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. 2020 Aug 1;87(2):394-402.
doi: 10.1093/neuros/nyz527.

Percutaneous Cordotomy for Pain Palliation in Advanced Cancer: A Randomized Clinical Trial Study Protocol

Ashwin Viswanathan  1 , Aditya Vedantam  1 , Loretta A Williams  2 , Dhanalakshmi Koyyalagunta  3 , Salahadin Abdi  3 , Patrick M Dougherty  3 , Tito Mendoza  2 , Roland L Bassett  4 , Ping Hou  5 , Eduardo Bruera  6
Affiliations

Percutaneous Cordotomy for Pain Palliation in Advanced Cancer: A Randomized Clinical Trial Study Protocol

Ashwin Viswanathan et al. Neurosurgery. .

Abstract

Background: Cancer pain, one of the most common symptoms for patients with advanced cancer, is often refractory to maximal medical therapy. A controlled clinical trial is needed to provide definitive evidence to support the use of ablative procedures such as cordotomy for patients with medically refractory cancer pain.

Objective: To assess the efficacy of cordotomy for patients with unilateral advanced cancer pain using a controlled clinical trial study design. The secondary objectives are to define the patient experience of cordotomy for medically refractory cancer pain as well as to determine the utility of magnetic resonance imaging as a non-invasive biomarker for successful cordotomy.

Methods: We will undertake a single-institution, double-blind, sham-controlled clinical trial of cordotomy in patients with refractory cancer pain. Patients in the cordotomy arm will undergo a percutaneous computed tomography-guided cordotomy at C1-C2, while patients in the control arm will undergo a similar procedure where the needle will not penetrate the thecal sac. The primary endpoint will be the reduction in pain intensity, as measured by the Edmonton Symptoms Assessment Scale.

Expected outcomes: We expect that patients randomized to cordotomy will have a significantly greater reduction in pain intensity than those patients randomized to the control surgical intervention.

Discussion: This randomized clinical trial comparing cordotomy with a control intervention will provide the level of evidence necessary to determine whether cordotomy should be the standard of care intervention for patients with advanced cancer pain.

Keywords: Cancer pain; Cordotomy; Diffusion tensor imaging; Palliative care; Randomized controlled trial; Refractory pain.

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Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Technical considerations for the cordotomy and control interventions. The risk of the control intervention is minimized by keeping the spinal needle a safe distance from the dura which surrounds the spinal cord.
Figure 3.
Figure 3.
Interview guide to define the patient experience of cordotomy for cancer pain refractory to palliative care.
See this image and copyright information in PMC

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