Vol 54, No 3 (2020)
Short Communication
Published online: 2020-04-14

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Radiation therapy in patients with implanted deep brain stimulation

Michał J. Schinwelski1, Jarosław Dulski23, Wojciech Łuczak4, Witold Libionka56, Tomasz Mandat7, Jarosław Sławek23
Pubmed: 32285432
Neurol Neurochir Pol 2020;54(3):280-283.

Abstract

Background. As deep brain stimulation (DBS) and radiation therapy (RT) have become established treatments for movement disorders and malignancies respectively, patients being treated with both simultaneously are becoming more frequent.

Objectives. Literature regarding the safety of RT in patients with implanted DBS is scarce, and there are no clear guidelines on how to manage them.

Methods. We present a follow-up of two Parkinson’s Disease (PD) patients with DBS undergoing RT in the context of previous literature.

Results. No adverse events nor malfunctioning of the DBS system were observed. This was in line with previous reports.

Conclusions.
Since there are no clear safety guidelines for RT in DBS patients, it is important to document experience in this field. A combined approach involving multidisciplinary discussions between neurosurgeons, radiotherapists, clinical oncologists and neurologists is recommended.

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References

  1. Ponce FA, Lozano AM. Deep brain stimulation state of the art and novel stimulation targets. Prog Brain Res. 2010; 184: 311–324.
  2. Delaney G, Jacob S, Featherstone C, et al. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005; 104(6): 1129–1137.
  3. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015; 65(2): 87–108.
  4. Szlufik S, Przybyszewski A, Dutkiewicz J, et al. Evaluating reflexive saccades and UDPRS as markers of Deep Brain Stimulation and Best Medical Treatment improvements in Parkinson's disease patients: a prospective controlled study. Neurol Neurochir Pol. 2019; 53(5): 341–347.
  5. Smilowska K, Bloem BR, Esselink RAJ, et al. Keep calm and beam on? Unmet needs in radiotherapy and deep brain stimulation. Parkinsonism Relat Disord. 2020; 71: 15–16.
  6. Nutt JG, Anderson VC, Peacock JH, et al. DBS and diathermy interaction induces severe CNS damage. Neurology. 2001; 56(10): 1384–1386.
  7. Henderson JM, Tkach J, Phillips M, et al. Permanent neurological deficit related to magnetic resonance imaging in a patient with implanted deep brain stimulation electrodes for Parkinson's disease: case report. Neurosurgery. 2005; 57(5): E1063; discussion E1063.
  8. Medtronic DBS Systems INDICATIONS, SAFETY, AND WARNINGS. https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/neurological/deep-brain-stimulation/indications-safety-warnings/brief-statement-movement-disorders.html (Nov 2017).
  9. Mazdai G, Stewart DP, Hounsell AR. Radical radiation therapy in a patient with head and neck cancer and severe Parkinson's disease. Clin Oncol (R Coll Radiol). 2006; 18(1): 82–84.
  10. Borkenhagen JF, Morris ZS, Hoberg JR, et al. Delivery of definitive dose external beam radiation in close proximity to an implanted deep brain stimulator. Pract Radiat Oncol. 2014; 4(5): 294–297.
  11. Munshi A, Agarwal JP, Pandey KC. Cancer patients with cardiac pacemakers needing radiation treatment: a systematic review. J Cancer Res Ther. 2013; 9(2): 193–198.
  12. Guy JB, Levy A, Malkoun N, et al. Preventing radiotherapy-induced side effects on deep brain stimulators: the need for a multidisciplinary management. Br J Neurosurg. 2014; 28(1): 107–109.
  13. Kotecha R, Berriochoa CA, Murphy ES, et al. Report of whole-brain radiation therapy in a patient with an implanted deep brain stimulator: important neurosurgical considerations and radiotherapy practice principles. J Neurosurg. 2016; 124(4): 966–970.
  14. Zaremba T, Jakobsen AR, Søgaard M, et al. Radiotherapy in patients with pacemakers and implantable cardioverter defibrillators: a literature review. Europace. 2016; 18(4): 479–491.
  15. Son BC, Kim JS, Park WC, et al. Management of Pulse Generators in a Breast Cancer Patient with in Situ Subthalamic Nucleus Deep Brain Stimulation. J Neurol Surg A Cent Eur Neurosurg. 2019; 80(3): 223–227.