Spinal cord stimulators and radiotherapy: First case report and practice guidelines

Radiation Oncology

Mojgan Hodaie⁴  Fei-Fei Liu¹  Alexandra Easson²  Philippe Bedard³  Thomas G Purdie¹  Daipayan Guha⁴  Lorraine Walsh¹ 

[1]Department of Radiation Oncology, University of Toronto, 610 University Avenue, Toronto M5G2M9, Ontario, Canada

[2]Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto M5G2M9, Ontario, Canada

[3]Division of Medical Oncology, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto M5G2M9, Ontario, Canada

[4]Department of Neurosurgery, University Health Network, 610 University Avenue, Toronto, M5G2M9, Ontario, Canada

关键词: electronic device;    pacemaker;    spinal cord stimulator;    radiotherapy;   

Others  :  1223872
DOI  :  10.1186/1748-717X-6-143

 received in 2011-06-21, accepted in 2011-10-25,  发布年份 2011

【 摘 要 】

Spinal cord stimulators (SCS) are a well-recognised treatment modality in the management of a number of chronic neuropathic pain conditions, particularly failed back syndrome and radiculopathies. The implantable pulse generator (IPG) component of the SCS is designed and operates in a similar fashion to that of a cardiac pacemaker. The IPG consists of an electrical generator, lithium battery, transmitter/receiver and a minicomputer. When stimulated, it generates pulsed electrical signals which stimulate the dorsal columns of the spinal cord, thus alleviating pain. Analogous to a cardiac pacemaker, it can be potentially damaged by ionising radiation from a linear accelerator, in patients undergoing radiotherapy. Herein we report our clinical management of the first reported case of a patient requiring adjuvant breast radiotherapy who had a SCS in situ. We also provide useful practical recommendations on the management of this scenario within a radiation oncology department.

【 授权许可】

   
2011 Walsh et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Delaney G, Jacob S, Featherstone C, Barton M: The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer 2005, 104:1129-37.
• [2]Solan AN, Solan MJ, Bednarz G, Goodkin MB: Treatment of patients with cardiac pacemakers and implantable cardioverter-defibrillators during radiotherapy. Int J Radiat Oncol Biol Phys 2004, 59:897-904.
• [3]Marbach JR, Sontag MR, Van Dyk J, Wolbarst AB: Management of radiation oncology patients with implanted cardiac pacemakers: report of AAPM Task Group No. 34. American Association of Physicists in Medicine. Med Phys 1994, 21:85-90.
• [4]Wadasadawala T, Pandey A, Agarwal JP, Jalali R, Laskar SG, Chowdhary S: Radiation therapy with implanted cardiac pacemaker devices: a clinical and dosimetric analysis of patients and proposed precautions. Clin Oncol (R Coll Radiol) 2011, 23:79-85.
• [5]Shealy CN, Mortimer JT, Reswick JB: Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg 1967, 46:489-91.
• [6]Turner JA, Loeser JD, Bell KG: Spinal cord stimulation for chronic low back pain: a systematic literature synthesis. Neurosurgery 1995, 37:1088-95. discussion 95-6
• [7]Kuchta J, Koulousakis A, Sturm V: Neurosurgical pain therapy with epidural spinal cord stimulation (SCS). Acta Neurochir Suppl 2007, 97(Pt 1):65-70.
• [8]Gonzalez J, Milbouw G: Alternative site of implantation of pulse generator for spinal cord stimulation. Neurochirurgie 2005, 51:489-91.
• [9]Hurkmans CW, Scheepers E, Springorum BG, Uiterwaal H: Influence of radiotherapy on the latest generation of implantable cardioverter-defibrillators. Int J Radiat Oncol Biol Phys 2005, 63:282-9.
• [10]Hurkmans CW, Scheepers E, Springorum BG, Uiterwaal H: Influence of radiotherapy on the latest generation of pacemakers. Radiother Oncol 2005, 76:93-8.
• [11]Hudson F, Coulshed D, D'Souza E, Baker C: Effect of radiation therapy on the latest generation of pacemakers and implantable cardioverter defibrillators: A systematic review. J Med Imaging Radiat Oncol 2010, 54:53-61.
• [12]Tondato F, Ng DW, Srivathsan K, Altemose GT, Halyard MY, Scott LR: Radiotherapy-induced pacemaker and implantable cardioverter defibrillator malfunction. Expert Rev Med Devices 2009, 6:243-9.
• [13]Calfee RV: Therapeutic radiation and pacemakers. Pacing Clin Electrophysiol 1982, 5:160-1.
• [14]Last A: Radiotherapy in patients with cardiac pacemakers. Br J Radiol 1998, 71:4-10.
• [15]Venselaar JL: The effects of ionizing radiation on eight cardiac pacemakers and the influence of electromagnetic interference from two linear accelerators. Radiother Oncol 1985, 3:81-7.
• [16]Mouton J, Haug R, Bridier A, Dodinot B, Eschwege F: Influence of high-energy photon beam irradiation on pacemaker operation. Phys Med Biol 2002, 47:2879-93.