Concurrent stereotactic robotic radiosurgery and hyperthermia for palliation of pain in recurrent advanced malignancies

• Published in: Journal of clinical oncology Vol. 30; no. 15_suppl; p. e19619
• Main Authors: Papaiah Susheela, Sridhar, Govindarajan, Mallarajapatna, Rajan, Sudhan, Bilimaga, Ramesh s, Anchineyan, Pichandi, Amalraj, Jerrin, Gupta, Monica, D, Madhusudan, Pundalika, Mohan, Ajaikumar, Basavalinga S.
• Format: Journal Article
• Language: English
• Published: 20.05.2012
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2012.30.15_suppl.e19619

Abstract only e19619 Background: The management of advanced recurrent malignancy after definitive treatment is challenging. Palliation of pain in these cases by medication alone may not be sufficient. The role of Radiotherapy and hyperthermia were tried in the past with little benefit but side effects of radiation were considerably high due to large volume of disease. This study aims at Concurrent Robotic radiosurgery with hyperthermia for large volume disease for palliation of pain in recurrent advanced malignancy. Methods: Ten cases of recurrent advanced malignancy with Visual analog pain scale (VAS) score of > 8 were treated by concurrent stereotactic robotic radiosurgery and hyperthermia between July 2010 to Jan 2012. All patients underwent PET CT based radiosurgery planning,Sterotactic Robotic Radiosurgery was delivered to Gross Tumor Volume (GTV) to dose of 30Gy in 3-5 fractions using fiducial tracking method.Hyperthermia was delivered using Celsius 42 locoregional hyperthermia device for an hour after stereotactic robotic radiosurgery on alternate day for 3-5 sessions. All patients received premedication and pain medications during treatment. All patients were analyzed for tolerance of treatment, acute toxicity and pain control. Pain control was assessed at the end of treatment and 6 weeks. Results: Among 10 patients 7 were female and 3 were male, age ranged from 40 to 72 years. 4 patients were carcinoma cervix, 2 were carcinoma rectum, 1 cholangiosarcoma, 1 carcinoma pancreas, 1 carcinoma esophagus with supraclavicular lymphnode, 1 mucoepidermoid ca of maxilla. All patients completed the planned treatment of concurrent Sterotactic Robotic Radiosurgery and Hyperthermia without any acute toxicity. At the end of treatment all patients had reduction in the pain. 7 patients had more than 60% reduction. At the end of 6 weeks 8 patients had >80% reduction and off the analgesics. Conclusions: Concurrent Sterotactic Robotic Radiosurgery and hyperthermia is well tolerated and may gives good palliation of pain with improved quality of life in recurrent advanced malignancy. However randomized trial in this regard will be required.