Dimitrios K Filippiadis1, Steven Yevich2, Frederic Deschamps3, Jack W Jennings4, Sean Tutton5, Alexis Kelekis6. 1. 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari, Athens, Greece. dfilippiadis@yahoo.gr. 2. Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France. 4. Department of Musculoskeletal Radiology, Washington University School of Medicine, St Louis, MO, USA. 5. Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Wauwatosa, WI, USA. 6. 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari, Athens, Greece.
Abstract
PURPOSE OF REVIEW: The purpose of this article is to describe the concepts of ablation techniques for pain relief in symptomatic oncologic patients. Controversies concerning techniques and products will be addressed. RECENT FINDINGS: Despite conventional pain palliative techniques, cancer patients often endorse unresolved somatic and neuropathic pain that can present as a great burden to quality of life. In non-operative patients, several techniques have been applied to minimize opioid dependence. While radiotherapy is often considered as a non-invasive option, percutaneous ablation has been advanced as a minimally-invasive alternative with clear procedural and outcome advantages. Similar to radiation therapy, percutaneous ablation techniques can act either upon nerve structures responsible for pain mediation signals (neurolysis) or directly upon the tumor to relieve tumor-mediated inflammation and decompress tumor compression of adjacent structures. Percutaneous ablation provides valuable neurolysis and tumor-directed pain palliative effects to be incorporated into clinical guidelines for pain reduction in oncologic patients. Selection among different ablation techniques should be based upon an individually tailored approach, to include consideration of all treatment modalities.
PURPOSE OF REVIEW: The purpose of this article is to describe the concepts of ablation techniques for pain relief in symptomatic oncologic patients. Controversies concerning techniques and products will be addressed. RECENT FINDINGS: Despite conventional pain palliative techniques, cancerpatients often endorse unresolved somatic and neuropathic pain that can present as a great burden to quality of life. In non-operative patients, several techniques have been applied to minimize opioid dependence. While radiotherapy is often considered as a non-invasive option, percutaneous ablation has been advanced as a minimally-invasive alternative with clear procedural and outcome advantages. Similar to radiation therapy, percutaneous ablation techniques can act either upon nerve structures responsible for pain mediation signals (neurolysis) or directly upon the tumor to relieve tumor-mediated inflammation and decompress tumor compression of adjacent structures. Percutaneous ablation provides valuable neurolysis and tumor-directed pain palliative effects to be incorporated into clinical guidelines for pain reduction in oncologic patients. Selection among different ablation techniques should be based upon an individually tailored approach, to include consideration of all treatment modalities.
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