癌症相关疼痛是一种常见且使人衰弱的疾病,可以显着影响患者的生活质量。阿片类药物,NSAIDs,抗抑郁药是一线疗法之一,但其疗效有限或因严重副作用而限制使用。神经调节和损伤技术也已被证明是治疗难治性疼痛的有价值的工具。对于已经用尽所有标准治疗选择的患者,垂体切除术可能是一种有效的替代治疗方法。我们对PubMed和Scielo数据库中关于使用垂体切除术治疗难治性癌症相关疼痛的现有文献进行了全面的系统评价。纳入研究的数据提取包括研究设计,治疗模式,接受治疗的患者数量,性别,年龄,Karnofsky绩效状态(KPS)得分,原发癌部位,从诊断到治疗的前置时间,酒精注射量,治疗数据,和临床结果。使用计数报告统计分析(N,%)和平均值(范围)。该研究包括来自24篇论文的735名患者的数据,这些患者接受了垂体切除术治疗难治性癌症相关疼痛。329例癌症相关疼痛患者接受NALP治疗,216与TSS,66带RF,55接受Y90近距离放射治疗,51伽玛刀放射外科(GK),和18冷冻消融。中位年龄为58.5岁。平均随访时间为8.97个月。在735例患者中,有557例疼痛缓解良好,268例患者中的108例疼痛完全缓解。TSS后24小时观察到疼痛改善发作,NALP或冷冻消融后几天,GK后几天到4周。并发症因治疗方式而异,尿崩症(DI)是最常见的并发症。尽管大多数人在现代神经外科实践中被遗忘,垂体切除术是治疗传统治疗失败后难治性癌症相关疼痛的一种有吸引力的选择.放射外科由于其高成功率和降低的并发症风险而成为一种有前途的治疗方式。
Cancer-related pain is a common and debilitating condition that can significantly affect the quality of life of patients. Opioids, NSAIDs, and antidepressants are among the first-line therapies, but their efficacy is limited or their use can be restricted due to serious side effects. Neuromodulation and lesioning techniques have also proven to be a valuable instrument for managing refractory pain. For patients who have exhausted all standard treatment options,
hypophysectomy may be an effective alternative treatment. We conducted a comprehensive systematic review of the available literature on PubMed and Scielo databases on using
hypophysectomy to treat refractory cancer-related pain. Data extraction from included studies included study design, treatment model, number of treated patients, sex, age, Karnofsky Performance Status (KPS) score, primary cancer site, lead time from diagnosis to treatment, alcohol injection volume, treatment data, and clinical outcomes. Statistical analysis was reported using counts (N, %) and means (range). The study included data from 735 patients from 24 papers treated with
hypophysectomy for refractory cancer-related pain. 329 cancer-related pain patients were treated with NALP, 216 with TSS, 66 with RF, 55 with Y90 brachytherapy, 51 with Gamma Knife radiosurgery (GK), and 18 with cryoablation. The median age was 58.5 years. The average follow-up time was 8.97 months. Good pain relief was observed in 557 out of 735 patients, with complete pain relief in 108 out of 268 patients. Pain improvement onset was observed 24 h after TSS, a few days after NALP or cryoablation, and a few days to 4 weeks after GK. Complications varied among treatment modalities, with diabetes insipidus (DI) being the most common complication. Although mostly forgotten in modern neurosurgical practice,
hypophysectomy is an attractive option for treating refractory cancer-related pain after failure of traditional therapies. Radiosurgery is a promising treatment modality due to its high success rate and reduced risk of complications.