What do you do for patients who require radiation for breast cancer (either post-lumpectomy or post-mastectomy) but who have a pacemaker on the ipsilateral side?

A pacemaker is always a challenge when located in or nearby a radiation field. Typically, I would prefer to treat patients as I would normally treat them so as not to compromise care.

However, that may require moving the pacemaker to the contralateral side.

When treatment is ready to start, protoc...

I have treated some of these patients with APBI using multichannel applicator if they have suitable pathology.

For those not technically suitable for APBI, I have treated with tangential beam but skipped RT to the upper part of breast to keep pacemaker dose below threshold dose.

If the above is not ...