CT-guided percutaneous cordotomy for intractable pain in what is more than a disease: lung malignancies.
OBJECTIVE
Lung cancer is the leading cause of cancer-related mortality worldwide.     Pain is a common problem in these patients, yet inadequate or dissatisfactory     management is prevalent.


METHODS
Between 1987 and 2012, 224     patients with intractable pain were treated with computerized tomography (CT)-     guided cordotomy. Among them, 210 had intractable pain due to malignancies. The     majority of the cases were diagnosed as pulmonary malignancies (108 patients).     Sixty-seven were pulmonary carcinoma, 26 mesothelioma and 15 Pancoast tumors.


RESULTS
After cordotomy, 98.13% of cancer patients reported initial pain     relief. Minimum and maximum preoperative scores of the Karnofsky Performance     Scale were 20 and 70, versus postoperative scores of 40 and 90 (p < 0.001).     The median preoperative VAS score was 8 (6-9). On the first postoperative day,     the score dropped sharply to 0 (0-8) (p < 0.001). In this selected series of     108 percutaneous cordotomy procedures, as well as in the total series of 224     patients, there was no mortality or major morbidity.


CONCLUSIONS
CT-guided     percutaneous cordotomy is an effective procedure that should be used in the     treatment of cancer-related pain problems. We suggest that cordotomy should be     preferred as soon as possible in patients who fail to respond to the classic     analgesic therapy.
President of the Turkish Academy of Sciences, Emeritus, Ankara University, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey.
Yucel
Y
Kanpolat
Mevci
M
Ozdemir
Eyyub
E
Al-Beyati
D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D002818:Cordotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008654:Mesothelioma / Q000150:complications*; D008875:Middle Aged; D009339:Needles; D010148:Intractable Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010178:Pancoast Syndrome / Q000150:complications; D013133:Spinothalamic Tracts / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome