Spinal cord stimulators and radiotherapy: first case report and practice guidelines.
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.
Radiation Medicine Program, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto M5G2M9, Ontario, Canada.
Lorraine
L
Walsh
Daipayan
D
Guha
Thomas G
TG
Purdie
Philippe
P
Bedard
Alexandra
A
Easson
Fei-Fei
FF
Liu
Mojgan
M
Hodaie
D001416:Back Pain / Q000150:complications / Q000628:therapy; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002278:Carcinoma in Situ / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000295:instrumentation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008161:Lumbosacral Region; D008408:Mastectomy; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D009437:Neuralgia / Q000150:complications / Q000628:therapy; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D013116:Spinal Cord / Q000503:physiopathology; D013123:Spinal Fusion