CT-guided percutaneous minimally invasive radiofrequency ablation for the relief of cancer related pain from metastatic non-small cell lung cancer patients: a retrospective study

Background: Radiofrequency ablation (RFA) is the current gold standard for palliative care of non-small cell lung cancer (NSCLC). Pain relief for advanced metastases of NSCLC is notoriously difficult. Combined RFA therapy may be more effective than palliating therapy alone in management of painful metastatic disease. The effects of RFA on quality of life, particularly pain, as well as long-term outcome studies are not well studied. To study the effectiveness of percutaneous minimal invasive RFA in pain management of NSCLC patients with metastatic chest wall, vertebral bodies and rib, and periphery lung nodule. Methods: Forty patients with 59 tumors underwent percutaneous computed tomography (CT) or ultrasound-guided RFA for pain management over a 4-week observation. Forty patients were referred to ablation because of persistent severe pain despite using analgesics, chemotherapy or radiotherapy. The tumors were located in the periphery lung, or metastatic to chest wall, rib or vertebral body. Quantitative pain scale values were quantified on a 0- 10 scale before, 24 hours, 72 hours, and 4 weeks after RFA. On the basis of changes in pain score and pain medication use, pain was reported with a composite measure as complete, partial, or no pain response. The overall survival (OS) rate was also collected and calculated with Kaplan-Meier method. Results: After 4-week follow-up, complete pain relief (pain scale score <= 1) was observed in 12 patients (30%) and partial pain relief (pain scale score <= 3) in 15 (37.5%) patients; pain relief did not occur in 13 patients (32.5%). There was a significant decrease in pain at 24-hour, 72-hour, and 4-week follow-up compared with pain level at baseline (P<0.01). Opiate use was decreased in 92.5% (37/40) patients, remained unchanged in 7.5% (3/40) at 4 weeks follow-up. There are minor adverse events caused by RFA therapy, including pleural effusion (5/40), post procedural infections (3/40), pneumothorax (2/40) which resolved spontaneously. The OS rates at 6 months in the percutaneous RFA group were 60%, with average OS of 6.5 months in the further follow-up. Conclusions: Percutaneous RFA resulted in sustained pain relief from in most advanced NSCLC patients with intractable pain and resistant to chemotherapy or radiotherapy. The effect of RFA was satisfactory, and patients can obtain a better life quality with less pain and complications.

Automated summary

Percutaneous RFA resulted in sustained pain relief in the majority of advanced NSCLC patients with intractable pain resistant to chemotherapy or radiotherapy. There was a significant decrease in pain levels at 24-hour, 72-hour, and 4-week follow-up, along with reduced opioid use. Minor adverse events caused by RFA therapy were resolved by 4 weeks follow-up.