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Monitoring Cardiovascular Implantable Electronic Devices (CIEDs) for Patients Receiving Radiotherapy (RT)
Proceedings of the 52nd Annual ASTRO Meeting biologic equivalent dose (BED), D90, V150, UrD5, and UrD30. A DIPSS. = 5 and DQOL. = 2 were considered clinically significant changes over baseline and were compared at various post-implant time points. IPSS resolution was defined as a return to IPSS baseline ±2. Results: Significantly more patients who underwent LDR had DIPSS. = 5 at 4 and 6 months compared with HDR (46% vs. 25%, p \ 0.001). No significant difference in DIPSS. = 5 or DQOL. = 2 between LDR and HDR was seen at 12 months. On multivariate analysis, only LDR was a significant predictor of DIPSS. = 5 at 4 and 6 months. The use of HT (p = 0.025) and higher D90 (p = 0.021) were significant predictors of DQOL. = 2. The median IPSS time to resolution was 14 and 16 months for HDR and LDR patients, respectively (p = 0.354). On multivariate analysis, pre-implant urinary medication use (p = 0.013) and V150. = 50% (p = 0.006) were predictive of a longer time to IPSS resolution. When comparing LDR and HDR brachytherapy, there were no significant differences in grade . = 2 urinary toxicity (18% vs. 15%, p = 0.136) or incontinence rates (2% vs. 2%). A trend toward more acute urinary retention was seen with HDR 2% vs. 7%, p = 0.066). Conclusions: LDR brachytherapy appears to be associated with more short-term urinary morbidity compared to HDR when used in combination with EBRT; however the time to resolution of symptoms appear similar. A trend toward higher acute urinary retention was seen with HDR brachytherapy. Author Disclosure: M.A. Kollmeier, None; E. Algur, None; M. Schechter, None; X. Pei, None; G. Cohen, None; Y. Yamada, None; B. Cox, None; M.J. Zelefsky, None.
2884
Monitoring Cardiovascular Implantable Electronic Devices (CIEDs) for Patients Receiving Radiotherapy (RT)
K. Bowman, R. Popple, H. Doppalapudi, J. B. Fiveash, R. Meredith, I. A. Brezovich, J. A. Bonner, S. A. Spencer The University of Alabama at Birmingham, Birmingham, AL Purpose/Objective(s): To determine the clinical impact of radiation on CIEDs and to establish clinical guidelines designed to enhance patient safety. The number of CIEDs worldwide is increasing, with 1.6 million devices implanted in the USA and Europe in 2007. Consequently, the number of patients with CIEDs treated in RT departments will also increase. The mechanism for radiation interactions with pacemakers has been described in the past and manufacturers have developed threshold dose guidelines. Newer implantable defibrillators also have manufacturer recommended threshold doses but the predictability of radiation effects is less clear. Monitoring guidelines of these devices are also not clearly defined. Materials/Methods: A retrospective review of 60 patients treated from April 2002 - March 2010 with CIEDs was undertaken. 23 of the CIEDs were defibrillators and the remainder pacemakers. In all cases, the CIED was located outside of the direct beam and radiation dose to the device was estimated prior to treatment. In all cases, the dose was below the lesser of the manufacturer’s recommendation or 2 Gy. Initially all patients were monitored with daily 3-lead EKG. From 2005 to October 2008, patients were monitored by daily 3-lead EKG and the CIED was interrogated by the manufacturer at varying times during treatment. Beginning October 2008, the CIED was interrogated prior to the first treatment, after each of the first three treatments, and weekly thereafter. 3-lead EKG monitoring was done during RT on the same days as device interrogation. Results: Three patients had one or more device resets related to RT. Two patients had multiple resets early in treatment and the third patient had a reset following treatment. Two patients were treated with photon energy . 10 MV, suggesting the possibility of neutron-induced events. Two additional patients had syncopal episodes and/or arrhythmia issues but it was not clear if the events were related to radiation therapy. Conclusions: The incidence of radiation induced CIED malfunction is small in our patient population, but not negligible. As a result of this review, we have revised our guidelines. Patients with CIEDs will be treated with photon energies less than or equal to 10 MV unless the treatment goals cannot be achieved without higher energy. EKG monitoring will be done during every treatment. Patients will be stratified into two groups: 1. High Risk: pacemaker dependency, history of prior defibrillator activation, or .10MV photons required; 2. Low Risk: all other patients. The CIEDs of high-risk patients will be interrogated daily. The CIEDs of low-risk patients will be interrogated prior to the first treatment, after the first treatment, and after the final treatment. Continued close followup of CIED patients is required. Author Disclosure: K. Bowman, None; R. Popple, Varian Medical Systems, B. Research Grant; H. Doppalapudi, None; J.B. Fiveash, Varian Medical Systems, D. Speakers Bureau/Honoraria; R. Meredith, None; I.A. Brezovich, None; J.A. Bonner, Varian Medical Systems, D. Speakers Bureau/Honoraria; Bristol-Myers- Squibb, Imclone Systems, F. Consultant/Advisory Board; Lilly Corporation, F. Consultant/Advisory Board; S.A. Spencer, None.
2885
Radiation Prophylaxis for Heterotopic Ossification in Non-hip Joints
L. C. Daugherty, D. O’Donnell, L. Komarnicky Hahnemann University Hospital, Philadelphia, PA Purpose/Objective(s): Heterotopic ossification (HO) is well-described and common complication following surgical manipulation of large extremity joints. The development of HO can seriously affect mobility and quality of life and in severe instances, can result in ankylosis of the affected joint. Risk factors, including pre-existing HO and prior surgical manipulation, have been identified to guide surgeons and radiation oncologists in offering HO prophylaxis. Abundant evidence exists to substantiate radiation prophylaxis to the hip joint in high-risk patients. This evidence is often extrapolated to non-hip joints such as the elbow or knee. However, there is a paucity of data to validate the efficacy and evaluate the long-term joint mobility following prophylactic radiotherapy to the elbow or knee for HO prevention. In this retrospective review, we report our institutions’ experience in 22 patients treated for HO to the elbow and knee joints.
S599
2884
Monitoring Cardiovascular Implantable Electronic Devices (CIEDs) for Patients Receiving Radiotherapy (RT)
K. Bowman, R. Popple, H. Doppalapudi, J. B. Fiveash, R. Meredith, I. A. Brezovich, J. A. Bonner, S. A. Spencer The University of Alabama at Birmingham, Birmingham, AL Purpose/Objective(s): To determine the clinical impact of radiation on CIEDs and to establish clinical guidelines designed to enhance patient safety. The number of CIEDs worldwide is increasing, with 1.6 million devices implanted in the USA and Europe in 2007. Consequently, the number of patients with CIEDs treated in RT departments will also increase. The mechanism for radiation interactions with pacemakers has been described in the past and manufacturers have developed threshold dose guidelines. Newer implantable defibrillators also have manufacturer recommended threshold doses but the predictability of radiation effects is less clear. Monitoring guidelines of these devices are also not clearly defined. Materials/Methods: A retrospective review of 60 patients treated from April 2002 - March 2010 with CIEDs was undertaken. 23 of the CIEDs were defibrillators and the remainder pacemakers. In all cases, the CIED was located outside of the direct beam and radiation dose to the device was estimated prior to treatment. In all cases, the dose was below the lesser of the manufacturer’s recommendation or 2 Gy. Initially all patients were monitored with daily 3-lead EKG. From 2005 to October 2008, patients were monitored by daily 3-lead EKG and the CIED was interrogated by the manufacturer at varying times during treatment. Beginning October 2008, the CIED was interrogated prior to the first treatment, after each of the first three treatments, and weekly thereafter. 3-lead EKG monitoring was done during RT on the same days as device interrogation. Results: Three patients had one or more device resets related to RT. Two patients had multiple resets early in treatment and the third patient had a reset following treatment. Two patients were treated with photon energy . 10 MV, suggesting the possibility of neutron-induced events. Two additional patients had syncopal episodes and/or arrhythmia issues but it was not clear if the events were related to radiation therapy. Conclusions: The incidence of radiation induced CIED malfunction is small in our patient population, but not negligible. As a result of this review, we have revised our guidelines. Patients with CIEDs will be treated with photon energies less than or equal to 10 MV unless the treatment goals cannot be achieved without higher energy. EKG monitoring will be done during every treatment. Patients will be stratified into two groups: 1. High Risk: pacemaker dependency, history of prior defibrillator activation, or .10MV photons required; 2. Low Risk: all other patients. The CIEDs of high-risk patients will be interrogated daily. The CIEDs of low-risk patients will be interrogated prior to the first treatment, after the first treatment, and after the final treatment. Continued close followup of CIED patients is required. Author Disclosure: K. Bowman, None; R. Popple, Varian Medical Systems, B. Research Grant; H. Doppalapudi, None; J.B. Fiveash, Varian Medical Systems, D. Speakers Bureau/Honoraria; R. Meredith, None; I.A. Brezovich, None; J.A. Bonner, Varian Medical Systems, D. Speakers Bureau/Honoraria; Bristol-Myers- Squibb, Imclone Systems, F. Consultant/Advisory Board; Lilly Corporation, F. Consultant/Advisory Board; S.A. Spencer, None.
2885
Radiation Prophylaxis for Heterotopic Ossification in Non-hip Joints
L. C. Daugherty, D. O’Donnell, L. Komarnicky Hahnemann University Hospital, Philadelphia, PA Purpose/Objective(s): Heterotopic ossification (HO) is well-described and common complication following surgical manipulation of large extremity joints. The development of HO can seriously affect mobility and quality of life and in severe instances, can result in ankylosis of the affected joint. Risk factors, including pre-existing HO and prior surgical manipulation, have been identified to guide surgeons and radiation oncologists in offering HO prophylaxis. Abundant evidence exists to substantiate radiation prophylaxis to the hip joint in high-risk patients. This evidence is often extrapolated to non-hip joints such as the elbow or knee. However, there is a paucity of data to validate the efficacy and evaluate the long-term joint mobility following prophylactic radiotherapy to the elbow or knee for HO prevention. In this retrospective review, we report our institutions’ experience in 22 patients treated for HO to the elbow and knee joints.
S599