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Headline: Single-fraction celiac plexus radiosurgery for complex pain arising from adjacent gastrointestinal or retroperitoneal malignancies works.

The Study: Kudos to this Isreali group for thinking outside the box to harness the power of radiosurgery. Built on initial successes with a proof-of-concept study detailing the how-to, this international single-arm phase 2 trial treated 125 patients with celiac axis radiosurgery for malignant celiac axis pain. Across 90 patients with available data at 3 weeks, over half (n=48) already had a pain response. On an 11-point pain scale, there was an average -2.5 decrease at 3 weeks and -3.2 at 6 weeks. Perhaps more persuasive was an average decrease in opioid requirements of -17 mg daily at 6 weeks, as well as an average decrease in required breakthrough doses of nearly -4x daily. What’s more, 6 of 125 experienced grade 3+ toxicities “possibly related” to treated versus local progression of disease.

TBL: It’s time to reach out to your medical, surgical and pain management colleagues to let them know about this effective and very safe alternative to continually increasing opioids for malignant celiac plexus pain. | Lawrence, ASTRO 2022



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