands

8 Dutch Society of Radiotherapy and Oncology (NVRO), Utrecht, The Netherlands

9 Dutch Society of Specialists in Invasive Heart Stimulation (VITHaS), Utrecht, The Netherlands

10 Dutch Society of Clinical Physics (NVKF), Utrecht, The Netherlands

11 Order of Medical Specialists (OMS), Utrecht, The Netherlands

12 Dutch Society of Cardiology (NVCC), Utrecht, The Netherlands

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Radiation Oncology 2012, 7:198  doi:10.1186/1748-717X-7-198

Published: 24 November 2012


Current clinical guidelines for the management of radiotherapy patients having either a pacemaker or implantable cardioverter defibrillator (both CIEDs: Cardiac Implantable Electronic Devices) do not cover modern radiotherapy techniques and do not take the patient’s perspective into account. Available data on the frequency and cause of CIED failure during radiation therapy are limited and do not converge. The Dutch Society of Radiotherapy and Oncology (NVRO) initiated a multidisciplinary task group consisting of clinical physicists, cardiologists, radiation oncologists, pacemaker and ICD technologists to develop evidence based consensus guidelines for the management of CIED patients. CIED patients receiving radiotherapy should be categorised based on the chance of device failure and the clinical consequences in case of failure. Although there is no clear cut-off point nor a clear linear relationship, in general, chances of device failure increase with increasing doses. Clinical consequences of device failures like loss of pacing, carry the most risks in pacing dependent patients. Cumulative dose and pacing dependency have been combined to categorise patients into low, medium and high risk groups. Patients receiving a dose of less than 2 Gy to their CIED are categorised as low risk, unless pacing dependent since then they are medium risk. Between 2 and 10 Gy, all patients are categorised as medium risk, while above 10 Gy every patient is categorised as high risk. Measures to secure patient safety are described for each category. This guideline for the management of CIED patients receiving radiotherapy takes into account modern radiotherapy techniques, CIED technology, the patients’ perspective and the practical aspects necessary for the safe management of these patients. The guideline is implemented in The Netherlands in 2012 and is expected to find clinical acceptance outside The Netherlands as well.

Pacemaker; Implantable cardioverter defibrillator; Guideline; CIED; Risk management