title: Cordotomy for treatment of cancer-related pain: patient selection and intervention timing.
abstract: Many neurosurgical interventions for the management of cancer-related pain have been tried, but their role in today's advanced supportive and palliative care is not well described. The authors discuss the current knowledge gaps that prevent successful integration of neurosurgical interventions and patients with cancer-related pain. Two patients underwent percutaneous CT-guided cordotomy for refractory cancer-related pain: one patient had melanoma and the other had ovarian carcinoma. Both patients seemed to have unilateral, somatic, nociceptive cancer-related pain. Cordotomy was effective for only 1 patient. Percutaneous CT-guided cordotomy is a low-risk intervention that can benefit carefully selected patients with cancer-related pain. There is a clear need for prospective controlled studies to evaluate the effectiveness of cordotomy for patients receiving optimal medical treatment. A multidisciplinary study design could help to identify factors correlated with a positive outcome.
authors.affiliation: Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. aviswanathan@mdanderson.org
authors.forename: Ashwin
authors.initials: A
authors.lastname: Viswanathan
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D002818:Cordotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010146:Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D018579:Patient Selection; D011446:Prospective Studies; D011859:Radiography; D012878:Skin Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome