title: Effect of cervical spinal cord stimulation on regional blood flow and oxygenation in advanced head and neck tumours.
abstract: 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.
authors.affiliation: Department of Radiation Oncology Research Unit, Dr Negrín Hospital, C/Barranco la Ballena s/n, 35020 Las Palmas, Canary Islands, Spain. bernardinoclavo@terra.es
authors.forename: B
authors.initials: B
authors.lastname: Clavo
authors.forename: F
authors.initials: F
authors.lastname: Robaina
authors.forename: L
authors.initials: L
authors.lastname: Catalá
authors.forename: J L
authors.initials: JL
authors.lastname: Pérez
authors.forename: M
authors.initials: M
authors.lastname: Lloret
authors.forename: M A
authors.initials: MA
authors.lastname: Caramés
authors.forename: J
authors.initials: J
authors.lastname: Morera
authors.forename: L
authors.initials: L
authors.lastname: López
authors.forename: G
authors.initials: G
authors.lastname: Suárez
authors.forename: D
authors.initials: D
authors.lastname: Macías
authors.forename: J
authors.initials: J
authors.lastname: Rivero
authors.forename: M A
authors.initials: MA
authors.lastname: Hernández
mesh_terms: 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*
chemical_list: D010100:Oxygen