How would you approach SBRT in a pacemaker-dependent elderly patient with Stage I NSCLC whose SBRT plan Dmax exceeds the pacemaker tolerance?  

For any patient who has a pacemaker, we always send them to be evaluated for the device by a cardiologist before simulation and after finishing all fractions of the SBRT. In addition, we check their vital signs daily after each fraction of SBRT.  For SBRT planning, we will minimize irradiating...

Thanks for the great insights from Dr. @Joe Y. Chang. Just one tip you might be willing to consider. We have sometimes tried simulation with arms above the head and arms down, and often the pacemaker moves for a few centimeters in the cranio-caudal direction, moving it away from the field in one of ...

Great point about the arm position. I would also consider the reason for the patient's pacemaker. Some patients may be pacemaker dependent, while others have it rarely deployed. Pacemaker manufacturers also vary in terms of pacemaker dose testing and the estimate of the damage that ionizing radiati...

I had this exact problem; the tumor lay under the pacemaker. The EP cardiologist simply transferred it to the right side. The pacemaker is in the patient for a reason; I think it is better to defer to the EP cardiologist who placed it as whatever condition led to its need is unlikely to correct its...

We have had this situation once or twice as well. Agree with the assessment of arm position, etc. In one of our cases with an ipsilateral apical tumor and adjacent pacemaker, we consulted cardiology. There was enough slack in the leads so the pocket could be extended causally and the pacemaker could...