Neurostimulators and Radiation Therapy: Is There Any Risk?

The use of neurostimulators has increased in recent decades. However, safety guidelines in patients undergoing radiation therapy (RT) are lacking. We report 2 cases of pelvic RT for prostate cancer in patients with spinal cord neurostimulators. The implantable pulse generator was placed close to the irradiated volume in the gluteal region and received a median and maximal dose of 2.8 and 5.68 Gy, respectively for patient 1; and 3.65 and 5.15 Gy, respectively for patient 2. During and after RT, No dysfunction of the device was recorded. Based on the similarity with the cardiac implantable electric devices, we recommend similar safety procedures, this include the following: (i) a cumulative dose <5 Gy, (ii) avoiding neutron-producing RT, (iii) ensuring the implantable pulse generator positioning outside the direct beams, (iv) switching the device to "off-mode" during treatment delivery, and (v) in vivo verification in case of implantable pulse generator close to irradiation volume. The final decision should involve neurology specialist.