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An increasing number of patients with implantable cardiac rhythm devices undergo radiotherapy (RT) for cancer and are thereby exposed to the risk of device failure. Current safety recommendations seem to have limitations by not accounting for the risk of pacemakers and implantable cardioverter defibrillators malfunctioning at low radiation doses. Besides scant knowledge about optimal safety measures, only little is known about the exact prevalence of patients with devices undergoing RT. In this review, we provide a short overview of the principles of RT and present the current evidence on the predictors and mechanisms of device malfunctions during RT. We also summarize practical recommendations from recent publications and from the industry. Strongly associated with beam energy of photon RT, device malfunctions occur at ∼3% of RT courses, posing a substantial issue in clinical practice. Malfunctions described in the literature typically consist of transient software disturbances and only seldom manifest as a permanent damage of the device. Through close cooperation between cardiologists and oncologists, a tailored individualized approach might be necessary in this patient group in waiting time for updated international guidelines in the field.

Purpose In order to share data on patient risk during radiotherapy (RT) on a national level and to stimulate a learning potential between the RT-centers, a national special group of interest in RT (RT-SIG) under the national society for medical physics was formed in 2016. Since then RT-SIG has collected and analyzed patient risk data from six centers. RT-SIG is stimulating the centers to analyze and categorize data in an inter-center consistent way facilitating sharing of data and making common reports and recommendations on patient RT safety improvements. Methods Adverse and near miss incidence reports in RT are collected and analyzed locally at each center. Events are categorized by two different systems, 1 Patient Consequence Coding (PCC) according to the kind of consequence experienced by the patient and 2 RT Pathway Coding (RPC) according to the RT process at which the incident originated. Consensus surveys are performed twice a year in order to standardize local data analysis by the local center Risk Analysis Team. During 2017 local data were collected, and incidence patterns on a national level as well as on local RT-centers were analyzed. Results Data of the consensus surveys are presented. Preliminary results on patient data analysis from 2016 have shown a big difference in the reporting activity between the participating centers whereas the risk patterns are quite similar. The majority of the incidents are found to occur in the planning steps of the RT course, giving risk of systematic errors through the entire course of RT. New national data for 2017 including anonymized inter-center comparison results will be presented. Data indicates consistent data analysis and similar risk profiles between the six participating RT-Centers. Conclusion Due to training of the risk analysis teams at different RT centers, it is possible to use a common data categorizing system making inter-center analysis and comparisons feasible. Data from six centers show a different reporting frequency. However, a similar risk profile indicates that pooled national data have the potential of developing a system for early warnings of RT risks between the centers and for common national recommendations on patient safety.

Pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) may develop malfunction during external beam radiotherapy (RT). We aimed to describe clinical practice in PM/ICD patients undergoing RT and to assess the rate and predictors of device malfunctions.We reviewed medical records of all PM/ICD patients undergoing RT at four centers in Western Denmark during 2003-2012. Logistic regression was applied to identify predictors of PM/ICD malfunctions.Five hundred sixty patients were included. The annual rate of RT courses in PM/ICD patients increased by 199% from 1.45 treatments per 100,000 person-years in 2003 to 4.33 in 2012. Safety measures included supplementary evaluations of PM/ICD (38.3%), reprogramming (1.5%), relocation of the device (3.5%), and application of a magnet to the ICD during RT (10.8%). At device evaluations after the RT (n = 453), malfunctions were detected in 10 (2.5%) PMs and four (6.8%) ICDs. Electrical resets constituted 11 (78.6%) of the malfunctions, and no failures were life-threatening or warranted PM/ICD removal. Factors associated with device malfunctions in logistic regression analysis were beam energy ≥15 MV (odds ratio [OR] 5.73; 95% confidence interval [CI], 1.58-20.76) and location of tumor below the diaphragm (OR 4.31; 95% CI, 1.42-13.12). However, the effect of tumor location declined (OR 2.27; 95% CI, 0.65-7.95) after adjustment for beam energy.Although the rate of RT in PM/ICD patients is increasing, the damaging effects of RT on the devices seem to be usually transient. Our data suggest that high beam energy plays the pivotal role in inducing impairments in these devices.

BACKGROUND: In radiotherapy (RT) of urinary bladder cancer, the use of intensity-modulated RT (IMRT) opens for sparing of considerable intestinal volumes. The purpose of the present study was to investigate the acute and late toxicities following either conformal RT (CRT) or IMRT for bladder cancer, and to correlate the toxicities to dose-volume parameters.MATERIAL AND METHODS: The study included 116 consecutively treated patients with muscle-invasive bladder cancer who received either CRT (n = 66) or IMRT (n = 50) during 2007-2010. Acute side effects were retrospectively collected whereas late effects were assessed by a cross-sectional evaluation by telephone interview of 44 recurrence-free patients. Acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Event (CTCAE) version 3.0.RESULTS: Acute diarrhoea grade ≥ 2 was more frequent in patients treated by CRT (56%) compared to IMRT (30%) (p = 0.008). Logistic regression analysis showed a correlation between acute diarrhoea and bowel cavity dose-volume parameters in the 10-50 Gy range. Severe late toxicity (grade ≥ 3) was recorded in 10% of the total cohort, with no statistical difference between the IMRT and CRT groups.CONCLUSION: Patients treated with IMRT for bladder cancer had significantly less acute diarrhoea compared to those treated with CRT, but there was no significant difference in late morbidity between the groups. The risk of acute diarrhoea was related to the volume of bowel irradiated.

Background This study shows how emotions are expressed in a trauma team setting and assesses their influence and importance with regard to team performance. The term ”Team emotion” can be interpreted as the emotions that trauma team members do/do not display in a trauma receiving unit. Health care professionals are expected to refrain from showing emotion in the presence of patients and colleagues, but at the same time these emotions have a provable effect on teamwork.

With an ageing population an increasing number of patients with a pacemaker or implantable cardioverter defibrillator will present at radiotherapy units due to malignancy. Two separate questionnaires concerning routines of departments treating this population were sent to Danish implanting cardiology centers and to radiotherapy departments. Differences in the handling of these patients were found. Removal of the devices and monitoring of the patients is assessed on a highly individual basis. In the absence of updated official guidelines, departments treating these patients should produce local instructions.

Capecitabine is an oral prodrug to 5-fluorouracil (5-FU). The primary target of 5-FU is thymidylate synthase (TS). A mainstay of colorectal adenocarcinoma chemotherapy is inhibition of TS, which may be one of many determinant factors when predicting the outcome of chemotherapies based on fluoropyrimidine treatment. This retrospective study included 39 patients with advanced colorectal adenocarcinoma treated with capecitabine. Response was assessed by measuring the amount of tumour in the course of treatment. TS expression was evaluated by scoring the immunohistochemical (IHC) reaction and assessing the predominant IHC reaction pattern. This study showed significant correlation between the predominant IHC reaction pattern and response, but no correlation between IHC score and response. The predominant IHC reaction pattern may be a useful parameter in prediction of clinical outcome in patients treated with capecitabine.

Udgivelsesdato: 2010