Percutaneous cervical cordotomy for cancer-related pain: national data

Abstract

ObjectivesPercutaneous cervical cordotomy (PCC) is an interventional ablative procedure in the armamentarium for cancer pain treatment, but there is limited evidence to support its use. This study aimed to assess the effectiveness and safety of PCC.MethodsAnalysis was undertaken of the first national (UK) prospective data repository of adult patients with cancer undergoing PCC for pain treatment. The relationship between pain and other outcomes before and after PCC was examined using appropriate statistical methods.ResultsData on 159 patients’ PCCs (performed from 1 January 2012 to 6 June 2017 in three centres) were assessed: median (IQR) age was 66 (58–71) years, 47 (30%) were female. Mesothelioma was the most common primary malignancy (57%). The median (IQR) time from cancer diagnosis to PCC assessment was 13.3 (6.2–23.2) months; PCC to follow-up was 9 (8–25) days; and survival after PCC was 1.3 (0.6–2.8) months. The mean (SD) for ‘average pain’ using a numerical rating scale was 6 (2) before PCC and 2 (2) at follow-up, and for ‘worst pain’ 9 (1) and 3 (3), respectively. The median (IQR) reduction in strong opioid dose at follow-up was 50% (34–50). With the exception of ‘activity’, all health-related quality of life scores (5-level version of EuroQol-5 Dimension) either improved or were stable after PCC. Six patients (4%) had PCC-related adverse events.ConclusionsPCC is an effective treatment for cancer pain; however, findings in this study suggest PCC referrals tended to be late in patients’ disease trajectories. Further study into earlier treatment and seeking international consensus on PCC outcomes will further enhance opportunities to improve patient care.

Percutaneous Cervical Cordotomy for the Treatment of Cancer Pain: A Prospective Case Series of 52 Patients with a Long‐Term Follow‐Up

“…In our experience, many doctors and other health care providers treating patients with oncological pain are not familiar with or even aware of PCC. As a result, a PCC is often not considered for patients with severe unilateral pain or performed too late in the palliative treatment, owing to which the patients do not receive the optimal benefit 21 . This is in contrast with the immediate efficacy of PCC and mild side effects in previous studies and the stable long‐term analgesia in the present study.…”

“…In a recent study, patient‐reported side effects were only 4% 21 . In previous studies, side effects were frequent but minor and self‐limiting, such as headache or urinary retention for some days 30,32,52 .…”

“…In a relatively small group of patients with strict unilateral cancer pain below C5, which is unresponsive to more conventional therapies, percutaneous cervical cordotomy (PCC) appears to be an effective pain treatment with minor side effects 7–15 . Serious side effects and complications are minimal in experienced hands 16–22 …”

“…Raslan and Slavik et al reported 72% pain relief at 6 months after PCC, Crul et al reported 95% pain relief immediately after PCC and 69% pain relief at end of life, and Collins and Patil reported 50% to 100% pain relief at end of life 28–31 . To date, to the best of our knowledge, there are only a few publications with a prospective data collection 11,15,21,32 …”

“…. Bain et al, Viswanathan et al, Fonoff et al, and Poolman et al 11,15,21,33 published prospective studies with follow‐up to 28 days. Only the study by Viswanathan et al was a randomized controlled study with a follow‐up of 1 week.…”