Preliminary Examination of Celiac Plexus Radiosurgery for Cancer-Related Pain Reduction

According to an article, published in the International Journal of Radiation Oncology, Biology, Physics, there is a need to improve contemporary approaches in palliative care of patients with refractory epigastric or mid-back pain associated with locally advanced abdominal malignancies, especially pancreatic cancer. The researchers, led by Liat Hammer, evaluated ablative radiation therapy targeted at the celiac plexus to alleviate this pain, and reported that “Celiac plexus radiosurgery appears to alleviate cancer-related pain.

The preliminary phase II trial included 31 patients in one prospective cohort. Patients who were eligible for final evaluation had celiac-related pain rated at least five out of 10 on the Numerical Rating Scale (NRS), had completed treatment per the study’s protocol, and had performed at least one follow-up visit post-treatment. The primary endpoint assessed by the investigators was change in NRS at week three post-celiac plexus radiosurgery. Secondary endpoints of the study included toxicity and pain interference, as measured with the Brief Pain Inventory.

Of the 31 recruited patients, 18 patients were treated with celiac plexus radiosurgery and eligible for final evaluation. The cohorts’ median age was 68 years (range: 51–79), 89% had pancreatic cancer, median Eastern Cooperative Oncology Group (ECOG) performance score was 1, median interval from initial diagnosis to treatment was nine months (range: 1–36), and patients received a median of one systemic treatment (range: 0–3). According to the report, acute toxicities were limited to grade I or II events. At week three, 16 patients (84%) reported a decrease in celiac pain, “with median pain level falling from 6/10 (IQR 5-7.5) at baseline to 3/10 (IQR 1-4.3).” Furthermore, at week six post-treatment, “NRS was further reduced to 2.8/10 (IQR 0-3.3, both p<0.005 vs. baseline) including four patients who reported complete eradication of their celiac pain.” The investigators observed a decrease from the total daily morphine milligram equivalents (MME) of 59 at baseline to 50 at three weeks and 45 at six weeks—though it was not statistically significant.

The study’s authors also found “significant improvement was seen in pain-interference scores;” Taken together with the study’s findings on celiac plexus radiosurgery for reduction of pancreatic cancer-related pain, the authors closed with a favorable judgement of the procedure’s feasibility, and noted that “an international multi-center phase II trial is currently accruing.”