Increased locoregional blood flow in brain tumors after cervical spinal cord stimulation.
OBJECTIVE
Patients with high-grade gliomas have poor prognoses following standard treatment. Generally, malignant brain tumors have a decreased blood flow that results in increased resistance to radiation and reduced delivery of chemotherapeutic agents and oxygen. The aim of the present study was to assess the effect of spinal cord stimulation (SCS) on locoregional blood flow in high-grade tumors in the brain.


METHODS
Fifteen patients (11 with Grade III and four with Grade IV brain tumors) had SCS devices inserted prior to scheduled radiotherapy. Both before and after SCS, the patients underwent the following procedures: 1) single-photon emission computerized tomography (SPECT) scanning; 2) middle cerebral artery (MCA) blood flow velocity measurements (centimeters/second) with the aid of transcranial Doppler (TCD) ultrasonography; and 3) common carotid artery (CCA) blood flow volume quantification (milliliters/minute) based on time-domain processing by using color Doppler ultrasonography. The indices demonstrated on SPECT scanning before SCS were significantly lower (p < 0.001) in tumor sites compared with those in peritumoral sites (32%) and healthy contralateral areas (41%). Poststimulation results revealed the following: 1) a mean increase of 15% in tumor blood flow in 75% of patients (p = 0.033), as demonstrated on SPECT scanning: 2) a mean increase of greater than 18% in systolic and diastolic blood flow velocities in both tumorous and healthy MCAs in all but one patient (p < 0.002), as exhibited on TCD ultrasonography; and 3) a mean increase of greater than 60% in blood flow volume in tumorous and healthy CCAs in all patients (p < 0.013), as revealed on color Doppler ultrasonography studies.


CONCLUSIONS
Preliminary data show that SCS can modify locoregional blood flow in high-grade malignant tumors in the brain, thus indicating that SCS could be used to improve blood flow, oxygenation, and drug delivery to such tumors and could be a useful adjuvant in chemoradiotherapy.
Clavo
Bernardino
B
Department of Radiation Oncology Research Unit, Dr. Negrín Hospital, Las Palmas, Canary Islands, Spain. bernardinoclavo@terra.es
Robaina
Francisco
F
Catalá
Luis
L
Valcárcel
Benilde
B
Morera
Jesús
J
Caramés
Miguel A
MA
Ruiz-Egea
Eugenio
E
Panero
Francisco
F
Lloret
Marta
M
Hernández
Maria A
MA
D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001783:Blood Flow Velocity; D001932:Brain Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000628:therapy*; D017536:Carotid Artery, Common / Q000502:physiology; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004558:Electric Stimulation / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D009367:Neoplasm Staging; D013116:Spinal Cord / Q000502:physiology*; D005641:Tegafur / Q000627:therapeutic use; D015899:Tomography, Emission-Computed, Single-Photon; D018615:Ultrasonography, Doppler, Color; D017585:Ultrasonography, Doppler, Transcranial
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D005641:Tegafur; D006918:Hydroxyurea