ICD lead in Field, What to do?

[Kroll2013]

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patient, 70yo, 80% dependent on his ICD due to an A-V bloc, presented with a left prevascular lesion; SCC on biopsy --> Work-up: unknown primary
ICD lead passing in close proximity to the tumor
plan: concomittant CRT
probl: subsequent risks of irradiating the lead to 60 Gy
What do you think?

I already read the AAPM TG report 34 and the recent Dutch guidelines on how to manage pacemaker in RT
but the only information i had about directly irradiating the lead was that it s insensitive , only one case report of ICD dysfunction

Thx

 

[Palex80]

I think the lead should not be an issue. I would however monitor the patient during & after treatment.

 

[Gfunk6]

I agree with Palex. Have the device manufacturer or one of the techs from your Cardiology division interrogate the device periodically during radiation treatment.

 

[seper]

I monitor all pacemaker-dependent pts for first 3 fractions, regardless how far from the field it is.

 

[Palex80]

I monitor all pacemaker-dependent pts for first 3 fractions, regardless how far from the field it is.

I generally do the same for the first fraction and then order a pacemaker/ICD check after a full week of treatment, somewhat in between (3-4th week) and after completion of treatment.
So far I have seen 3 cases of pacemaker problems during/after RT:
one was a complete reset, the other two were premature battery-discharge issues.