Dorsal Rhizotomy for Pain from Neoplastic Lumbosacral Plexopathy in Advanced Pelvic Cancer

Abstract

Background: Pain from neoplastic lumbosacral plexopathy is resistant to conventional pain treatment. According to a recent review of destructive procedures for cancer pain, only cordotomy has been reported to play an important role in the treatment of cancer pain. To date, the effectiveness of dorsal rhizotomy, which selectively interrupts pain transmission, has not been shown in neoplastic lumbosacral plexopathy. Objectives: The present study seeks to find out the effectiveness of selective dorsal rhizotomies for intractable pain from neoplastic lumbosacral plexopathy in terminal pelvic cancer patients. Methods: Dorsal rhizotomies of the involved segments were performed on 6 cancer patients in whom neuropathic pain from lumbosacral plexus involvement in terminal pelvic cancer had been refractory to other therapies. Clinical efficacy of the procedure was assessed by comparing patient pain ratings and narcotic usage before and after dorsal rhizotomy. Results: Examination of the results indicated a significant reduction in pain ratings as well as a significant reduction in daily narcotic use. No adverse neurological effects were observed and no recurrence of pain from neoplastic lumbosacral plexopathy was noted. Conclusions: These findings provide corroborating clinical evidence for the effectiveness of selective dorsal root rhizotomy for the intractable pain from lumbosacral plexopathy in terminal pelvic cancer patients.

Malignant psoas syndrome associated with gynecological malignancy: Three case reports and a review of the literature

“…The survival of patients with MPS is considered to be very short, as demonstrated by many previous studies, and the reported median survival duration was 5.5-10.7 months after diagnosis (2,4,19,23). In the present study, patients in cases 1 and 2 died at 8 and 7 months from the time of diagnosis, respectively.…”

“…Recent studies have shown that rotation switching of opioids to methadone was effective for refractory neuropathic pain (6,20). Other studies reported the efficacy of intervention strategies, including epidural analgesia (9,19), injection from a psoas sheath catheter (21) or intrathecal catheter (19,22), and dorsal rhizotomy (23). Radiotherapy is occasionally adapted for both cancer-directed and palliative therapy, although its efficacy remains to be clarified (1,2,4,5).…”

Augmented Package of Palliative Care for Women With Cervical Cancer: Responding to Refractory Suffering

“…Another surgical option is to open the lumbar dura and cut the dorsal roots to the pelvis. 69 For pelvic pain mainly on one side, the spinothalamic tract on the contralateral side of the spinal cord can be interrupted by an open surgical or percutaneous cordotomy. Cordotomy usually is performed only unilaterally because bilateral cordotomy has a high risk of permanent motor weakness.…”

Neoplastic Plexopathies

“…8 Neural sacrifice usually is unavoidable. 127 More destructive procedures (e.g., limb amputations) are ineffective. 22 Survivin, a member of the inhibitor of apoptosis family that is highly expressed during embryogenesis and largely undetectable in normal adult tissue, is overexpressed in transformed cells, including human malignant NSTs, prompting clinical trials using antisurvivin strategies.…”