Everything old is new again. revisiting hypophysectomy for the treatment of refractory cancer-related pain: a systematic review.

Cancer-related pain is a common and debilitating condition that can significantly affect the quality of life of patients. Opioids, NSAIDs, and antidepressants are among the first-line therapies, but their efficacy is limited or their use can be restricted due to serious side effects. Neuromodulation and lesioning techniques have also proven to be a valuable instrument for managing refractory pain. For patients who have exhausted all standard treatment options, hypophysectomy may be an effective alternative treatment. We conducted a comprehensive systematic review of the available literature on PubMed and Scielo databases on using hypophysectomy to treat refractory cancer-related pain. Data extraction from included studies included study design, treatment model, number of treated patients, sex, age, Karnofsky Performance Status (KPS) score, primary cancer site, lead time from diagnosis to treatment, alcohol injection volume, treatment data, and clinical outcomes. Statistical analysis was reported using counts (N, %) and means (range). The study included data from 735 patients from 24 papers treated with hypophysectomy for refractory cancer-related pain. 329 cancer-related pain patients were treated with NALP, 216 with TSS, 66 with RF, 55 with Y90 brachytherapy, 51 with Gamma Knife radiosurgery (GK), and 18 with cryoablation. The median age was 58.5 years. The average follow-up time was 8.97 months. Good pain relief was observed in 557 out of 735 patients, with complete pain relief in 108 out of 268 patients. Pain improvement onset was observed 24 h after TSS, a few days after NALP or cryoablation, and a few days to 4 weeks after GK. Complications varied among treatment modalities, with diabetes insipidus (DI) being the most common complication. Although mostly forgotten in modern neurosurgical practice, hypophysectomy is an attractive option for treating refractory cancer-related pain after failure of traditional therapies. Radiosurgery is a promising treatment modality due to its high success rate and reduced risk of complications.

Extent and pattern of symptom relief following surgical castration in patients with advanced prostate cancer treated at a tertiary referral hospital in Tanzania: a prospective cohort study.

BACKGROUND: Advanced prostate cancer leads to many symptoms, notably bone pain and lower urinary tract symptoms (LUTs); however, the degree and duration of pain relief, changes in LUTs severity and underlying factors associated with the extent of symptom relief remain inadequately understood. Surgical castration has proven effective in relieving both bone pain and urinary symptoms for metastatic prostate cancer patients. OBJECTIVE: To determine the extent and pattern of symptom relief in advanced prostate cancer patients following surgical castration at Muhimbili National Hospital (MNH). METHODS: We conducted a prospective cohort study for a period of 6 months involving men with advanced Prostate cancer (PCa) undergoing surgical castration at MNH and followed them for 30 days. The international prostate symptoms score tool was used to assess changes in LUTs, and the pain rating scale was used for assessing changes in bone pain symptoms before and after surgery. Logistic regression model was used to determine factors associated with complete bone pain relief. RESULTS: A total of 210 participants with a mean age of 72.3 years were recruited. The LUTS score showed a decrease of 7.1 points after surgical castration (95% CI: 6.4 to 7.7, p < 0.001). The bone pain score showed an absolute decrease of 39.8% (95% CI: 34.7 to 44.9, p < 0.001) after surgical castration, with more than half of the patients (111, 52.9%) reporting bone pain relief within the first two weeks. Among the factors associated with greater pain relief were being in a marital union (aOR 2.73, 95% CI: 1.26 to 5.89, p < 0.011). Normal BMI was also linked to pain relief in bivariate analysis (OR 1.92, 95% CI: 1.03 to 3.61, p < 0.035). Additionally, patients with severe bone pain before surgical castration were more likely to achieve complete pain relief compared to those with mild or moderate pain (odds ratio 8.32, 95% CI: 3.63 to 19.1, p < 0.001). CONCLUSION: Surgical castration improves both bone pain and lower urinary tract symptoms in patients with advanced prostate cancer. Notably, patients experiencing severe bone pain reported resolution of bone pain symptoms within the first and second weeks, respectively, indicating the prompt effectiveness of the surgery on these symptoms.

Effectiveness of CT-guided percutaneous cordotomy in intractable cancer pain: Experience in 14 patients.

BACKGROUND: Severe and treatment-resistant pain is a major issue for patients with cancer. Cordotomy is an effective approach for addressing severe cancer-related pain. It is based on blocking the transmission of pain by damaging the lateral spinothalamic tract. METHODS: Computed tomography guided cordotomy was performed on 14 patients who did not respond to medical and interventional pain management methods. RESULTS: Fourteen patients with cancer pain underwent CT-guided percutaneous cordotomy. Pain relief was reported in 86% of the patients. The visual analog scale values before and after cordotomy were compared and a significant difference was found (p = 0.0001). The improvement in the Karnofsky Performance Scale score of the patients was found to be statistically significant (p = 0.0001). CONCLUSION: We believe that CT-guided cordotomy, performed by experienced hands in a team of experienced individuals and applied to the right patients, is an effective treatment. However, it is crucial to exercise extreme caution regarding potential side effects and serious complications during the cordotomy procedure.

Open thoracic cordotomy for intractable cancer pain: a how I do it.

BACKGROUND: Some cancers of the lower extremity involve nerves and plexuses and can produce extreme drug-resistant noceptive pain. In these cases, open thoracic cordotomy can be proposed. METHOD: This procedure involves disruption of the spinothalamic tract, which sustains nociceptive pathways. After placement in the prone position, selection of the side to be operated on (contralateral to the pain), and dura exposure, microsurgery is used to section the anterolateral spinal cord quadrant previously exposed by gently pulling on the dentate ligament. CONCLUSION: Open thoracic cordotomy is a moderate invasive, safe, and effective option for the management of drug-resistant unilateral lower extremity cancer pain in well-selected patients.

[Modified Harrington Procedure in the Treatment of Extensive Tumor Defects of the Acetabulum]. / Modifikovaná Harringtonova operace v terapii rozsáhlých nádorových defektu acetabula.

PURPOSE OF THE STUDY The increasing prevalance of patients with metastatic bone cancer and their improved survival puts more emphasis on the quality of treatment of bone metastases. Although most pelvic lesions are treated non-operatively, extensive destruction of the acetabular segment poses a therapeutic challenge. A potential treatment option may be the modified Harrington procedure. MATERIAL AND METHODS At our department, this surgical procedure has been opted for in 14 patients (5 men and 9 women) since 2018. The mean age at the time of surgery was 59 years (range 42 to 73). Twelve patients suffered from metastatic cancer, one patient had a fibrosarcoma metastasis and one female patient presented with aggressive pseudotumor. Radiological and clinical followup of the patients was performed. Pain was assessed using the Visual Analogue Scale, and the Harris Hip Score and the MSTS score were used to evaluate the functional outcome. The paired samples Wilcoxon test was used to analyze the statistical significance of the difference. RESULTS The mean follow-up period was 25 months. At the time of assessment, ten patients were alive with the mean follow-up of 29 months (range 2 to 54 months) and four patients had died of cancer progression, with the mean follow-up being 16 months. No perioperative death or mechanical failure were reported. One female patient developed a hematogenous infection during febrile neutropenia, which was successfully managed with early revision and implant preservation. Statistically, a significant improvement in the MSTS (median 23) and HHS (median 86) functional scores compared to the preoperative values (MSTS median 2, p<0.01, r-effect size = 0.6; HHS preop median 0, p<0.005, r-effect size = -0.7) was observed. There was also a statistically significant reduction in pain (VAS postoperative median 1, VAS preoperative median 8, p<0.01, r-effect size = -0.6). All patients were capable of independent ambulation after the surgery, nine patients walked without support. DISCUSSION There are not many alternatives to this surgical procedure. Apart from non-operative palliative treatment, the options include ice cream cone prostheses or customized 3D implants which are, impractical in terms of time and cost. Our results are comparable to other studies, confirming the reproducibility and reliability of the method. CONCLUSIONS The Harrington procedure is an efective method for management of large acetabular tumor defects with good functional outcomes, an acceptable perioperative risk and a low risk of failure in the medium term, thus suitable also for patients with good cancer prognosis. Key words: umor, metastasis, acetabulum, pelvis, Harrington, reconstruction.

Uterine Artery Embolization Compared with High-intensity Focused Ultrasound Ablation for the Treatment of Symptomatic Uterine Myomas: A Systematic Review and Meta-analysis.

OBJECTIVE: This study aimed to compare the clinical effects of uterine artery embolization (UAE) with those of high-intensity focused ultrasound (HIFU) ablation for the treatment of symptomatic uterine myomas. DATA SOURCES: We searched PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, and ClinicalTrials.gov for studies from January 2000 to August 2020. Related articles and relevant references of the included studies were also searched. METHODS OF STUDY SELECTION: Two researchers independently performed the data selection. We included comparative studies that compared the clinical outcomes of UAE with those of HIFU ablation in women with myomas. TABULATION, INTEGRATION, AND RESULTS: We assessed the study quality using the Cochrane Handbook for Systematic Reviews of Interventions for evaluating the risk of bias. Two independent researchers performed the article selection according to the screening criteria and rated the quality of evidence for each article. We calculated pooled mean difference with 95% confidence interval (CI) for continuous data and relative risk (RR) with 95% CI for dichotomous data. The systematic review registration number is CRD42020199630 on the International Prospective Register of Systematic Reviews. A total of 7 articles (5 trials), involving 4592 women with symptomatic uterine myomas, were included in the meta-analysis. Compared with the HIFU ablation group, the decrease in "uterine fibroid symptom" scores as well as the increase in quality-of-life scores at the time of follow-up were higher in the UAE group, with overall mean difference 19.54 (95% CI, 15.21-23.87; p <.001) and 15.72 (95% CI, 8.30-23.13; p <.001), respectively. The women in the UAE group had a significantly lower reintervention rate (RR 0.25; 95% CI, 0.15-0.42; p <.001). The women undergoing UAE had a significantly lower pregnancy rate than those undergoing HIFU ablation (RR 0.06; 95% CI, 0.01-0.45; p = .006). The difference in the incidence of adverse events between the 2 groups was not statistically significant (p = .53). CONCLUSION: Compared with HIFU ablation, UAE provided more significant alleviation of symptoms and improvement in quality of life, lower postoperative reintervention rate, and lower pregnancy rate for women with uterine myomas. However, we cannot conclude that HIFU ablation is more favorable for desired pregnancy than UAE because of the confounding factors.

Outcomes of palliative-intent surgery in retroperitoneal sarcoma-Results from the US Sarcoma Collaborative.

BACKGROUND AND OBJECTIVES: Outcomes of palliative-intent surgery in retroperitoneal sarcomas (RPS) are not well understood. This study aims to define indications for and outcomes after palliative-intent RPS resection. METHODS: Using a retrospective 8-institution database, patients undergoing resection of primary/recurrent RPS with palliative intent were identified. Logistic regression and Cox-proportional hazards models were constructed to analyze factors associated with postoperative complications and overall survival (OS). RESULTS: Of 3088 patients, 70 underwent 87 palliative-intent procedures. Most common indications were pain (26%) and bowel obstruction (21%). Dedifferentiated liposarcoma (n = 17, 24%), leiomyosarcoma (n = 13, 19%) were predominant subtypes. Median OS was 10.69 months (IQR, 3.91-23.23). R2 resection (OR, 8.60; CI, 1.42-52.15; P = .019), larger tumors (OR, 10.87; CI, 1.44-82.11; P = .021) and low preoperative albumin (OR, 0.14; CI, 0.04-0.57; P = .006) were associated with postoperative complications. Postoperative complications (HR, 1.95; CI, 1.02-3.71; P = .043) and high-grade histology (HR, 6.56; CI, 1.72-25.05; P = .006) rather than resection status were associated with reduced OS. However, in R2-resected patients, development of postoperative complications significantly reduced survival (P = .042). CONCLUSIONS: Postoperative complications and high-grade histology rather than resection status impacts survival in palliative-intent RPS resections. Given the higher incidence of postoperative complications which may diminish survival, palliative-intent R2 resection should be offered only after cautious consideration.

Bone metastases: a comprehensive review of the literature.

The last report of the World Health Organization (WHO) stated that approximately four million people experience bone pain due to malignant diseases. Among them, metastatic bone pain is one of the most important sources of complaint. The estimated median survival in the presence of bone metastases ranks from 10 to 12 weeks. Bone represents a potential target of distant metastases for the majority of malignant tumours. However, the exact incidence of bone metastases is unknown. Bone metastases have an important socio-economic impact, and due to the enhancement of the overall survivorship, their incidence is increasing. Malignant neoplasms such as lung, thyroid, renal cancer, multiple myeloma, and melanoma often metastasize to the bone. Bone metastases commonly localize to the spinal column, pelvis, shoulder, and distal femur. The proper treatment for painful skeletal metastases is still unknown. Hence, the purpose of this review of the literature was to update current evidence concerning the aetiogenesis, biological behaviour, and treatment algorithms for painful skeletal metastases.

Preoperative insomnia and its association with psychological factors, pain and anxiety in Chinese colorectal cancer patients.

PURPOSE: Sleep disturbances are common in cancer patients, but little is known about preoperative insomnia and its associated factors in colorectal cancer (CRC) patients. The aim of this study was to clarify the relationship between preoperative insomnia and its associated factors (i.e., pain, anxiety, self-esteem, and coping styles) in CRC patients. METHODS: A cross-sectional study was conducted in consecutive CRC inpatients (N = 434), who were required to complete the questionnaires about insomnia, pain, anxiety, self-esteem, and coping styles (acceptance/resignation, confrontation, avoidance) before the day of surgery. Hierarchical regression analyses were conducted to explore the relationships between preoperative anxiety and its associated factors. RESULTS: Based on the cutoff value of Athens Insomnia Scale (scores ≥ 6) in Chinese cancer patients, the prevalence of insomnia was 38.2% before surgery. Pain (ß = 0.087, p = 0.015) and anxiety (ß = 0.372, p < 0.001) were positively associated with preoperative insomnia, while self-esteem (ß = - 0.479, p < 0.001) and confrontation coping (ß = - 0.124, p = 0.003) showed protective effects on preoperative insomnia when putting them together into hierarchical regression. The associated factors together accounted for an additional variance of preoperative insomnia (47.6%). CONCLUSIONS: In line with previous findings, the detrimental effects of pain and anxiety on preoperative insomnia were also observed in our study. More importantly, our main new findings were that self-esteem and confrontation coping played important roles in alleviating preoperative insomnia among CRC patients. Clinicians should take these results into account when developing cancer care management to relieve preoperative insomnia.

Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety.

PURPOSE: Radiofrequency ablation (RFA) is the most common percutaneous technique applied to treat painful spinal metastasis; however, experience in this field is somehow still limited. A systematic literature research was performed to understand the effects of RFA in terms of analgesia and safety. MATERIALS AND METHODS: Inclusion criteria for the studies were as follows: (1) randomised controlled or non-randomised studies with a prospective or retrospective design; (2) population made up of adults with spinal metastasis; (3) spinal metastasis treated with RFA alone or in combination/comparison with other treatments; (4) studies reporting about patients' pain before and at least one time-point following RFA; and (5) English-language studies. RESULTS: Seven hundred and thirty-three articles were screened and 8 (4 prospective, 4 retrospective) matched the inclusion criteria. Study population ranged between 10 and 92 patients across studies. Five out of eight studies reported a highly effective pain management (≥4 points of pain reduction between baseline and the last time-point available); 2/8 studies reported moderate results (≥2 points of pain reduction between baseline and the last time-point available). All studies combined RFA with cement augmentation in the vast majority of patients (40-100%) or metastasis (94-95.8%). Grade I-IIIa neural complications were reported in up to 16% of the cases and were always managed conservatively or with steroids. CONCLUSIONS: RFA, combined with vertebral augmentation in most of the cases, is effective and safe in achieving short- to mid-term (from 1 week to 6 months) analgesia in patients affected by painful spinal metastasis.

Low-power bipolar radiofrequency ablation and vertebral augmentation for the palliative treatment of spinal malignancies.

AIM: To investigate the analgesic properties and the safety of low power bipolar radiofrequency ablation (RFA) performed with internally cooled electrodes and vertebral augmentation for the treatment of painful spinal malignancies. MATERIALS AND METHODS: Consent was waived for retrospective study participation. Review of electronic records identified 11 consecutive patients (6 females; 5 males; mean age 61.3 ± 11.6 years) with one-index painful spinal tumour, who were treated between June 2016 and October 2017 with bipolar RFA and vertebral augmentation. Patients were treated if they presented with focal pain (≥4/10 on a 0-10 visual analogic scale in the 24-h period) corresponding to a metastatic vertebral level on cross sectional imaging. The Wilcoxon test was used to evaluate the significance of the post-operative pain. RESULTS: Lumbar levels were treated in 72.7% cases; metastatic epidural involvement was noted in 81.8% cases; 54.5% patients received associated treatments in addition to RFA, which was coupled to vertebral augmentation in all cases. Two (18.2%) complications were noted. Mean pain score measured at last clinical follow-up available (mean 1.9 ± 1.4 months) was 3.5 ± 2 (versus 7.8 ± 1.1 at baseline; p <0.01). CONCLUSIONS: Low-power bipolar RFA performed with internally cooled electrodes and coupled to vertebral augmentation provides safe and effective early analgesia in patients affected by painful spinal malignancies.

Efficacy of Cryoablation to Control Cancer Pain: A Systematic Review.

The use of opioids to control cancer pain could be insufficient. Interventional techniques such as a cryoablation have emerged as alternatives to opioids. OBJECTIVES: To summarize the current scientific evidence on the use of cryoablation to control cancer pain. METHODS: A systematic search of the Scopus, PubMed, and Cochrane databases was performed. All articles published before December 31, 2015, whose title or abstract specified cancer pain control as the endpoint were selected. Articles without abstracts and all nonsystematic reviews were excluded. RESULTS: 22 articles were included: 1 randomized clinical trial (RCT), 2 non-RCTs, 1 ambispective study, 9 retrospective studies, 2 nonspecified cohort studies, 3 case series, and 4 case reports. 496 patients with 580 lesions were treated. Lung cancer was the most common primary tumor. 82.8% of the metastases were bone metastases, with or without soft tissue involvement. Cryoablation decreased mean pain scores by 62.5% at 24 hours post-cryoablation, by 70% at 3 months, and by 80.9% at 6 months. Cryoablation was associated with a 44.2% improvement in quality of life after 4 weeks and a 59.6% improvement at 8 weeks. The need for opioids decreased by 75% at 24 hours and by 61.7% at 3 months. Cryoablation in combination with radiotherapy, vertebroplasty, or bisphosphonates appears to be better than cryoablation alone. Complications were highly variable among the studies, but no fatal complications were reported. CONCLUSIONS: Cryoablation is effective in controlling cancer pain without relevant side effects. However, more studies are needed to confirm these results.

[NEUROSURGICAL INTERVENTIONS FOR INTRACTABLE ONCOLOGICAL PAIN].

INTRODUCTION: Pain is one of the most common symptoms among cancer patients, and particularly in those who suffer from metastatic or terminal disease. There is great importance in delivering good pain management to these patients in order to alleviate their suffering, improve their functional status and their overall quality of life. In most cases, pain management is based on pharmacotherapy with opioids and other medications. However, there are selected patients for whom pharmacotherapy does not achieve acceptable pain relief or is associated with marked side effects. These patients, who suffer from refractory cancer pain, may benefit from neurosurgical procedures selectively intervening in different locations along the pain signaling pathways. This article summarizes several of these neurosurgical procedures: percutaneous cordotomy for unilateral pain, punctuate midline myelotomy for visceral pain and stereotactic cingulotomy for diffuse pain syndromes. This article demonstrates the use of careful patient selection by an interdisciplinary team which is critical for the success of these procedures. The team consists of palliative care specialists, pain specialists and a neurosurgeon. These neurosurgical interventions are presented through representative clinical cases, followed by a discussion of the clinical considerations that guided the choice of the therapeutic approach for each case.

Use of Spinal Cord Diffusion Tensor Imaging to Quantify Neural Ablation and Evaluate Outcome after Percutaneous Cordotomy for Intractable Cancer Pain.

BACKGROUND: Up to 20% of patients experience only partial pain relief after percutaneous cordotomy for cancer pain. OBJECTIVE: To determine whether diffusion tensor imaging (DTI) can quantify neural ablation and help evaluate early postoperative outcomes after cordotomy. METHODS: Patients undergoing percutaneous CT-guided cordotomy for intractable cancer pain were prospectively studied. Pre- and postoperative assessment was made using the visual analog scale (VAS) on pain and the pain severity scores of the Brief Pain Inventory Short Form. On postoperative day 1, DTI images of the high cervical spinal cord were obtained. DTI metrics were correlated with the number of ablations as well as early postoperative pain outcomes. RESULTS: Seven patients (4 male, mean age 53.8 ± 4.6 years) were studied. Fractional anisotropy of the hemicord was significantly lower on the side of the lesion as compared to the contralateral side (0.54 ± 0.03 vs. 0.63 ± 0.03, p < 0.001). Mean diffusivity correlated with the improvement in the VAS score at 1 week (r = 0.88, 95% CI = 0.34-1.00, p = 0.008), as well as the change in pain severity scores at 1 week (r = 0.99, 95% CI = 0.82-1.00, p < 0.001). CONCLUSION: DTI metrics are sensitive to the number of ablations as well as early improvement in pain scores after cordotomy. DTI of the cervical spinal cord is a potential biomarker of neural ablation after percutaneous cordotomy for intractable cancer pain.

O-Arm-Guided Percutaneous Radiofrequency Cordotomy.

BACKGROUND: Pain is often one of the most debilitating symptoms in patients with advanced oncological disease. Patients with localized pain due to malignancy refractory to medical treatment can benefit from selective percutaneous cordotomy that disconnects the ascending pain fibers in the spinothalamic tract. OBJECTIVES: Over the past year, we have been performing percutaneous radiofrequency cordotomy with the use of the O-Arm intraoperative imaging system that allows both 2D fluoroscopy and 3D reconstructed computerized tomography imaging. We present our experience using this technique, focusing on technical nuances and complications. METHODS: A retrospective analysis was conducted of all patients who underwent percutaneous cordotomy between March 2016 and March 2017. RESULTS: Nineteen patients underwent percutaneous cordotomy procedures. Two patients developed intraoperative delirium and were unable to tolerate the procedure. In 16 out of 17 completed procedures, we achieved excellent immediate pain relief (94%). At 1 month after operation, 15 of the 17 (88%) patients were pain free, and at 3 months 5 out of 5 patients available for follow-up were still free of their original pain. Mirror pain developed in 6 of the 17 patients (35%), but was mild in 4 of these cases and controlled with medications. We experienced 1 serious complication (6%) of ipsilateral hemiparesis. CONCLUSION: Percutaneous cordotomy using the O-Arm is safe and effective in the treatment of intractable oncological pain.

Double Anterior Stereotactic Cingulotomy for Intractable Oncological Pain.

BACKGROUND: Stereotactic anterior cingulotomy has been used in the treatment of patients suffering from refractory oncological pain due to its effects on pain perception. However, the optimal targets as well as suitable candidates and outcome measures have not been well defined. We report our initial experience in the ablation of 2 cingulotomy targets on each side and the use of the Brief Pain Inventory (BPI) as a perioperative assessment tool. METHODS: A retrospective review of all patients who underwent stereotactic anterior cingulotomy in our Department between November 2015 and February 2017 was performed. All patients had advanced metastatic cancer with limited prognosis and suffered from intractable oncological pain. RESULTS: Thirteen patients (10 women and 3 men) underwent 14 cingulotomy procedures. Their mean age was 54 ± 14 years. All patients reported substantial pain relief immediately after the operation. Out of the 6 preoperatively bedridden patients, 3 started ambulating shortly after. At the 1-month follow-up, the mean preoperative Visual Analogue Scale score decreased from 9 ± 0.9 to 4 ± 2.7 (p = 0.003). Mean BPI pain severity and interference scores decreased from levels of 29 ± 4 and 55 ± 12 to 16 ± 12 (p = 0.028) and 37 ± 15 (p = 0.043), respectively. During the 1- and 3-month follow-up visits, 9/11 patients (82%) and 5/7 patients (71%) available for follow-up reported substantial pain relief. No patient reported worsening of pain during the study period. Neuropsychological analyses of 6 patients showed stable cognitive functions with a mild nonsignificant decline in focused attention and executive functions. Adverse events included transient confusion or mild apathy in 5 patients (38%) lasting 1-4 weeks. CONCLUSIONS: Our initial experience indicates that double stereotactic cingulotomy is safe and effective in alleviating refractory oncological pain.

Percutaneous Cementoplasty For Acetabulum In Patients With Bone Metastasis.

The purpose of this study is to demonstrate the surgical technique and to show the results of percutaneous cementoplasty (PC) for acetabular metastases using lateral approach under regional anesthesia. Forty-two cases underwent PC for acetabular metastases. The PC was performed using spinal anesthesia, lateral approach and fluoroscopic guidance. We assessed visual analogue scale (VAS) and revised musculoskeletal tumor society (MSTS) rating system and maximum standardized uptake value (SUVmax) of the acetabular lesion using F-18-FDG PET/CT before and after the PC. The mean injected volume of polymethylmethacrylamide to the pelvis was 21±11.8 ml. The mean of regional VAS (6.2±1.1 vs. 3.1±2.7, p<0.001), MSTS (10.3±3.9 vs. 18.3±3.2, p<0.001) and local SUVmax (8.6±5.2 vs. 5.7±3.6 , p = 0.012) on PET/CT showed significant reductions after surgery. Twenty-three patients (55%) died of disease at mean 11.8±4.8 months after surgery. PC using lateral approach and regional anesthesia could be a simple and safe surgical method for relieving pain and maintaining skeletal stability against acetabular metastasis.

Surgical treatment for metastases of the cervical spine.

BACKGROUND: There are limited information and inconclusive results for the management of patients with cervical spine metastases. Therefore, we performed this study to evaluate the survival and outcome of these patients, and the surgical risk and complications. MATERIALS AND METHODS: We retrospectively studied 24 patients [14 men and 10 women; mean age, 71 years (range 54-89 years)], with cervical spine metastases, who underwent palliative surgical treatment, from December 2010 to December 2016. Mean follow-up was 14 months (range 1-42 months). We evaluated the survival and the outcome of the patients with respect to pain relief and neurological status, and the surgical risk and complications. RESULTS: At the last follow-up, three patients were alive with disease, and 21 patients were dead with disease. Overall median survival was 14.8 months (range 1-47 months). A posterior approach was performed in 15 patients, an anterior approach with corpectomy and fusion in eight patients, and a two-stage combined approach in one patient. Overall, 21 patients experienced complete or almost complete, two patients mild, and one patient no pain relief; seven patients experienced complete neurological improvement, two patients moderate, while four patients remained stable. Overall, five patients experienced six complications including residual pain, sagittal malalignment with instability, and wound dehiscence; in five complications, a reoperation was necessary. CONCLUSIONS: Palliative surgical treatment is usually performed in patients with metastatic bone disease of the cervical spine. Appropriate selection of the surgical technique is mandatory. However, the survival of the patients is dismal, and complications should be expected.

Reconstruct the proximal radius with iliac graft and elastic intramedullary nail fixation after tumor resection.

BACKGROUND: This study aims to introduce a novel technique in treating benign bone tumors of the proximal radius by elastic intramedullary nail fixation and iliac graft after tumor resection. METHOD: In this retrospective case series, the treatment outcomes of 17 patients with benign bone tumor involving the proximal radius were reported from January 2010 to August 2014. All the patients received reconstruction surgery with iliac graft and elastic intramedullary nail fixation after tumor resection. Pain scoring was assessed using the 0 to 10 numerical rating scale. The quality of life scoring was assessed using the SF-30 scoring system. In addition, functional outcome was assessed with the Musculoskeletal Tumor Society score and the Disabilities of the Arm, Shoulder, and Hand score. RESULTS: The mean follow-up was 16 months (range, 10-22). The average bone consolidate time was 19.2 weeks (range, 16-24 weeks). The pre- and postoperative pain scores were 5.47 ± 1.58 and 1.18 ± 0.39, respectively. The pain symptom was significantly ameliorated after the operation (t = 13.50, p < 0.01). The pre- and postoperative and the quality of life scores were 48.29 ± 6.58 and 77.47 ± 5.89, respectively; the quality of life score was dramatically improved (t = -20.11, p < 0.01). The mean Musculoskeletal Tumor Society score was 83.41 % (range, 63-93 %) and the mean Disabilities of the Arm, Shoulder, and Hand score was 14.1 (range, 5.8-38.3). CONCLUSION: Taken together, the application of iliac graft and elastic intramedullary nail fixation after excision of lesions might be associated to a significant reduction of the pain and improvement of QOL (quality of life) and limb function of patients with benign bone tumors of proximal radius.

Bipolar radiofrequency ablation for cancer pain in the trigeminal distribution.

Tumours in patients with head and neck cancer (HNC) are associated with a more significant decrease in quality of life compared with the rest of patients with cancer. We present a patient with pain due to HNC successfully treated with bipolar radiofrequency ablation. A man in his 70s presented with a tumour in the left V2 and V3 region, with disabling pain, Visual Analogue Scale (VAS) score of 10/10, pain on swallowing, chewing and speaking, 3 months of evolution. The patient was evaluated in the pain management department, and the interventional treatment proposed consisted of bipolar pulsed radiofrequency, followed by bipolar thermal radiofrequency of the left V2 and V3 branches with fluoroscopic guidance to achieve better control and coverage of the affected trigeminal branches. Immediately after the procedure, the patient reported a significant improvement in pain with a 0-10 VAS; hypoesthesia in the affected V2 and V3 territory was identified, but no motor weakness. The improvement in pain was maintained for 6 months with a significant improvement in quality of life and pain, which allowed him to speak, chew and swallow without pain. Later, the patient died from complications associated with the disease. The treatment approach in these patients is both pain treatment and achieving independence by allowing better speech ability and improving eating, the above as a pillar of treatment focused on improving the patient's quality of life. This approach is a potential tool in the early stage of the disease in patients with pain due to HNC.