ABSTRACT
PURPOSE: To evaluate the safety and efficacy of cryoneurolysis (CNL) in patients with refractory thoracic neuropathic pain related to tumor invasion. MATERIALS AND METHODS: Between January 2013 and May 2017, this single-center and retrospective study reviewed 27 computed tomography-guided CNLs performed on 26 patients for refractory thoracic neuropathic pain related to tumor invasion. Patients with cognitive impairment were excluded. Pain levels were recorded on a visual analog scale (VAS) before the procedure, on days 1, 7, 14, 28 and at each subsequent follow-up appointment. CNL was clinically successful if the postprocedural VAS decreased by 3 points or more. To determine the duration of clinical success, the end of pain relief was defined as either an increased VAS of 2 or more points, the introduction of a new analgesic treatment, a death with controlled pain, or for lost to follow-up patients, the latest follow-up appointment date with controlled pain. RESULTS: Technical success rate was 96.7% and clinical success rate was 100%. Mean preprocedural pain score was 6.4 ± 1.7 and decreased to 2.4 ± 2.4 at day 1; 1.8 ± 1.7 at day 7 (P < .001); 3.3 ± 2.5 at day 14; 3.4 ± 2.6 at day 28 (P < .05). The median duration of pain relief was 45 days (range 14-70). Two minor complications occurred. CONCLUSIONS: Cryoneurolysis is a safe procedure that significantly decreased pain scores in patients with thoracic neuropathic pain related to tumor invasion, with a median duration of clinical success of 45 days.
Subject(s)
Cryosurgery , Denervation/methods , Neoplasms/complications , Neuralgia/surgery , Pain Management/methods , Pain, Intractable/surgery , Thoracic Nerves/surgery , Adolescent , Adult , Aged , Cryosurgery/adverse effects , Denervation/adverse effects , Female , Humans , Male , Middle Aged , Neoplasm Invasiveness , Neoplasms/diagnostic imaging , Neoplasms/pathology , Neuralgia/diagnosis , Neuralgia/etiology , Neuralgia/physiopathology , Pain Management/adverse effects , Pain Measurement , Pain, Intractable/diagnosis , Pain, Intractable/etiology , Pain, Intractable/physiopathology , Retrospective Studies , Thoracic Nerves/diagnostic imaging , Thoracic Nerves/physiopathology , Time Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment. OBJECTIVE: To assess the safety and effectiveness of such treatment at a single center. MATERIALS AND METHODS: We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months. RESULTS: Eleven gastrostomies were performed in 11 children and young adults (3-20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects -- local leakage and granulation tissue formation -- both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight. CONCLUSION: The procedure and devices were well tolerated and mostly effective in our cohort.
Subject(s)
Gastrostomy/instrumentation , Neoplasms/complications , Radiography, Interventional , Adolescent , Adult , Child , Child, Preschool , Feasibility Studies , Female , Humans , Male , Postoperative Complications , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Surgical curettage is currently the standard of care for the chondroblastoma, but in peri-articular tumors it is limited by its morbidity. In this preliminary report, we evaluate the feasibility of percutaneous cryotherapy as an alternative ablative treatment for chondroblastoma. Three patients with a chondroblastoma treated by CT scan-guided cryotherapy are presented in this article. Pain permanently disappeared 2 days after the procedure. No local tumor recurrence or cartilage damage was observed by MRI performed 1 year after the intervention. This preliminary case report suggests that percutaneous cryotherapy may be a possible alternative to the current standard of care in chondroblastoma. Further studies are needed to evaluate if this technique offers similar anti-tumoral efficacy while providing better pain relief and less morbidity than curettage.