Xiaoyun Zhou1, Hongsen Li2, Qing Qiao3, Hongming Pan4, Yong Fang5. 1. Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China; Department of Medical Oncology, Sir Run Run Shaw Hospital, Xiasha Campus, Hangzhou, China. 2. Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China. 3. Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China. 4. Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China. panhongming@zju.edu.cn. 5. Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China. fangyong@zju.edu.cn.
Abstract
BACKGROUND: Radiofrequency ablation (RFA) is the current gold standard for palliative care of non-small cell lung cancer (NSCLC). Pain relief for advanced metastases of NSCLC is notoriously difficult. Combined RFA therapy may be more effective than palliating therapy alone in management of painful metastatic disease. The effects of RFA on quality of life, particularly pain, as well as long-term outcome studies are not well studied. To study the effectiveness of percutaneous minimal invasive RFA in pain management of NSCLC patients with metastatic chest wall, vertebral bodies and rib, and periphery lung nodule. METHODS: Forty patients with 59 tumors underwent percutaneous computed tomography (CT) or ultrasound-guided RFA for pain management over a 4-week observation. Forty patients were referred to ablation because of persistent severe pain despite using analgesics, chemotherapy or radiotherapy. The tumors were located in the periphery lung, or metastatic to chest wall, rib or vertebral body. Quantitative pain scale values were quantified on a 0-10 scale before, 24 hours, 72 hours, and 4 weeks after RFA. On the basis of changes in pain score and pain medication use, pain was reported with a composite measure as complete, partial, or no pain response. The overall survival (OS) rate was also collected and calculated with Kaplan-Meier method. RESULTS: After 4-week follow-up, complete pain relief (pain scale score ≤1) was observed in 12 patients (30%) and partial pain relief (pain scale score ≤3) in 15 (37.5%) patients; pain relief did not occur in 13 patients (32.5%). There was a significant decrease in pain at 24-hour, 72-hour, and 4-week follow-up compared with pain level at baseline (P<0.01). Opiate use was decreased in 92.5% (37/40) patients, remained unchanged in 7.5% (3/40) at 4 weeks follow-up. There are minor adverse events caused by RFA therapy, including pleural effusion (5/40), post procedural infections (3/40), pneumothorax (2/40) which resolved spontaneously. The OS rates at 6 months in the percutaneous RFA group were 60%, with average OS of 6.5 months in the further follow-up. CONCLUSIONS: Percutaneous RFA resulted in sustained pain relief from in most advanced NSCLC patients with intractable pain and resistant to chemotherapy or radiotherapy. The effect of RFA was satisfactory, and patients can obtain a better life quality with less pain and complications.
BACKGROUND: Radiofrequency ablation (RFA) is the current gold standard for palliative care of non-small cell lung cancer (NSCLC). Pain relief for advanced metastases of NSCLC is notoriously difficult. Combined RFA therapy may be more effective than palliating therapy alone in management of painful metastatic disease. The effects of RFA on quality of life, particularly pain, as well as long-term outcome studies are not well studied. To study the effectiveness of percutaneous minimal invasive RFA in pain management of NSCLCpatients with metastatic chest wall, vertebral bodies and rib, and periphery lung nodule. METHODS: Forty patients with 59 tumors underwent percutaneous computed tomography (CT) or ultrasound-guided RFA for pain management over a 4-week observation. Forty patients were referred to ablation because of persistent severe pain despite using analgesics, chemotherapy or radiotherapy. The tumors were located in the periphery lung, or metastatic to chest wall, rib or vertebral body. Quantitative pain scale values were quantified on a 0-10 scale before, 24 hours, 72 hours, and 4 weeks after RFA. On the basis of changes in pain score and pain medication use, pain was reported with a composite measure as complete, partial, or no pain response. The overall survival (OS) rate was also collected and calculated with Kaplan-Meier method. RESULTS: After 4-week follow-up, complete pain relief (pain scale score ≤1) was observed in 12 patients (30%) and partial pain relief (pain scale score ≤3) in 15 (37.5%) patients; pain relief did not occur in 13 patients (32.5%). There was a significant decrease in pain at 24-hour, 72-hour, and 4-week follow-up compared with pain level at baseline (P<0.01). Opiate use was decreased in 92.5% (37/40) patients, remained unchanged in 7.5% (3/40) at 4 weeks follow-up. There are minor adverse events caused by RFA therapy, including pleural effusion (5/40), post procedural infections (3/40), pneumothorax (2/40) which resolved spontaneously. The OS rates at 6 months in the percutaneous RFA group were 60%, with average OS of 6.5 months in the further follow-up. CONCLUSIONS: Percutaneous RFA resulted in sustained pain relief from in most advanced NSCLCpatients with intractable pain and resistant to chemotherapy or radiotherapy. The effect of RFA was satisfactory, and patients can obtain a better life quality with less pain and complications.
Entities:
Keywords:
Non-small cell lung cancer (NSCLC); cancer related pain; metastasis, CT-guided percutaneous radiofrequency ablation; pain relief
Authors: Giuseppe Roberto Giammalva; Gianluca Ferini; Fabio Torregrossa; Lara Brunasso; Sofia Musso; Umberto Emanuele Benigno; Rosa Maria Gerardi; Lapo Bonosi; Roberta Costanzo; Federica Paolini; Paolo Palmisciano; Giuseppe Emmanuele Umana; Rina Di Bonaventura; Carmelo Lucio Sturiale; Domenico Gerardo Iacopino; Rosario Maugeri Journal: Life (Basel) Date: 2022-04-12