Del Cid Paola, Aquino Liliana, Moreira Alejandra, Caceros Víctor, Tobar Carlos, Blanco Alejandro, Carvajal Gabriel, Bermudez-Guzman Luis, Lovo Eduardo E
Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, El Salvador.
Robotic Radiosurgery Center, International Cancer Center, San José, Costa Rica.
Br J Pain. 2025 Jun 18:20494637251350331. doi: 10.1177/20494637251350331.
Cancer pain is one of the most severe components of the symptom burden among cancer patients, especially those with advanced or metastatic disease. Palliative interventions are necessary to alleviate cancer pain and reduce opioid-related side effects, thereby minimizing patient suffering. Radiosurgery has been effectively used to target the medial thalamus and the hypophysis for the treatment of chronic pain syndromes. These two areas are critical for pain modulation and control, and their precise targeting with radiosurgery and its non-invasive nature can provide relief for patients suffering from cancer-related intractable pain. Our previous work with single target irradiation of the hypophysis revealed promising pain relief in terminal cancer patients, albeit more suited for hormone-mediated tumours or bone-derived pain rather than complex mixed pain syndromes. Given that, we previously introduced the concept of triple-target irradiation (hypophysis + both thalami) in a small report of terminally ill cancer patients. Here, we report a larger case series of terminally ill patients ( = 8) with complex cancer pain treated with a triple-target approach, with radiation doses generally considered low or non-ablative (90 Gy), in contrast to the usual single-target, ablative approach comprising higher doses. We noted a substantial decrease in VAS scores and the medications needed to manage pain across all patients, experiencing minimal to no side effects. Our findings indicate that a minimally invasive triple-target method, utilising low radiation doses, effectively alleviates pain, lowers medication dependency, and enhances the quality of life with few side effects. Furthermore, additional research is essential to optimise pain relief and ensure long-term effectiveness.
癌症疼痛是癌症患者症状负担中最严重的组成部分之一，尤其是那些患有晚期或转移性疾病的患者。姑息性干预对于减轻癌症疼痛和减少阿片类药物相关副作用是必要的，从而将患者的痛苦降至最低。放射外科已被有效地用于靶向内侧丘脑和垂体，以治疗慢性疼痛综合征。这两个区域对于疼痛调节和控制至关重要，通过放射外科对其进行精确靶向及其非侵入性性质可为患有癌症相关顽固性疼痛的患者提供缓解。我们之前对垂体进行单靶点照射的研究显示，晚期癌症患者的疼痛缓解效果良好，尽管更适用于激素介导的肿瘤或骨源性疼痛，而非复杂的混合性疼痛综合征。鉴于此，我们之前在一份关于晚期癌症患者的小型报告中引入了三靶点照射（垂体 + 双侧丘脑）的概念。在此，我们报告了一个更大的晚期患者病例系列（n = 8），这些患者患有复杂的癌症疼痛，采用三靶点方法进行治疗，与通常的包括更高剂量的单靶点、消融性方法相比，放射剂量通常被认为较低或非消融性（90 Gy）。我们注意到所有患者的视觉模拟评分（VAS）以及控制疼痛所需的药物都大幅减少，且副作用极小或没有副作用。我们的研究结果表明，一种使用低放射剂量的微创三靶点方法能有效缓解疼痛、降低药物依赖性，并在副作用很少的情况下提高生活质量。此外，进行更多研究对于优化疼痛缓解效果并确保长期有效性至关重要。
