Metastatic work-up was negative for distant disease. Fine needle aspiration of a left axillary node identified invasive ductal carcinoma (IDC). Biopsy identified a grade 3 ductal carcinoma in-situ (DCIS). Digital mammography identified a 10 cm mass occupying the left breast. We outline our management plan in ensuring the safe delivery of radiation for this patient, and suggest recommendations for the management of this uncommon, but potentially serious clinical scenario.Ī 46 year old peri-menopausal woman, with no known breast cancer risk factors, self-detected a left breast mass. Herein, we present the first reported case of a patient with a SCS in-situ, who required adjuvant RT for breast cancer. When irradiated however, the IPG could be potentially damaged by the ionizing radiation itself, or by electromagnetic interference generated from the linear accelerator, in the same way that ionising radiation can damage a cardiac pacemaker or ICD. The logic and control section includes a microprocessor and controls the programmable functions of the device via a crystal oscillator (Rutecki: United States Patent, Number 5330515, July 1994). The terminals of the battery cell are connected to the input terminals of the voltage regulator, which provides power to the logic and control section of the IPG. The IPG contains a battery similar to that of a cardiac pacemaker, typically a single lithium thionyl chloride cell or lithium-iodine battery. The amplitude (intensity), frequency, and width of the stimulating electrical signals can be adjusted for the desired effect. The IPG closely resembles and operates similarly to a cardiac pacemaker, generating pulsed electrical signals which stimulate the dorsal columns. Typical IPG locations include the gluteal and flank regions, with sub-clavicular and abdominal wall placement performed less frequently. The IPG is then implanted into a subcutaneous pocket and connected to the leads. The system is deemed suitable for insertion (stage 2) if there is adequate pain relief (typically greater than 50% pain relief) and lack or minimal side effects of stimulation. Less commonly patients can remain in hospital for 2-5 days after the procedure during which time pain level and functional capacity improvements are assessed. The majority of patients are trialled as out-patients. The leads are inserted under local anesthesia with sedation, following which they are connected to an external connector lead and controller that allows the patient to manipulate the device once ambulating. The SCS can also be placed to cover exiting nerve roots in the epidural space, in addition to or instead of posterior placement over dorsal columns. One to four leads are placed in the epidural space in the cervical, thoracic or lumbar regions as appropriate, either percutaneously or via a small laminotomy. Surgical techniques for SCS implantation are largely similar regardless of indication and are typically performed in two stages. They are increasingly applied to other conditions including intractable angina and ischemic pain secondary to peripheral vascular disease, though long-term efficacy remains undetermined. These devices are an important treatment modality for chronic neuropathic pain conditions refractory to conservative management, including complex regional pain syndrome, radiculopathies, failed back syndrome, phantom limb pain, and post-herpetic neuralgia. The SCS system consists of 3 components: an electrode array which is implanted in the epidural space overlying the dorsal columns of the spinal cord an implantable pulse generator (IPG) which consists of an electrical generator, battery, transmitter/receiver and a minicomputer, which is placed beneath the skin and controlled transcutaneously by the patient and insulating wiring connecting the electrodes to the IPG. Spinal cord neuromodulation using implantable electrodes placed over the dorsal columns in the epidural space can be an effective strategy for the control of severe, longstanding, neuropathic pain. Safety guidelines do not yet exist however, for implanted electronic spinal cord stimulators (SCS). Given the increasing use of these devices for a broad range of medical applications, recommendations have been developed regarding the safe delivery of RT with such devices in-situ. However, RT can interfere with and potentially damage implanted electronic devices such as cardiac pacemakers or implanted cardioverter-defibrillators (ICD). Radiotherapy (RT) is a major cancer treatment modality, applied to approximately 60% of patients at some point in their natural history for curative and palliative intent.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |