Multimodal locoregional procedures for cancer pain management: a literature review

Abstract

Pain is the most common and fearsome symptom in cancer patients, particularly in the advanced stage of disease. In cancer pain management, the first option is represented by analgesic drugs, whereas surgery is rarely used. Prior to considering surgical intervention, less invasive locoregional procedures are available from the wide pain management arsenal. In this review article, comprehensive information about the most commonly used locoregional options available for treating cancer pain focusing on interventional radiology (neurolysis, augmentation techniques, and embolization) and interventional radiotherapy were provided, also highlighting the potential ways to increase the effectiveness of treatments.

Figure 1.

A 59-year-old male affected by pancreatic cancer and suffering chronic drug-uncontrollable pain due to perivascular celiac infiltration (a, thin arrow). Percutaneous alcoholization of the celiac trunk (b–e) is performed with the patient prone and a posterior approach. After the localization scan (b) performed with cutaneous markers (white circles), (c) local anesthesia is performed and (d) 20-Gauge needles are inserted in the proximity of the celiac trunk. (e) Final CT control shows the mixture of 95% ethanol and contrast medium being correctly distributed.

Figure 2.

A 54-year-old female multiple myeloma patient with an extensive lytic L4 lesion treated with spinal augmentation using a PEEK polymer cage (KIVA system). (A) Cone beam CT sagittal reconstruction illustrating the working cannula and the PEEK polymer cage deployed inside L4 vertebral body. (B) Cone beam CT coronal reconstruction post-polymer injection.

Figure 3.

A 68-year-old male HCC patient with a lytic metastatic lesion in the left acetabulum treated with percutaneous microwave ablation and cementoplasty. (A) Anteroposterior fluoroscopy view illustrating the microwave antenna inside the lesion. (B) Anteroposterior fluoroscopy view post ablation illustrating a bone trocar for polymer injection. (C) Anteroposterior fluoroscopy view illustrating filling of the lytic lesion with polymer. HCC, hepatocellular carcinoma.

Figure 4.

A 43-year-old male sarcoma patient treated with pre-operative embolization in order to decrease vascularity. Pre- (A) and post-embolization (B) images.