Vol.:(0123456789) 1 3 Australasian Physical & Engineering Sciences in Medicine https://doi.org/10.1007/s13246-019-00751-8 REVIEW PAPER A review and analysis of stereotactic body radiotherapy and radiosurgery of patients with cardiac implantable electronic devices Hossein Aslian 1  · Tomas Kron 2  · Francesco Longo 1,3  · Roya Rad 4  · Mara Severgnini 5 Received: 23 May 2018 / Accepted: 27 March 2019 © Australasian College of Physical Scientists and Engineers in Medicine 2019 Abstract The implementation of stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) has greatly increased due to its convenience and advantages from perspectives ranging from radiobiology to radio physics. Because SBRT/SRS delivers high doses in few fractions, precise dose delivery to target volumes and sufcient sparing of adjacent organs at risk (OARs) are required. Achieving these conficting objectives is challenging for all patients receiving SBRT/SRS and may be particularly challenging when SBRT/SRS is adopted for treating patients with cardiac implantable electronic devices (CIEDs) because cumulative doses in CIEDs must be limited. Published research considering the diferent aspects of stereo- tactic treatment in patients with CIEDs was reviewed to summarise their fndings in the following sections: (I) conventional linear accelerator (linac)-based SBRT and SRS; (II) CyberKnife, Gamma-Knife, VERO and helical tomotherapy SBRT and SRS; and (III) proton therapy. A total of 65 patients who had CIEDs and underwent SRS, SBRT, or SABR treatments were identifed in the reviewed studies. The functionality of the CIEDs was assessed for 58 patients. Of those, CIED malfunctions (such as data loss, mode change, and inappropriate shock) were reported in four patients (6.89%). This review highlights the available sparse information in the literature by posing questions for future research. Keywords Stereotactic body radiotherapy (SBRT) · Stereotactic radiosurgery (SRS) · CyberKnife · Gamma-knife · Tomotherapy · Pacemaker · Implantable cardioverter defbrillator Introduction Stereotactic body radiotherapy (SBRT), which was more recently defned as stereotactic ablative body radiotherapy (SABR), is increasingly used in the treatment of difer- ent malignancies, including both primary and metastatic lung, liver, brain, vertebral, kidney and pancreatic tumours [1]. The increased use of SBRT is due to the possibility of achieving a highly localised dose distribution facilitated by the common use of non-coplanar beam deliveries, the explicit inclusion of motion management and the use of image guidance [2]. Although a higher dose per fraction can provide high rates of tumour control, it can increase the risk of long-term toxicity to normal tissues. Therefore, SBRT requires pre- cise delivery of the dose to target volumes and sufcient sparing of adjacent organs at risk (OARs) [1, 2]. Achieving these conficting objectives is challenging when planning radiotherapy for patients receiving SBRT/SRS and may be particularly challenging when SBRT/SRS is adopted for treating patients with cardiac implantable electronic devices (CIEDs). The American Association of Physicists in Medi- cine (AAPM) report (TG34) was the earliest guideline published for the management of patients with CIEDs receiving general radiotherapy (RT) in 1994 [3]. Since * Hossein Aslian h-aslian@mail.com 1 Department of Physics, University of Trieste, Via Alfonso Valerio, 2, 34127 Trieste, Italy 2 Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia 3 Italian National Institute of Nuclear Physics (INFN), sezione di Trieste, Trieste, Italy 4 Viterbi School of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA 5 Medical Physics Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy