美国神经外科医师协会关于癌症疼痛神经消融治疗的系统评价和循证临床实践指南
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain.
机构信息
Department of Neurological Surgery, School of Medicine, Oregon Health & Science University Healthcare, Portland, Oregon.
Department of Neurological Surgery, University of California San Diego, San Diego, California.
出版信息
Neurosurgery. 2021 Feb 16;88(3):437-442. doi: 10.1093/neuros/nyaa527.
BACKGROUND
Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a malignancy. Although neuromodulation has a role in the treatment of cancer pain for some patients, these therapies may not be suitable for all patients. Therefore, neuroablative procedures, which were once a mainstay in treating intractable cancer pain, are again on the rise. This guideline serves as a systematic review of the literature of the outcomes following neuroablative procedures.
OBJECTIVE
To establish clinical practice guidelines for the use of neuroablative procedures to treat patients with cancer pain.
METHODS
A systematic review of neuroablative procedures used to treat patients with cancer pain from 1980 to April 2019 was performed using the United States National Library of Medicine PubMed database, EMBASE, and Cochrane CENTRAL. After inclusion criteria were established, full text articles that met the inclusion criteria were reviewed by 2 members of the task force and the quality of the evidence was graded.
RESULTS
In total, 14 646 relevant abstracts were identified by the literature search, from which 189 met initial screening criteria. After full text review, 58 of the 189 articles were included and subdivided into 4 different clinical scenarios. These include unilateral somatic nociceptive/neuropathic body cancer pain, craniofacial cancer pain, midline subdiaphragmatic visceral cancer pain, and disseminated cancer pain. Class II and III evidence was available for these 4 clinical scenarios. Level III recommendations were developed for the use of neuroablative procedures to treat patients with cancer pain.
CONCLUSION
Neuroablative procedures may be an option for treating patients with refractory cancer pain. Serious adverse events were reported in some studies, but were relatively uncommon. Improved imaging, refinements in technique and the availability of new lesioning modalities may minimize the risks of neuroablation even further.The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-on-neuroablative-procedures-patients-wi.
背景
管理癌症疼痛，一旦对常规治疗产生抗药性，仍然是那些致力于为恶性肿瘤患者服务的护理人员的挑战。尽管神经调节在某些患者的癌症疼痛治疗中具有作用，但这些治疗方法可能并不适合所有患者。因此，神经消融术曾经是治疗难治性癌症疼痛的主要方法，现在又再次兴起。本指南是对神经消融术治疗癌症疼痛的文献进行的系统回顾。
目的
制定使用神经消融术治疗癌症疼痛患者的临床实践指南。
方法
使用美国国立医学图书馆 PubMed 数据库、EMBASE 和 Cochrane CENTRAL 对 1980 年至 2019 年 4 月期间用于治疗癌症疼痛患者的神经消融术进行了系统回顾。在确定纳入标准后，由 2 名工作组成员对符合纳入标准的全文文章进行了回顾，并对证据质量进行了分级。
结果
通过文献检索共确定了 14646 篇相关摘要，其中 189 篇符合初步筛选标准。经过全文审查，189 篇文章中有 58 篇被纳入，并细分为 4 种不同的临床情况。这些情况包括单侧躯体伤害性/神经性躯体癌症疼痛、颅面癌症疼痛、中线下膈内脏癌症疼痛和扩散性癌症疼痛。这 4 种临床情况有 II 类和 III 类证据。针对使用神经消融术治疗癌症疼痛患者的问题制定了 III 级推荐。
结论
神经消融术可能是治疗难治性癌症疼痛患者的一种选择。一些研究报告了严重的不良事件，但相对少见。改进的成像、技术的改进和新的消融模式的可用性可能会进一步降低神经消融的风险。完整的指南可在 https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-on-neuroablative-procedures-patients-wi 上获取。
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