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Wu R, Majdalany BS, Lilly M, Prologo JD, Kokabi N. Agents Used for Nerve Blocks and Neurolysis. Semin Intervent Radiol 2022; 39:387-393. [PMID: 36406019 PMCID: PMC9671686 DOI: 10.1055/s-0042-1757315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The recognition of pain and the treatments used for it are vital for all practitioners. Many types of pain can be treated in a locoregional fashion, which has significant implications not just for any individual patient but for society as a whole. These treatments are most effective when performed in a minimally invasive, image-guided fashion. Interventional radiologists should play a central role in providing these lifestyle-limiting treatments. This article describes the medications most typically used for spinal and extra-axial treatments in the management of patients in pain.
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Affiliation(s)
- Richard Wu
- Emory University School of Medicine, Atlanta, Georgia
| | - Bill S. Majdalany
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Meghan Lilly
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - J. David Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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2
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Lohse I, Brothers SP. Pathogenesis and Treatment of Pancreatic Cancer Related Pain. Anticancer Res 2020; 40:1789-1796. [PMID: 32234867 DOI: 10.21873/anticanres.14133] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 02/08/2023]
Abstract
Pancreatic cancer is often diagnosed due to the patient seeking medical attention for abdominal pain. It is among the most painful cancers, with pain severity strongly correlating with prognosis. Perineural invasion is a prominent feature of pancreatic cancer and often the first route of metastasis resulting in neuropathic pain. While surgical pain is present, it is generally short-lived; chemo- and radio-therapy associated side effect pain is often longer lasting and more difficult to manage. Treatment-induced mucositis in response to chemotherapy occurs throughout the GI tract resulting in infection-prone ulcers on the lip, buccal mucosa, palate or tongue. Cisplatin treatment is associated with axonal neuropathy in the dorsal root ganglion, although other large sensory fibers can be affected. Opioid-induced hyperalgesia can also emerge in patients. Along with traditional means to address pain, neurolytic celiac plexus block of afferent nociceptive fibers has been reported to be effective in 74% of patients. Moreover, as cancer treatments become more effective and result in improved survival, treatment-related side effects become more prevalent. Here, pancreatic cancer and treatment associated pain are reviewed along with current treatment strategies. Potential future therapeutic strategies to target the pathophysiology underlying pancreatic cancer and pain induction are also presented.
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Affiliation(s)
- Ines Lohse
- Center for Therapeutic Innovation, Miller School of Medicine, University of Miami, Miami, FL, U.S.A.,Department of Psychiatry and Behavioral Sciences, University of Miami, FL, U.S.A.,Molecular Therapeutics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami, FL, U.S.A
| | - Shaun P Brothers
- Center for Therapeutic Innovation, Miller School of Medicine, University of Miami, Miami, FL, U.S.A. .,Department of Psychiatry and Behavioral Sciences, University of Miami, FL, U.S.A.,Molecular Therapeutics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami, FL, U.S.A
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3
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Lugnani F, Zhao JG. Translation of Cryobiological Techniques to Socially Economically Deprived Populations—Part 2: Cryosurgery. J Med Device 2020. [DOI: 10.1115/1.4045836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AbstractCold and cryogenic temperatures are used for treating cancer and other pathological conditions in various fields of medicine. Cryosurgery, which resides at the interface of medicine and engineering, has attracted the interest of engineers, scientists, and medical doctors. Recently, particularly since the end of the 1980s, technological developments in cryotherapy equipment and enormous advances in imaging techniques, such as computed tomography and ultrasonography, have allowed surgeons and interventional radiologists to precisely guide cryogenic probes into tumors while avoiding damage to surrounding tissues. Extensive studies have allowed us to conclude that the use of cryogenics facilitates the successful treatment of solid tumors in various organs such as lung, liver, bones, kidneys, prostate, etc. Its simplicity of use, effectiveness, low cost, and limited demand on hospital infrastructure and personnel have made cryosurgery particularly suitable for the treatment of patients of socio-economically deprived populations.
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Affiliation(s)
- Franco Lugnani
- Hippocrates Doo, Brezec pri Divaci 9a, Divaca 6215, Slovenia
| | - John Guojiang Zhao
- Asia-Pacific Institute for Biomedical Research, 28 Connaught Road West, Hong Kong, China
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4
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Careskey H, Narang S. Interventional Anesthetic Methods for Pain in Hematology/Oncology Patients. Hematol Oncol Clin North Am 2019; 32:433-445. [PMID: 29729779 DOI: 10.1016/j.hoc.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article reviews anesthetic interventional approaches to the management of pain in hematology and oncology patients. It includes a discussion of single interventions including peripheral nerve blocks, plexus injections, and sympathetic nerve neurolysis, and continuous infusion therapy through implantable devices, such as intrathecal pumps, epidural port-a-caths, and tunneled catheters. The primary objective is to inform members of hematology and oncology care teams regarding the variety of interventional options for patients with cancer-related pain for whom medical pain management methods have not been effective.
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Affiliation(s)
- Holly Careskey
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Sanjeet Narang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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5
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Ferrer-Mileo L, Luque Blanco AI, González-Barboteo J. Efficacy of Cryoablation to Control Cancer Pain: A Systematic Review. Pain Pract 2018; 18:1083-1098. [DOI: 10.1111/papr.12707] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/22/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Laura Ferrer-Mileo
- Department of Medical Oncology; Catalan Institute of Oncology-Hospitalet; Barcelona Spain
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6
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He L, Niu L, Korpan NN, Sumida S, Xiao Y, Li J, Sutedja B, Lu Y, Zuo J, Liu J, Xu K. Clinical Practice Guidelines for Cryosurgery of Pancreatic Cancer: A Consensus Statement From the China Cooperative Group of Cryosurgery on Pancreatic Cancer, International Society of Cryosurgery, and Asian Society of Cryosurgery. Pancreas 2017; 46:967-972. [PMID: 28742542 PMCID: PMC5555970 DOI: 10.1097/mpa.0000000000000878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/08/2017] [Indexed: 12/12/2022]
Abstract
Pancreatic cancer (PC), one of the most lethal malignancies, accounts for 8% to 10% of digestive system cancers, and the incidence is increasing. Surgery, chemotherapy, and radiotherapy have been the main treatment methods but are not very effective. Cryosurgery was first used in 1984 for treatment of locally advanced PC and has since become a considerable treatment for most cases of unresectable PC. During the past decade, cryosurgery has been applied in some hospitals in China, and the newly developed technique of computed tomography- and/or ultrasound-guided percutaneous cryosurgery has shown better results than chemotherapy in cases of unresectable locally advanced PC, with the 1-year survival rate reported to be more than 50%. To develop standardized criteria for the application of cryosurgery in PC, the International Society of Cryosurgery and Asian Society of Cryosurgery assembled experts from Austria, Japan, and China to discuss treatment methods and arrive at a consensus on the indications, contraindications, and preferred techniques of PC cryosurgery.
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Affiliation(s)
- Lihua He
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Lizhi Niu
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Nikolai N. Korpan
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Sajio Sumida
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yueyong Xiao
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiaping Li
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Barlian Sutedja
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Youyong Lu
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiansheng Zuo
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Jianguo Liu
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Kecheng Xu
- From the *Department of Oncology, Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; †International Society of Cryosurgery, Austria Society of Cryosurgery, International Institute for Cryosurgery, Vienna, Austria; ‡International Society of Cryosurgery, Japan Society for Low Temperature Medicine, Tokyo, Japan; §Asian Society of Cryosurgery; PLA General Hospital, Beijing; and ∥Oncological Intervention Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; ¶Indonesian Society of Cryosurgery, Jakarta, Indonesia; and #Laboratory of Molecular Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
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7
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Supportive care in pancreatic ductal adenocarcinoma. Clin Transl Oncol 2017; 19:1293-1302. [PMID: 28612201 DOI: 10.1007/s12094-017-1682-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 05/15/2017] [Indexed: 12/27/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the cancers with poorest prognosis and represents the third leading cause of cancer-related deaths in Western countries. Despite advances in diagnostic procedures and treatment, diagnosis is made in most cases when the disease is locally advanced or metastatic. Supportive care aims to improve symptoms, reduce hospital admission rates, and preserve quality of life. Proper symptomatic management is critical to allow administration of chemotherapy and radiotherapy. Symptomatic management should be accomplished in a multidisciplinary fashion. Its primary aims include relief of biliary or duodenal obstruction, prevention and/or treatment of thromboembolic disease, and control cancer-related pain. Nutritional support and optimal replacement therapy in patients with endocrine and/or exocrine insufficiency, is mandatory. This manuscript highlights the most significant problems faced when caring for patients with advanced PDAC and provides an evidence-based approach to symptomatic management.
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Paice JA, Mulvey M, Bennett M, Dougherty PM, Farrar JT, Mantyh PW, Miaskowski C, Schmidt B, Smith TJ. AAPT Diagnostic Criteria for Chronic Cancer Pain Conditions. THE JOURNAL OF PAIN 2017; 18:233-246. [PMID: 27884691 PMCID: PMC5439220 DOI: 10.1016/j.jpain.2016.10.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 10/11/2016] [Accepted: 10/26/2016] [Indexed: 12/15/2022]
Abstract
Chronic cancer pain is a serious complication of malignancy or its treatment. Currently, no comprehensive, universally accepted cancer pain classification system exists. Clarity in classification of common cancer pain syndromes would improve clinical assessment and management. Moreover, an evidence-based taxonomy would enhance cancer pain research efforts by providing consistent diagnostic criteria, ensuring comparability across clinical trials. As part of a collaborative effort between the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) and the American Pain Society (APS), the ACTTION-APS Pain Taxonomy initiative worked to develop the characteristics of an optimal diagnostic system. After the establishment of these characteristics, a working group consisting of clinicians and clinical and basic scientists with expertise in cancer and cancer-related pain was convened to generate core diagnostic criteria for an illustrative sample of 3 chronic pain syndromes associated with cancer (ie, bone pain and pancreatic cancer pain as models of pain related to a tumor) or its treatment (ie, chemotherapy-induced peripheral neuropathy). A systematic review and synthesis was conducted to provide evidence for the dimensions that comprise this cancer pain taxonomy. Future efforts will subject these diagnostic categories and criteria to systematic empirical evaluation of their feasibility, reliability, and validity and extension to other cancer-related pain syndromes. PERSPECTIVE The ACTTION-APS chronic cancer pain taxonomy provides an evidence-based classification for 3 prevalent syndromes, namely malignant bone pain, pancreatic cancer pain, and chemotherapy-induced peripheral neuropathy. This taxonomy provides consistent diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms for these potentially serious cancer pain conditions that can be extended and applied with other cancer-related pain syndromes.
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Affiliation(s)
- Judith A Paice
- Division of Hematology-Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Matt Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Michael Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Patrick M Dougherty
- The Division of Anesthesia and Critical Care Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - John T Farrar
- Department of Epidemiology, Neurology, and Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick W Mantyh
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, California
| | - Brian Schmidt
- Bluestone Center for Clinical Research, New York University College of Dentistry, New York, New York
| | - Thomas J Smith
- Department of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland
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9
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Pain Analysis in Patients with Pancreatic Carcinoma: Irreversible Electroporation versus Cryoablation. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2543026. [PMID: 28074177 PMCID: PMC5198095 DOI: 10.1155/2016/2543026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/31/2016] [Accepted: 11/29/2016] [Indexed: 12/18/2022]
Abstract
The aim of this article is to evaluate and compare the postprocedure pain in patients with pancreatic carcinoma treated with irreversible electroporation (IRE) and cryoablation (CRYO). We compared 22 patients with 22 lesions in pancreas treated with IRE and 26 patients with 27 lesions treated with cryosurgery. All the patients in the two groups were under celiac plexus block (CPB) treatment to alleviate the postprocedure pain. A numerical rating scale (VAS) consisting of 11-point scales and the 24 h total hydromorphone use were recorded for the analysis of the pain level in the patients who underwent these two technologies separately. Other parameters, such as the complications and the ECOG performance status, were also noted. Statistical analysis was performed by Fisher's exact test, the Chi-square test, and Student's t-test. All the pancreatic carcinoma patients in our study were reported to have postprocedure pain in the two groups. But there was no significant difference in the mean pain score (4.95 (IRE) versus 4.85 (CRYO); P = 0.52) and 24 h total hydromorphone use (3.89 mg (IRE) versus 3.97 mg (CRYO); P = 0.30). IRE is comparable to cryotherapy in the amount of pain that patients with pancreatic carcinoma experience.
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10
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Fan WZ, Niu LZ, Wang Y, Yao XH, Zhang YQ, Tan GS, Yang JY, Li JP. Initial Experience: Alleviation of Pain with Percutaneous CT-Guided Cryoablation for Recurrent Retroperitoneal Soft-Tissue Sarcoma. J Vasc Interv Radiol 2016; 27:1798-1805. [PMID: 27617909 DOI: 10.1016/j.jvir.2016.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/16/2016] [Accepted: 06/27/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the pain-alleviating effect of computed tomography (CT)-guided percutaneous cryoablation for recurrent retroperitoneal soft-tissue sarcomas (RPSs). MATERIALS AND METHODS Data from 19 men and 20 women (median age, 50.3 y) with recurrent malignant RPS who underwent percutaneous cryoablation were reviewed retrospectively. A total of 50 tumors were treated by cryoablation, including a single tumor in 29 patients, 2 tumors in 9, and 3 tumors in 1. Adverse events and analgesic outcomes were compared as a function of tumor size (< 10 cm and ≥ 10 cm). Efficacy was assessed based on modified Response Evaluation Criteria In Solid Tumors and progression-free survival (PFS). RESULTS Grade 1/2 adverse events included fever (n = 17), emesis (n = 7), frostbite (n = 5), and local pain (n = 4). The median follow-up period and PFS were 18.5 months (range, 12-42 mo) and 13.4 months ± 6.2, respectively. At the end of follow-up, 13 patients had died and 26 were living. The mean severe local pain scores on pretreatment day 1 and posttreatment days 1, 5, 10, 15, 20, and 25 were 7.49, 7.40, 6.51, 5.81, 5.35, 5.04, and 5.44, respectively, and significant differences versus pretreatment (P < .001) were reported for posttreatment days 5-25. Immediate relief occurred more frequently in the small-tumor group (4 of 7; 57.1%; P = .018), whereas delayed relief occurred more frequently in the large-tumor group (17 of 22; 77.3%; P = .030). CONCLUSIONS Minimally invasive percutaneous cryoablation improves local pain and is a feasible treatment for recurrent RPSs.
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Affiliation(s)
- Wen-Zhe Fan
- Departments of Interventional Oncology Guangzhou, China
| | - Li-Zhi Niu
- Fuda Cancer Hospital, Jinan University School of Medicine, Guangzhou, China; Fuda Institute of Cryosurgery for Cancer, Guangzhou, China
| | - Yu Wang
- Departments of Interventional Oncology Guangzhou, China
| | - Xue-Hua Yao
- Departments of Interventional Oncology Guangzhou, China
| | | | | | - Jian-Yong Yang
- Interventional Radiology, Guangzhou, China; Medical Imaging, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jia-Ping Li
- Departments of Interventional Oncology Guangzhou, China.
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Spadi R, Brusa F, Ponzetti A, Chiappino I, Birocco N, Ciuffreda L, Satolli MA. Current therapeutic strategies for advanced pancreatic cancer: A review for clinicians. World J Clin Oncol 2016; 7:27-43. [PMID: 26862489 PMCID: PMC4734936 DOI: 10.5306/wjco.v7.i1.27] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/22/2015] [Accepted: 11/23/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer (PC) would become the second leading cause of cancer death in the near future, despite representing only 3% of new cancer diagnosis. Survival improvement will come from a better knowledge of risk factors, earlier diagnosis, better integration of locoregional and systemic therapies, as well as the development of more efficacious drugs rising from a deeper understanding of disease biology. For patients with unresectable, non-metastatic disease, combined strategies encompassing primary chemotherapy and radiation seems to be promising. In fit patients, new polychemotherapy regimens can lead to better outcomes in terms of slight but significant survival improvement associated with a positive impact on quality of life. The upfront use of these regimes can also increase the rate of radical resections in borderline resectable and locally advanced PC. Second line treatments showed to positively affect both overall survival and quality of life in fit patients affected by metastatic disease. At present, oxaliplatin-based regimens are the most extensively studied. Nonetheless, other promising drugs are currently under evaluation. Presently, in addition to surgery and conventional radiation therapy, new locoregional treatment techniques are emerging as alternative options in the multimodal approach to patients or diseases not suitable for radical surgery. As of today, in contrast with other types of cancer, targeted therapies failed to show relevant activity either alone or in combination with chemotherapy and, thus, current clinical practice does not include them. Up to now, despite the fact of extremely promising results in different tumors, also immunotherapy is not in the actual therapeutic armamentarium for PC. In the present paper, we provide a comprehensive review of the current state of the art of clinical practice and research in PC aiming to offer a guide for clinicians on the most relevant topics in the management of this disease.
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12
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Luo XM, Niu LZ, Chen JB, Xu KC. Advances in cryoablation for pancreatic cancer. World J Gastroenterol 2016; 22:790-800. [PMID: 26811625 PMCID: PMC4716077 DOI: 10.3748/wjg.v22.i2.790] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/07/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Pancreatic carcinoma is a common cancer of the digestive system with a poor prognosis. It is characterized by insidious onset, rapid progression, a high degree of malignancy and early metastasis. At present, radical surgery is considered the only curative option for treatment, however, the majority of patients with pancreatic cancer are diagnosed too late to undergo surgery. The sensitivity of pancreatic cancer to chemotherapy or radiotherapy is also poor. As a result, there is no standard treatment for patients with advanced pancreatic cancer. Cryoablation is generally considered to be an effective palliative treatment for pancreatic cancer. It has the advantages of minimal invasion and improved targeting, and is potentially safe with less pain to the patients. It is especially suitable in patients with unresectable pancreatic cancer. However, our initial findings suggest that cryotherapy combined with 125-iodine seed implantation, immunotherapy or various other treatments for advanced pancreatic cancer can improve survival in patients with unresectable or metastatic pancreatic cancer. Although these findings require further in-depth study, the initial results are encouraging. This paper reviews the safety and efficacy of cryoablation, including combined approaches, in the treatment of pancreatic cancer.
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13
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Pusceddu C, Melis L, Sotgia B, Fancellu A, Meloni GB. Computed Tomography-Guided Cryoablation of Local Recurrence after Primary Resection of Pancreatic Adenocarcinoma. Clin Pract 2015; 5:741. [PMID: 26236454 PMCID: PMC4500876 DOI: 10.4081/cp.2015.741] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/17/2015] [Accepted: 03/11/2015] [Indexed: 02/08/2023] Open
Abstract
The optimal management of local recurrences after primary resection of pancreatic cancer still remains to be clarified. A 58-year-old woman developed an isolated recurrence of pancreatic cancer six year after distal pancreatectomy. Re-resection was attempted but the lesion was deemed unresectable at surgery. Then chemotherapy was administrated without obtaining a reduction of the tumor size nor an improvement of the patient’s symptoms. Thus the patient underwent percutaneous cryoablation under computed tomography (CT)-guidance obtaining tumor necrosis and a significant improvement in the quality of life. A CT scan one month later showed a stable lesion with no contrast enhancement. While the use of percutaneous cryoblation has widened its applications in patients with unresectable pancreatic cancer, it has never been described for the treatment of local pancreatic cancer recurrence after primary resection. Percutaneous cryoablation deserves further studies in the multimodality treatment of local recurrence after primary pancreatic surgery.
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Affiliation(s)
- Claudio Pusceddu
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco , Cagliari
| | - Luca Melis
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco , Cagliari
| | - Barbara Sotgia
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco , Cagliari
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Prologo JD, Lin RC, Williams R, Corn D. Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia. Skeletal Radiol 2015; 44:709-14. [PMID: 25511935 DOI: 10.1007/s00256-014-2075-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous CT-guided cryoablation of the pudendal nerve for the treatment of refractory pudendal neuralgia. MATERIALS AND METHODS Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. Brief Pain Inventory questionnaires were administered prior to the procedure, during the immediate 24 h post procedure, and 45 days and 6 months following the procedure. RESULTS Prior to treatment, the average level of pain on a scale from 0 (no pain) to 10 (worst pain imaginable) was 7.6, with pain described as "burning" (80%), "pulling" (37.5%), "crushing" (50%), "pressure" (84.5%), "throbbing" (50%), "knife-life" (52%), and "other" (60%). At 24 h, 45 days, and 6 months post-treatment, pain intensity dropped to 2.6, 3.5, and 3.1, respectively (p < 0.005). There were no procedure-related complications. CONCLUSIONS CT-guided percutaneous cryoablation may represent a safe and efficacious option for selected patients with refractory pudendal neuralgia.
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Affiliation(s)
- J David Prologo
- Department of Radiology and Imaging Sciences Division of Interventional Radiology and Image-Guided Medicine, Emory University Hospital, 1364 Clifton Road, NE Suite D112, Atlanta, GA, 30322, USA,
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15
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Xu J, Li J, Zhou X, Zeng J, Yao F, Wang Y, Mu F, Niu L, Chen J, Liu J, Xu K. Cryotherapy for local recurrent dermatofibrosarcoma protuberans: experience in 19 patients. Cryobiology 2014; 68:134-8. [PMID: 24463091 DOI: 10.1016/j.cryobiol.2014.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 11/18/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, cutaneous, malignant tumor characterized by a high propensity for local relapse. Wide and deep local excision with reconstructive surgery is the current standard therapy for DFSP, with a local recurrence rate (LRR) of nearly 40%. In this study, we cured 19 patients with local recurrence of DFSP with 39 sessions of percutaneous cryoablation performed between July 2004 and August 2008. The LRRs after one, two and three cryosurgery sessions per patient were 68%, 54% and 0%, respectively. Moreover, the LRR did not differ with tumor location or size. Furthermore, all patients had a progression-free survival of >5 years. Only minor complications such as fever, local edema, mild nerve injury and local pain occurred, and were resolved within 1 week with symptomatic treatment. In our experience, percutaneous cryoablation is a relatively safe and efficient technique for the treatment of local recurrence of DFSPs.
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Affiliation(s)
- Jiongyuan Xu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jialiang Li
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Xulong Zhou
- Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jianying Zeng
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Fei Yao
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Yuan Wang
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Feng Mu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Lizhi Niu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jibing Chen
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China.
| | - Jianguo Liu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Kecheng Xu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
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Alleviating the pain of unresectable hepatic tumors by percutaneous cryoablation: Experience in 73 patients. Cryobiology 2013. [DOI: 10.1016/j.cryobiol.2013.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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