How Radiologists Could Use Cryoablation to Put Cancer Pain on Ice

The pain that comes with cancer is often debilitating and demoralizing for patients with cancer. Severe pain impacts patients’ normal routines and also negatively impacts their mental health. Strong opioids are often used to manage pain, but the significant adverse effects (AEs) can further aggravate patients’ quality of life; it is not uncommon for patients to have continued pain despite narcotics use.

Imagine if there was a treatment that could help a patient with cancer who is immobilized by pain feel strong enough to run nearly 50 miles in 4 days the very next week. Fortunately, this is not a hypothetical scenario but a reality, if a little known one.

Cryoablation, is an established and still evolving minimally invasive treatment that uses extreme cold to freeze the cells or stop the nerve signals causing pain. The treatment is performed by interventional radiologists, physicians who use cutting-edge image guidance to treat conditions across the body, including cancer and cancer-related pain. Managing cancer pain is a job for a multidisciplinary team of physicians treating patients with cancer, and interventional radiologists are a key partner for oncologists to provide patients the pain relief they require.

To treat pain with cryoablation,interventional radiologistsuse live CT scan imaging guidance to direct a needle through the skin into the diseased tissue, tumor, or transmitting nerve. Tailored cryoablation cycles destroy target tissues without damaging the surrounding healthy tissue. What’s more, cryoablation can block pain signals by exposing nerves to cold without the trauma or collateral damage associated with surgery or heat. Cryoablation uses local numbing, so patients experience minimal pain and shorter recovery times. These procedures are often performed as outpatient treatments, allowing patients to leave the hospital quickly, and maximize time with their loved ones.

The use of cryoablation for pain management in oncology is rapidly expanding, particularly for patients with metastatic disease whose surgery or chemotherapy was unsuccessful. One study on patients with pelvic bone metastases showed that mean pain scores declined sharply and quickly, from a pre-procedure score of 7.9 to 1.2 on the following day—a powerful indicator of success.¹

Our patient experienced this firsthand. A mother in her late 30s who had led an active life as a runner prior to her diagnosis with stage IV metastatic breast cancer, Esther was shocked and devastated by her diagnosis and a large tumor on her back caused agonizing pain. She was determined to do anything possible to restore her quality of life and her ability to run.

Her oncologist prescribed oxycodone, but it made her “feel like a zombie” and had uncomfortable gastrointestinal AEs. Fortunately, Esther reached out and we performed cryoablation. Twenty-four hours later her pain virtually vanished, and she almost felt like her old self. The following week, Esther completed the Dopey Challenge race at Disney World—a 5k, 10k, half-marathon, and full marathon over the course of four days. This was a significant life goal she set long before her cancer diagnosis and because of cryoablation, she was able to achieve it.

Esther’s success is not unique. A systematic review of 22 papers showed that cryoablation decreased mean pain scores by 62.5% at 24 hours, 70.0% at 3 months, and 80.9% at 6 months following the procedure.² It also showed that the need for opioids decreased by 75% at 24 hours and by 61.7% at 3 months. Most importantly, cryoablation does not interfere with chemotherapy or other treatment regimens.

Thousands of cancer patients who are living in unnecessary pain or with intolerable AEs could be successfully treated with cryoablation. Growing evidence shows that interventional radiology can be life-changing for patients with chronic cancer pain. People who are living in pain deserve to know about the innovative approaches offered by interventional radiologists so they can live a full life during their cancer treatment without the harsh AEs of opioids. I encourage more oncologists to reach out to interventional radiologists in their clinics and health systems so that we can work together to get patients the relief they all deserve.

J. David Prologo, MD, is an interventional radiologist at Emory Healthcare whose research has focused on the application of image guided techniques to the delivery of stem cell therapies, the treatment of cancer pain, and for weight management. He is a nationally recognized expert in ablative therapies and has pioneered several new procedures in the specialty, including the cryoablation of nerves.

References

1. Coupal TM, Pennycooke K, Mallinson PI, et al. The Hopeless Case? Palliative Cryoablation and Cementoplasty Procedures for Palliation of Large Pelvic Bone Metastases. Pain Physician. 2017;20(7):E1053-E1061.
2. Ferrer-Mileo L, Luque Blano AI, González-Barboteo J. Efficacy of Cryoablation to Control Cancer Pain: A Systematic Review. Pain Pract. 2018;18(8):1083-1098. doi:10.1111/papr.12707