Percutaneous cervical cordotomy for the control of pain in patients with pleural mesothelioma

Background-Severe chest pain is common in mesothelioma. Percutaneous cervic al cordotomy, which interrupts the spinothalamic tract at the C1/C2 level c ausing contralateral loss of pain sensation, is particularly appropriate in mesothelioma as the tumour is unilateral and systemic analgesia may be ine ffective and is limited by harmful side effects. Method-A retrospective review was performed to determine the effectiveness and complication rate of this procedure. Results-Fifty two patients were using opioids prior to cordotomy. The media n daily dose of morphine before and after cordotomy was 100 mg (range 0-100 0 mg) and 20 mg (range 0-520 mg), respectively (p<0.001). Forty three patie nts (83%) had a reduction in pain such that their dose of opioid could be a t least halved. Twenty patients (38%) were able to stop completely. Recurre nce of pain requiring an increase in opioid medication was recorded in 18 p atients at a median time of nine weeks (range 0.7-26 weeks). Four patients developed mild weakness, two had troublesome dysaesthesia. The median time from cordotomy to death was 13 weeks (range 0.3-52 weeks). Six early deaths within two weeks of cordotomy occurred early in the series and reflect pos toperative chest infection and poor selection as the patients were in the t erminal stages of mesothelioma. Conclusions-Percutaneous cervical cordotomy is successful in treating pain from mesothelioma. There was a low complication rate in this series. Referr al to a unit experienced in cordotomy is recommended as soon as pain from c hest wall invasion is suspected.