According to proceedings from the 2006 annual meeting of the Society of Interventional Radiology, a therapeutic technique referred to ablation, in conjunction with radiation therapy, appears to significantly reduce pain and may improve survival in patients with cancer that has spread to the chest wall.
In advanced stages of cancer, the disease often spreads from its site of origin to several sites in the body. The wall of the chest is a site that some cancers may spread. If the metastasis (spread) to the chest wall becomes large, it can encroach on the ribs or spine and cause severe pain. These patients often receive large doses of opioids to control their pain.
Ablation is a procedure where a probe is inserted into the skin and guided to the sites of cancer through scans such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound. The probe destroys the cancer cells through such mechanisms as high frequency radio waves or extreme temperatures. Ablation tends to be minimally invasive in comparison to surgery and can be performed on an outpatient basis.
Researchers from the Brown Medical School recently conducted a clinical trial to evaluate ablation techniques in the treatment of cancer patients who had metastasis to the chest wall. This trial included 52 adults. Most participants were treated with radiofrequency ablation (RFA), and most had an original diagnosis of non-small cell lung cancer. The median diameter of the cancer in the chest wall was 4.7 centimeters.
Ablation significantly improved outcomes in these patients:
- 70% of the procedures resulted in an improvement in pain.
- When radiation therapy was given within 90 days of ablation, 100% of patients reported improvement in their pain.
- Nearly 67% of patients reported that their pain was under control one year following ablation.
- 30% of the patients who reported an improvement in their pain following ablation were alive two years following the procedure.
- None of the patients who did not report an improvement in their pain following ablation were alive 6 months after the procedure.
The researchers concluded that although this is preliminary evidence, it appears that ablative procedures can significantly reduce pain associated with metastasis to the chest wall, particularly when combined with radiation therapy. Furthermore, it appears that patients who benefit from this treatment may have improved survival. However, further study is necessary to confirm these findings.
Patients with chest wall metastasis who are experiencing severe pain may wish to speak with their physician regarding their individual risks and benefits of ablative procedures.
Reference: C.A. Grieco et al. Percutaneous Thermoablation as a Palliative Treatment for Chest Wall Masses. Proceedings from the 2006 annual Society of Interventional Radiology Meeting. April 2006. Abstract 168.
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