ROLE OF PERCUTANEOUS CERVICAL CORDOTOMY FOR PAIN OF MALIGNANT ORIGIN

Objective: To discuss the place of, and indications for, percutaneous cervical cordotomy in the relief of cancer pain and to report a series of patients on whom the operation was performed at the Royal Brisbane Hospital. Setting and patients: Two hundred and seventy-three patient s underwent percutaneous cervical cordotomy of approximately 4000 canc er patients referred to the Pain Clinic, Royal Brisbane Hospital, a te rtiary referral centre, in the years 1979 to 1991. Both public and pri vate patients were included. All received the same level of clinical c are from the authors, all operations being performed by the first auth or. The major indication for the procedure was unilateral cancer pain below the head and neck, but other factors influencing the decision fo r operation were respiratory function, age, general condition and expe ctation of life. Major outcome measures: Effectiveness of pain relief, first-week mortality, quality of life. Results: Satisfactory pain rel ief was achieved in 89% of patients. First-week mortality was 3.3%. Lo ng-term survivors (eight and five years) have remained free of their o riginal pain. Particular emphasis is placed on the successful pain rel ief in 114 patients suffering from primary lung cancer, including meso thelioma. Side effects and complications have been few. Conclusion: Un ilateral percutaneous cervical cordotomy is a valuable method of treat ment of cancer pain in selected patients. The procedure has a special place in the treatment of the large group of patients suffering pain a ssociated with primary lung cancer including mesothelioma. We support the view of overseas workers that percutaneous cervical cordotomy is t he only effective method of achieving stable pain control in these pat ients, many of whom are referred late.