title: Report of whole-brain radiation therapy in a patient with an implanted deep brain stimulator: important neurosurgical considerations and radiotherapy practice principles.
abstract: Patients with implanted neuromodulation devices present potential challenges for radiation therapy treatment planning and delivery. Although guidelines exist regarding the irradiation of cardiac pacemakers and defibrillators, fewer data and less clinical experience exist regarding the effects of radiation therapy on less frequently used devices, such as deep brain stimulators. A 79-year-old woman with a history of coarse tremors effectively managed with deep brain stimulation presented with multiple intracranial metastases from a newly diagnosed lung cancer and was referred for whole-brain radiation therapy. She was treated with a German helmet technique to a total dose of 30 Gy in 10 fractions using 6 MV photons via opposed lateral fields with the neurostimulator turned off prior to delivery of each fraction. The patient tolerated the treatment well with no acute complications and no apparent change in the functionality of her neurostimulator device or effect on her underlying neuromuscular disorder. This represents the first reported case of the safe delivery of whole-brain radiation therapy in a patient with an implanted neurostimulator device. In cases such as this, neurosurgeons and radiation oncologists should have discussions with patients about the risks of brain injury, device malfunction or failure of the device, and plans for rigorous testing of the device before and after radiation therapy.
authors: Department of Radiation Oncology, Taussig Cancer Institute.
authors: Rupesh
authors: R
authors: Kotecha
authors: Department of Radiation Oncology, Taussig Cancer Institute.
authors: Camille A
authors: CA
authors: Berriochoa
authors: Department of Radiation Oncology, Taussig Cancer Institute.|Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic.
authors: Erin S
authors: ES
authors: Murphy
authors: Center for Neurological Restoration, and |Departments of 4 Neurological Surgery.|Neurosciences, and.|Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.
authors: Andre G
authors: AG
authors: Machado
authors: Department of Radiation Oncology, Taussig Cancer Institute.|Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic.
authors: Samuel T
authors: ST
authors: Chao
authors: Department of Radiation Oncology, Taussig Cancer Institute.|Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic.
authors: John H
authors: JH
authors: Suh
authors: Department of Radiation Oncology, Taussig Cancer Institute.
authors: Kevin L
authors: KL
authors: Stephans
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D046690:Deep Brain Stimulation; D004567:Electrodes, Implanted; D005260:Female; D006260:Head Protective Devices; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods*; D010166:Palliative Care; D011878:Radiotherapy / Q000379:methods*; D016896:Treatment Outcome
keywords: DBS = deep brain stimulation; IPG = implantable pulse generator; brain metastasis; deep brain stimulator; functional neurosurgery; ionizing radiation; neurostimulator; oncology; radiation therapy; whole-brain