Abstract
IntroductionWe report our initial series of terminally ill cancer patients treated with radiosurgery to the pituitary gland to alleviate pain.MethodsA fully automated rotating gamma ray unit was used to deliver a high dose of radiation (150Gy) using an 8 mm collimator to the neurohypophysis in 11 patients suffering from opioid-refractory pain deriving from cancer.ResultsFrom November 2016 to November 2018, 11 patients were treated, and 10 were eligible for follow-up evaluation. Pain from bone metastases was present in 70%; others suffered from neuropathic and visceral pain. The median survival was 119.7 days (range: 32 to 370). The visual analogue scale (VAS) was nine (7-10) and standardized to 10; eight patients (80%) responded. The average VAS at the time of response was three (range: 1-6), and the average time to response was 2.8 days (range: 2-5). In the first week, 40% of the patients categorized the result as 'excellent', 30% deemed the result 'good', and 20% reported the result as 'poor'. One patient (10%) referred to the result as 'regular'. Those who responded were able to reduce their medications by at least 25%. The one-month average VAS score was five (range: 1-6), 60% reported a 'good' effect, 20% reported 'excellent' results, and 20% had no response. Of the study participants, 60% maintained their level of medicine consumption at lower than baseline. At the end of life, five patients (50%) presented substantial pain, two (20%) never had a therapeutic effect, and three (30%) died without substantial pain. There were no clinical complications that could be attributed directly to the treatment. ConclusionRadiosurgery to the pituitary gland is effective and safe and warrants further investigation to understand its potential role in palliative care in cancer patients.
Highlights
We report our initial series of terminally ill cancer patients treated with radiosurgery to the pituitary gland to alleviate pain
A fully automated rotating gamma ray unit was used to deliver a high dose of radiation (150Gy) using an 8 mm collimator to the neurohypophysis in 11 patients suffering from opioidrefractory pain deriving from cancer
We report the first series of terminally ill patients that were treated for refractory oncological pain using stereotactic radiosurgery with a fully automated rotating gamma ray unit in a country categorized as a limited resource setting
Summary
A fully automated rotating gamma ray unit was used to deliver a high dose of radiation (150Gy) using an 8 mm collimator to the neurohypophysis in 11 patients suffering from opioidrefractory pain deriving from cancer.Received 04/06/2019 Review began 04/18/2019 Review ended 06/01/2019 Published 06/03/2019. A fully automated rotating gamma ray unit was used to deliver a high dose of radiation (150Gy) using an 8 mm collimator to the neurohypophysis in 11 patients suffering from opioidrefractory pain deriving from cancer. We conducted a prospective non-randomized trial of radiosurgical hypophysectomy for patients in palliative care suffering from cancer pain, refractory to opioid therapy in whom no reasonable alternative intervention therapy (such as surgery, radiation, or pain medication) was feasible. The inclusion criteria were patients with cancer-related pain categorized as severe (scoring 7-10) on the visual analog scale (VAS) despite the best medical algology practice and optimal opioid dosing, were 18 years or older with a life expectancy under six months, and their pain could derive from bone metastases or other organs affected by the disease. The main endpoints of the study were the reduction of the VAS score by at least 50% and a reduction in opioid or pain medicine consumption.
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