Abstract
RATIONALE: Stereotactic body radiotherapy (SBRT) is a precise treatment modality for lung cancer, delivering high-dose radiation to tumors while sparing surrounding organs. However, because of their intracardiac placement and proximity to the chest radiation field, leadless pacemakers (LLPMs) pose unique challenges that are not fully addressed by the existing protocols for conventional pacemakers. PATIENT CONCERNS: In this case study, we aimed to emphasize the importance of identifying LLPMs before initiating SBRT for lung cancer and to discuss the necessary adjustments in treatment planning needed to accommodate these devices. DIAGNOSES: An 81-year-old female with stage IA adenocarcinoma in the left lower lobe of the lung underwent SBRT. INTERVENTIONS: During initial planning, the presence of an LLPM implanted in the right ventricle of the heart was overlooked. According to the original rotational arc therapy plan, 5 Gy of radiation would have been delivered to the pacemaker; therefore, a revised treatment plan using a fixed-beam multiport approach was adopted to avoid exposing the device to radiation. OUTCOMES: Pacemaker functionality was unaffected post-treatment, and the therapy was concluded without complications. LESSONS: This case emphasizes the critical need for identifying LLPMs prior to treatment and the importance of tailored radiotherapy plans to prevent device malfunction. The increasing use of these devices necessitates adherence to guidelines which recommend cumulative radiation doses of <5 Gy. Consequently, a thorough patient history and meticulous imaging review are required since identifying LLPMs on computed tomography can be challenging. Furthermore, effective SBRT in patients with lung cancer and LLPMs requires careful planning to ensure safety and therapeutic success. This case provides valuable insights for radiation oncologists, advocating for diligent pretreatment evaluation and customized radiation strategies in the context of evolving cardiac implant technologies.