Particle therapy using protons or carbon ions for cancer patients with cardiac implantable electronic devices (CIED): a retrospective multi-institutional study

Jpn J Radiol. 2022 May;40(5):525-533. doi: 10.1007/s11604-021-01218-1. Epub 2021 Nov 15.


Purpose: To evaluate the outcomes of particle therapy in cancer patients with cardiac implantable electronic devices (CIEDs).

Materials and methods: From April 2001 to March 2013, 19,585 patients were treated with proton beam therapy (PBT) or carbon ion therapy (CIT) at 8 institutions. Of these, 69 patients (0.4%, PBT 46, CIT 22, and PBT + CIT 1) with CIEDs (64 pacemakers, 4 implantable cardioverter defibrillators, and 1 with a cardiac resynchronization therapy defibrillator) were retrospectively reviewed. All the patients with CIEDs in this study were treated with the passive scattering type of particle beam therapy.

Results: Six (13%) of the 47 PBT patients, and none of the 23 CIT patients experienced CIED malfunctions (p = 0.105). Electrical resets (7) and over-sensing (3) occurred transiently in 6 patients. The distance between the edge of the irradiation field and the CIED was not associated with the incidence of malfunctions in 20 patients with lung cancer. A larger field size had a higher event rate but the test to evaluate trends as not statistically significant (p = 0.196).

Conclusion: Differences in the frequency of occurrence of device malfunctions for patients treated with PBT and patients treated with CIT did not reach statistical significance. The present study can be regarded as a benchmark study about the incidence of malfunctioning of CIED in passive scattering particle beam therapy and can be used as a reference for active scanning particle beam therapy.

Keywords: Carbon ion therapy; Cardiac implantable electronic devices; Electrical reset; Proton beam therapy; Secondary neutron.

Publication types

  • Multicenter Study

MeSH terms

  • Carbon / therapeutic use
  • Electronics
  • Humans
  • Neoplasms* / radiotherapy
  • Pacemaker, Artificial*
  • Protons
  • Retrospective Studies


  • Protons
  • Carbon