Cryoneurolysis in Patients with Dorsal Neuropathic Pain Secondary to Tumor Invasion

PURPOSE

To evaluate the safety and efficacy of cryoneurolysis (CNL) in patients with refractory thoracic neuropathic pain related to tumor invasion.

MATERIALS AND METHODS

Between January 2013 and May 2017, this single-center and retrospective study reviewed 27 computed tomography-guided CNLs performed on 26 patients for refractory thoracic neuropathic pain related to tumor invasion. Patients with cognitive impairment were excluded. Pain levels were recorded on a visual analog scale (VAS) before the procedure, on days 1, 7, 14, 28 and at each subsequent follow-up appointment. CNL was clinically successful if the postprocedural VAS decreased by 3 points or more. To determine the duration of clinical success, the end of pain relief was defined as either an increased VAS of 2 or more points, the introduction of a new analgesic treatment, a death with controlled pain, or for lost to follow-up patients, the latest follow-up appointment date with controlled pain.

RESULTS

Technical success rate was 96.7% and clinical success rate was 100%. Mean preprocedural pain score was 6.4 ± 1.7 and decreased to 2.4 ± 2.4 at day 1; 1.8 ± 1.7 at day 7 (P < .001); 3.3 ± 2.5 at day 14; 3.4 ± 2.6 at day 28 (P < .05). The median duration of pain relief was 45 days (range 14-70). Two minor complications occurred.

CONCLUSIONS

Cryoneurolysis is a safe procedure that significantly decreased pain scores in patients with thoracic neuropathic pain related to tumor invasion, with a median duration of clinical success of 45 days.

Percutaneous Cryotherapy for Treatment of Chondroblastoma: Early Experience

Surgical curettage is currently the standard of care for the chondroblastoma, but in peri-articular tumors it is limited by its morbidity. In this preliminary report, we evaluate the feasibility of percutaneous cryotherapy as an alternative ablative treatment for chondroblastoma. Three patients with a chondroblastoma treated by CT scan-guided cryotherapy are presented in this article. Pain permanently disappeared 2 days after the procedure. No local tumor recurrence or cartilage damage was observed by MRI performed 1 year after the intervention. This preliminary case report suggests that percutaneous cryotherapy may be a possible alternative to the current standard of care in chondroblastoma. Further studies are needed to evaluate if this technique offers similar anti-tumoral efficacy while providing better pain relief and less morbidity than curettage.

De novo radiologic placement of button gastrostomy: a feasibility study in children with cancer

BACKGROUND

Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment.

OBJECTIVE

To assess the safety and effectiveness of such treatment at a single center.

MATERIALS AND METHODS

We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months.

RESULTS

Eleven gastrostomies were performed in 11 children and young adults (3-20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects -- local leakage and granulation tissue formation -- both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight.

CONCLUSION

The procedure and devices were well tolerated and mostly effective in our cohort.