Pulsed Radiofrequency Analgesia in a Patient With Abdominal Wall Metastasis From Colorectal Cancer: A Case Report

Abstract

Pulsed radiofrequency is a widely used neuromodulation technique in analgesic therapy ( 1. Chua NH Vissers KC Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: Mechanisms and potential indications - a review. Acta Neurochir (Wien). 2011; 153: 763-771 Crossref PubMed Scopus (207) Google Scholar ). Its use is relatively recent in oncology, a setting in which only anecdotal experiences have been described ( 2. Miceli L Bednarova R Rizzardo A Brescia F Bove T. Ulnar nerve pulsed radio frequency (PRF) pain treatment in a patient with sarcoma surgically treated. Minerva Anestesiol. 2019; 85: 693-694 Crossref PubMed Scopus (1) Google Scholar ). We report a case of severe pain in the abdominal wall arising from a parietal metastasis that was successfully treated with this technique. The patient is an 55-year-old woman who was diagnosed with colorectal cancer about three years ago. She underwent colon resection surgery with pelvic peritonectomy, left ovariectomy, omentectomy, and intraperitoneal chemohyperthermia. The disease was staged as pT3-N0-M1. She also underwent adjuvant chemotherapy (oxaliplatin plus capecitabine), but a year later was diagnosed radiologically with recurrence in the left iliac fossa. She was treated with chemotherapy (folinic acid, 5-fluorouracil, irinotecan, bevacizumab) and parietal resection (at left the iliac fossa). Close to the diagnosed lesion was another lesion that had infiltrated the left rectus abdominis muscle in its full thickness. Histologic examination confirmed the diagnosis of a recurrence of the primary cancer. After 13 months, positron emission tomography–computed tomography (PET-CT) showed radiotracer uptake in the left iliac fossa and left abdominal wall, treated again with chemotherapy (folinic acid, 5-fluorouracil, irinotecan, bevacizumab).