Safe Delivery of Radiotherapy for Breast Cancer Patient With Left Ventricular Assist Device: Case Report and Review of the Literature

The increasing use of cardiac artificial devices, such as cardiac implantable electronic devices (CIED) and left ventricular assist devices (LVAD), results in longer life expectancy and thus may eventually coincide with a risk of cancer diagnosis and requirement for radiotherapy. Safe irradiation dose limits are better studied and reported for CIEDs, but data on LVAD irradiation are scarce. We present a case of a patient diagnosed with breast cancer who developed heart failure and was given an LVAD, received appropriate oncological care including chemotherapy, surgery, and, after careful multidisciplinary review, radiotherapy. The patient's right-sided initial stage II (T1N1) disease necessitated radiation treatment to the chest wall and regional lymphatic nodal areas. Meticulous radiotherapy planning and treatment delivery were performed, and daily LVAD performance checks were done. Maximum and mean doses received by the LVAD system were 767 cGy and 227 cGy, respectively, for the whole treatment period (5000 cGy/25 fractions). During radiotherapy and after 41 months of follow-up, no VLAD malfunction was observed. As this case shows, having an LVAD does not appear to be a contraindication for radiotherapy delivery. Possible risks and consequences should be evaluated in a multidisciplinary setting.