Cordotomy in mesothelioma-related pain: a systematic review

Our plain-English summary of Cordotomy in mesothelioma-related pain: a systematic review, by B.D. France, R.A. Lewis, M.L. Sharma, et al (BMJ Supportive & Palliative Care, 2014).

The study

• Authors: B.D. France, R.A. Lewis, M.L. Sharma, M. Poolman
• Journal: BMJ Supportive & Palliative Care
• Published: 2014;4(1):19-29
• Type of article: Systematic review
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Cordotomy can be effective in relieving pain for patients with mesothelioma, but the evidence to support continued provision is limited. This review forms part of the Invasive Neurodestructive Procedures in Cancer Pain pilot study: The role of cordotomy in mesothelioma-related pain in the UK.

Aim/design: We report on the results of the first comprehensive systematic review of the use of cordotomy in mesothelioma-related pain, with specific reference to effectiveness in relieving pain and safety. The review was conducted according to guidelines reported in the NHS Centre for Reviews and Dissemination and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses.

Data Sources: 14 databases from inception to March 2012 were searched, with no limitations on language or publication type.

Results: Nine studies met the inclusion criteria, all of which were case series of percutaneous cervical cordotomy (PCC) involving 160 patients. All studies demonstrated good pain relief in the majority of patients. Initial post-procedure measurements showed the greatest reduction in pain. Some side effects (headache, mirror pain, motor weakness) occurred relatively frequently but were mostly transient. Respiratory dysfunction post-PCC was rare. No deaths were directly ascribed to cordotomy.

Conclusions: The available evidence is significantly limited in quantity and quality. Although it seems to suggest that cordotomy might be safe and effective in this setting, more reliable evidence is needed to aid decision making on continued provision. A national registry for cordotomy would be a valuable first step in this process.

In plain English

This article was a systematic review. The authors searched 14 databases, from their start to March 2012, for studies of cordotomy (a procedure that creates a permanent lesion in a pain pathway of the spinal cord) used to treat pain from mesothelioma. Nine studies met their criteria. All were case series of percutaneous cervical cordotomy, recorded between 1983 and 2011 and covering 160 patients. Up to 2 days after the procedure, complete pain relief was reported in 80.22% (73/91) of patients for whom the procedure was intended. Combining six studies gave an estimated 75% (95% confidence interval 52% to 89%). In one study, complete relief became less common over time, falling to 8 of 24 patients at 6 months. Headache, mirror pain and motor weakness occurred relatively frequently but were mostly transient. Respiratory problems were rare, and no deaths were specifically ascribed to the procedure. The authors concluded that the evidence was significantly limited in quantity and quality. They called for more reliable evidence, with a UK-wide registry as a possible first step.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic review of published and unpublished studies, with a meta-analysis of pain relief up to 2 days. The authors searched Medline plus 13 other databases from inception to March 2012, and all included studies were case series.
• Who was studied: Nine case series, recorded between 1983 and 2011, with a total of 160 adult patients with mesothelioma for whom percutaneous cervical cordotomy was intended to control severe or intractable pain. Sample sizes ranged from 3 to 53, and all studies were in secondary care settings.
• Exposure: Not an asbestos exposure study. The intervention reviewed was cordotomy, the creation of a permanent lesion (often made with heat by radiofrequency) in the lateral spinothalamic tract of the spinal cord. All included studies used the percutaneous cervical method and none used open cordotomy. No fiber types or occupational exposures were reported.
• Main results:
  • In six studies, up to 2 days after the procedure, complete pain relief was reported in 80.22% (73/91) of patients for whom cordotomy was intended.
  • Among patients who actually received a heat lesion, complete pain relief up to 2 days was recorded in 84.88% (73/86).
  • In the meta-analysis of six studies, the estimated proportion with complete pain relief up to 2 days among patients for whom cordotomy was intended (n=91) was 75% (95% CI 52% to 89%), using a random-effects model.
  • In the meta-analysis, among patients who had heat lesions (n=86), the estimated proportion with complete pain relief up to 2 days was 83% (95% CI 72% to 90%), using a fixed-effect model.
  • In one study (Raslan 2008, 24 mesothelioma patients), 22 of 24 (91.67%) had pain relief at 6 months, but only eight (33.33%) had complete pain relief.
  • In the Jackson et al study, 43 of 52 patients (82.69%) had more than a 50% reduction in opioid dose, and 20 of 52 (38.46%) stopped taking opioids altogether.
  • Repeat cervical cordotomy or other invasive procedures were deemed necessary in 9 of 160 patients (5.63%).
  • In four studies, neurological deficit (including persistent or transient weakness and 'nerve damage') was recorded in 15 of 127 patients (11.81%).
  • Headache, mirror pain and motor weakness occurred relatively frequently (in more than 10% of reports) but were mostly transient.
  • Three studies (81 patients) reported no respiratory dysfunction after the procedure. One study (Nicosia et al) noted respiratory failure in 1 of 20 cases, a figure that pooled patients with mesothelioma and other diagnoses.
  • Three studies gave details of deaths after the procedure, but none of these deaths was specifically ascribed to cordotomy.
• The authors' conclusion: The authors concluded that the available evidence was significantly limited in quantity and quality. Although it seemed to suggest that cordotomy might be safe and effective for mesothelioma-related pain, more reliable evidence was needed. They proposed a UK-wide registry for cordotomy as a possible first step.
• Limitations the authors state:
  • All included studies were case series, which are generally placed at the bottom of the evidence hierarchy.
  • The included studies had small sample sizes, were retrospective, and/or used a variety of outcome measures at different reporting intervals.
  • Two of the included studies were unpublished.
  • Three single-author studies, in which the author performed all procedures, might be seen as less reliable and generalisable than studies with a reporting team.
  • The studies did not use directly comparable criteria for selecting patients, so the evidence did not indicate when the procedure should be considered.
  • The authors could not obtain separate mesothelioma patient data from eight studies.
  • Most studies did not give clear follow-up times for adverse events, and three studies pooled adverse-event data for patients with mesothelioma and other diagnoses.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Systematic Review.

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• Pleurectomy for persistent pain in benign asbestos-related pleural disease — D.I. Fielding, J.L. McKeon, et al. (1995)
• Is Radiotherapy Useful for Treating Pain in Mesothelioma?: A Phase II Trial — N. MacLeod, A. Chalmers, et al. (2015)
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• Chronic pleuritic pain in four patients with asbestos induced pleural fibrosis — A. Miller (1990)

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