The Impact of Radiation Therapy on Intrathecal Drug Delivery System Functioning and Safety.

Abstract

Purpose of review: Intrathecal drug delivery systems (IDDS) are integral to managing chronic pain and spasticity, especially in oncology patients who may also require radiation therapy (RT). Concerns regarding the potential effects of ionizing radiation on IDDS functionality have been raised, with limited but growing evidence on device resilience. This review summarizes the current literature on radiation-induced IDDS malfunctions, identifies key risk factors, and discusses mitigation strategies.

Recent findings: Although most IDDS remain functional during RT, isolated cases of radiation-induced pump failure have been reported. Factors such as radiation dose, proximity to the treatment field, and shielding methods influence device susceptibility to failure. Case studies and retrospective reviews have suggested that cumulative doses above 10 Gy may increase malfunction risks, though some devices have withstood doses as high as 36 Gy without failure. Advances in RT, including proton therapy and stereotactic techniques, may reduce exposure to IDDS. Current recommendations emphasize preemptive planning, shielding strategies, and close post-radiation monitoring to mitigate these potential risks. RT presents unique challenges for patients with IDDS, requiring a multidisciplinary approach to balance cancer treatment efficacy with device integrity. While modern IDDS demonstrate resilience to radiation exposure, careful consideration of radiation dose thresholds, device placement, and shielding is needed. Given the lack of standardized guidelines, more research is needed to establish evidence-based protocols to optimize patient safety and device performance during RT.