title: Painful pelvic recurrence of rectal cancer: percutaneous radiofrequency ablation treatment.
abstract: OBJECTIVE
  To retrospectively evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency thermal ablation (RFA) in reducing the pain in patients with painful pelvic recurrence of rectal cancer ineligible for surgical resection.
  
  
  METHODS
  Twelve consecutive patients (10 men and 2 women; mean age 67 ± 10 years) with painful pelvic recurrence of rectal cancer underwent CT-guided RFA treatments under conscious sedation. At baseline, in all patients pelvic-sacral pain was classified as severe by Visual Analog Scale (VAS; VAS score ≥75 mm). The tumor density and carcinoembryionic antigen (CEA) serum level averages were 46 ± 7 HU and 15.7 ± 9.3 ng/mL, respectively. Clinical outcome was evaluated by VAS with a mean follow-up period of 23 months.
  
  
  RESULTS
  All RFA sessions were completed and well tolerated. Morbidity consisted of recto-vesical fistula (8 %) and rectal abscess (8 %). 1 month after RFA procedure, complete lack of enhancement was obtained in 7 cases (58 %). A significant difference in HU and CEA serum level averages between baseline and 1 month post-RFA was revealed (p < 0.000 and p < 0.002, respectively). A significant reduction in pain was obtained: VAS score was significantly different between baseline and the clinical evaluations at week 1 and month 3, 6, 12, and 22) (p < 0.000). At the end of follow-up, 11 patients (92 %) were symptom free.
  
  
  CONCLUSIONS
  CT-guided RFA of painful pelvic recurrence of rectal cancer can be considered as a feasible and effective treatment for reducing the pain in selected cases.
authors.affiliation: Division of Interventional Radiology, Department of Oncologic Radiology, Businco Hospital, Regional Referral Center for Oncologic Disease, 09100, Cagliari, Italy, clapusceddu@gmail.com.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pusceddu
authors.forename: Barbara
authors.initials: B
authors.lastname: Sotgia
authors.forename: Luca
authors.initials: L
authors.lastname: Melis
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Fele
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Meloni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery*; D009367:Neoplasm Staging; D010147:Pain Measurement; D017699:Pelvic Pain / Q000209:etiology; D011846:Radio Waves; D015641:Radiography, Interventional; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome