title: Spinal cord stimulation as adjuvant during chemotherapy and reirradiation treatment of recurrent high-grade gliomas.
abstract: OBJECTIVE
  Relapsed high-grade gliomas (HGGs) have poor prognoses and there is no standard treatment. HGGs have ischemia/hypoxia associated and, as such, drugs and oxygen have low access, with increased resistance to chemotherapy and radiotherapy. Tumor hypoxia modification can improve outcomes and overall survival in some patients with these tumors. In previous works, we have described that cervical spinal cord stimulation can modify tumor microenvironment in HGG by increasing tumor blood flow, oxygenation, and metabolism. The aim of this current, preliminary, nonrandomized, study was to assess the clinical effect of spinal cord stimulation during brain reirradiation and chemotherapy deployed for the treatment of recurrent HGG; the hypothesis being that an improvement in oxygenated blood supply would facilitate enhanced delivery of the scheduled therapy.
  
  
  METHODS
  Seven patients had spinal cord stimulation applied during the scheduled reirradiation and chemotherapy for the treatment of recurrent HGG (6 anaplastic gliomas and 1 glioblastoma). Median dose of previous irradiation was 60 Gy (range = 56-72 Gy) and median dose of reirradiation was 46 Gy (range = 40-46 Gy). Primary end point of the study was overall survival (OS) following confirmation of HGG relapse.
  
  
  RESULTS
  From the time of diagnosis of last tumor relapse before reirradiation, median OS was 39 months (95% CI = 0-93) for the overall study group: 39 months (95% CI = 9-69) for those with anaplastic gliomas and 16 months for the patient with glioblastoma. Posttreatment, doses of corticosteroids was significantly decreased (P = .026) and performance status significantly improved (P = .046).
  
  
  CONCLUSIONS
  Spinal cord stimulation during reirradiation and chemotherapy is feasible and well tolerated. In our study, spinal cord stimulation was associated with clinical improvement and longer survival than previously reported in recurrent anaplastic gliomas. Spinal cord stimulation as adjuvant during chemotherapy and reirradiation in relapsed HGGs merits further research.
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain ICIC (Canary Islands Institute for Cancer Research), Las Palmas, Spain GICOR (Grupo de Investigación Clínica en Oncología Radioterápica), Madrid, Spain bernardinoclavo@gmail.com.
authors.forename: Bernardino
authors.initials: B
authors.lastname: Clavo
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain ICIC (Canary Islands Institute for Cancer Research), Las Palmas, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Robaina
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain.
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Jorge
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Cabrera
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Ruiz-Egea
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain.
authors.forename: Adam
authors.initials: A
authors.lastname: Szolna
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Otermin
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Llontop
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Carames
authors.affiliation: Dr Negrín University Hospital, Las Palmas, Spain.
authors.forename: Norberto
authors.initials: N
authors.lastname: Santana-Rodríguez
authors.affiliation: VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Sminia
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000473:pathology / Q000628:therapy*; D005910:Glioma / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019233:Retreatment; D062187:Spinal Cord Stimulation / Q000379:methods*; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: EQD2; anaplastic astrocytoma; complementary treatment; glioblastoma; reirradiation; relapsed brain tumor; spinal cord stimulation; temozolomide