Pain complex.
Patients with advanced pancreatic cancer and other upper GI malignancies can suffer from severe abdominal and back pain. This is thought to result from tumor involvement of the celiac plexus. In this prospective single-center single-arm study, 18 patients with upper abdominal and/or back pain (score 5 or higher) from their malignancy received single fraction palliative SRS. The target was contoured using a 5 mm brush along the anterolateral aspect of the aorta from T12 to L2, and it was prescribed 25 Gy in 1 fraction with 20 Gy in 1 fraction prescribed to an additional 5 mm expansion. Adjacent gross disease could receive 10-15 Gy, however the max dose within 5 mm of bowel was limited to 10 Gy and within 5-10 mm was limited to 15 Gy. Median pain score was significantly reduced at 3 weeks from 6.2 to 3.0 and even further at 6 weeks to 2.8, with most patients experiencing at least a 2-point decrease in pain. While the decrease in total daily opioid consumption was not significantly decreased, the median number of opioid rescue doses was reduced from four to one. | Hammer, Int J Radiat Oncol Biol Phys 2022
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