Effect of cervical spinal cord stimulation on regional blood flow and oxygenation in advanced head and neck tumours.
BACKGROUND
Tumour ischaemia leads to decreased delivery of oxygen, chemotherapy and radiosensitisers. Hypoxia in head and neck (H&N) tumours is an important adverse prognostic factor. Spinal cord stimulation (SCS) is a well-established neurosurgical technique in the treatment of several ischaemic syndromes. This prospective study evaluated the effect of cervical-SCS on common carotid artery (CCA) blood flow and tumour oxygenation in patients with advanced H&N cancer.


METHODS
Sixteen patients with advanced H&N tumours were enrolled. Cervical-SCS devices were inserted subcutaneously prior to commencement of scheduled chemoradiotherapy. Pre- and post-SCS measurements were as follows: (i) tumour oxygenation (mmHg) using polarographic probes; (ii) blood flow quantification (ml/min) and diastolic and systolic velocimetry (cm/s) in the CCA using colour Doppler.


RESULTS
After SCS, median tumour oxygenation increased in two-thirds of patients (34%; P = 0.023), all patients had improved CCA blood flow (50%; P <0.001) and almost all patients showed an increased CCA diastolic velocity (26%; P = 0.003) and systolic velocity (20%; P = 0.011).


CONCLUSIONS
Cervical-SCS increased tumour oxygenation and CCA blood flow, and could enhance the loco-regional delivery of oxygen, radiosensitising and chemotherapeutic drugs. Cervical-SCS as adjuvant in chemoradiotherapy of these tumours warrants further investigation.
Clavo
B
B
Department of Radiation Oncology Research Unit, Dr Negrín Hospital, C/Barranco la Ballena s/n, 35020 Las Palmas, Canary Islands, Spain. bernardinoclavo@terra.es
Robaina
F
F
Catalá
L
L
Pérez
J L
JL
Lloret
M
M
Caramés
M A
MA
Morera
J
J
López
L
L
Suárez
G
G
Macías
D
D
Rivero
J
J
Hernández
M A
MA
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017536:Carotid Artery, Common; D002574:Cervical Vertebrae; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000098:blood supply* / Q000188:drug therapy / Q000503:physiopathology* / Q000532:radiotherapy; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis*; D011446:Prospective Studies; D012039:Regional Blood Flow; D013116:Spinal Cord / Q000502:physiology*
D010100:Oxygen