S2802
RTT - RTT contouring, target definition, and treatment planning
ESTRO 2026
according to international recommendations, including AAPM TG-203 guidelines. Results:
The two-isocenter configuration for lower extremities improved efficiency and precision of TMI. RTTs played a keyrole in implementing procedural innovation, ultimately contributing to enhanced treatment quality and patient experience. References: 1. Lambri N, Antonetti SL, Dei D, Bellu L, Bramanti S, Brioso RC, Carlo-Stella C, Castiglioni I, Clerici E, Crespi L, De Philippis C, Galdieri C, Loiacono D, Navarria P, Reggiori G, Rusconi R, Tomatis S, Scorsetti M, Mancosu P. Impact of the Extremities Positioning on the Set-Up Reproducibility for the Total Marrow Irradiation Treatment. Curr Oncol. 2023 Apr 6;30(4):4067-4077. doi: 10.3390/curroncol30040309. PMID: 37185422; PMCID: PMC10136565 Keywords: Total Marrow Irradiation, Patient Setup, Quality Digital Poster 4481 Radiotherapy in Patients with Cardiac Implantable Electronic Devices: Retrospective Analysis of Dosimetric Parameters Rosa Patrício 1,2 , Alice Alves 1 , Rui Castro 2 , Patrícia Varzim 1 , Fernando M. Costa 1,2 , Daniela Saraiva 1,3 , Gabriel Farinha 1 , Armanda Monteiro 1,2 , Lígia Osório 1 1 Radiation Oncology Department, São João Universitary Hospital Center, Porto, Portugal. 2 Medical Imaging and Radiotherapy Department, School of Health, Polytechnic of Porto, Porto, Portugal. 3 School of Engineering, University of Vigo, Vigo, Spain Purpose/Objective: The increasing number of patients with cardiac implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter- defibrillators (ICDs), combined with the growing oncology population undergoing radiotherapy (RT), represents a significant challenge for treatment planning and clinical safety. Inadvertent exposure of these devices to radiation can result in temporary or permanent malfunctions, affecting patient safety. In this context, monitoring dosimetric parameters and implementing appropriate protection protocols are essential to minimize risks. The aim of this study was to retrospectively evaluate dosimetric parameters, device tolerance, and clinical outcomes in patients with CIEDs treated with RT at a single hospital center. Material/Methods: A retrospective analysis was conducted on patients with pacemakers or ICDs treated with external beam radiotherapy between 2023 and 2025, evaluating tumor site, technique, total dose, and estimated dose to the device. Device function was monitored during and after treatment, and results were analyzed
A total of 49 patients were included. Of these, 10 (20.4%) had measurable dose exposure to the CIED, mainly in thoracic and cervico-thoracic tumors (lung, breast, axillary lymphoma, esophagus, and head and neck). Patients with pelvic tumors (prostate, rectum, bladder, gastric) and central nervous system tumors showed no detectable dose. Nine patients had measurable exposure: breast (right) Dmax 42.54 Gy, Dmed 41 Gy; axillary lymphoma Dmax 27.51 Gy, Dmed 12.1 Gy; lung Dmax 4.63 Gy, Dmed 1.90 Gy; others (ORL, esophagus, skin metastasis) had Dmax < 2 Gy. All below the 2 Gy safety threshold proposed by AAPM TG-203. Cases with higher doses corresponded to situations where the device was within the treatment field, emphasizing the need for careful planning and the use of intensity modulation techniques or additional shielding. Conclusion: Our results are consistent with the literature, radiotherapy can be safely delivered to patients with CIEDs. Cooperation between radiation oncologists, cardiologists, medical physicists, and radiation technologists is needed to achieve the best practice management in these patients. References: 1. Hurkmans CW, Djajaputra D, Muhs BE, et al. Report No. 203 – Management of Radiotherapy Patients with Implanted Cardiac Pacemakers and Defibrillators: A Report of the AAPM TG-203. Med Phys. 2019;46(8):e741–e768. doi:10.1002/mp.138382. Institute of Physics and Engineering in Medicine (IPEM). Management of patients with cardiac implantable electronic devices receiving radiotherapy. Radiotherapy Board; 2025. Available from: https://www.ipem.ac.uk/media/easnixzk/manag ement-of-patients-with-cieds-receiving-rt_jan2025_.pdf Keywords: CIEDs, ICDs, Dosimetry Digital Poster 4805 Bridging precision and access: challenge of adaptive radiotherapy in Head and Neck oncology in low- and middle-income countries khedija Ben Zid 1 , Cyrine Mokrani 1 , Alia Mousli 1 , Alia Methnani 2 , Rim Abidi 1 , Skander Kedous 2 , Chiraz Nasr 1 1 Radiotherapy, salah azaiz institute, tunis, Tunisia. 2 Head and Neck surgery, salah azaiz institute, Tunis, Tunisia Purpose/Objective: Radiotherapy frequently serves as the cornerstone of treatment for head and neck cancers (HNC). However,
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