Oncologists from the Centre use radiosurgery as an innovative and non-invasive method of functional treatment, for example in patients with cardiac arrhythmia or trigeminal neuralgia. For some time, they have also been involved in a clinical trial aimed at reducing or eliminating pain using radiofrequency ablation of the celiac plexus in patients with advanced pancreatic cancer.

Dr. Marcin Miszczyk from the Centre said: “Pancreatic cancer, like other advanced tumours located in the abdominal cavity, can induce somatic and neuropathic celiac pain resulting from direct damage to the celiac plexus by through the penetration of neoplastic cells between the plexus structures, damaging nerve cells and causing local inflammation. Radiofrequency ablation of the celiac plexus covers two of these types of pain - celiac and neuropathic pain.”

The pain originating from damage to the celiac plexus is usually resistant to painkillers, which can only slightly relieve it while causing side effects. Doctors reduce it by using blockade (temporarily shutting down the nerves by administering a local anaesthetic) or neurolysis (local administration of a nerve degeneration agent). These are safe and effective methods, considered to be the 'gold standard' of treatment. Unfortunately, their availability in Poland is limited, and some patients do not qualify for such treatment due to the significant size of tumours, especially those located within the body and tail of the pancreas, or due to the massive tumour infiltration of the vessels.

This was one of the reasons for the search for an alternative, minimally invasive method of counteracting pain and resorting to stereotaxic radiotherapy. For many years, oncologists from Gliwice have been using stereotaxic radiotherapy in the treatment of neoplastic diseases and pathological changes. The method consists in administering one or several large doses of radiation to the area limited to the tumour in a short time, saving the surrounding healthy tissues.

The centre in Gliwice is one of the most experienced and renowned cancer centres in this field. Advanced equipment used for this purpose includes EDGE, CyberKnife and TrueBeam linear accelerators. Recently, this very precise technique of delivering a beam of ionising radiation has been used in Gliwice in the treatment of pain. The huge potential of this method has been confirmed by an experimental pilot study conducted in 2018 by the Israeli Sheba Medical Center in Ramat Gan.

Dr. Miszczyk said: “The first author of this study, Dr. Yaacov Richard Lawrence from Sheba Medical Center, observed that in patients with severe pain, after using high-dose stereotactic therapies on the primary pancreatic tumour, these ailments subsided completely or partially.

“I had the opportunity to meet one of the participants of that study at the ASTRO conference in the US. Thanks to this cooperation, our centre is the first in Europe and the only one in Poland to participate in the second phase of this international, multicentre therapeutic experiment +Celiac plexus radiosurgery for pain management in advanced cancer patients+, in which facilities in Israel, the United States, Canada and Portugal also participate.”

As part of the project, which is under the supervision of the deputy head of the Department of Radiotherapy of the Gliwice institute, Professor Jerzy Wydmański, in September 2020 Dr. Miszczyk performed the first celiac plexus radiosurgery in a 61-year-old patient. Since then, a dozen more patients have benefited from the treatment.

Miszczyk said: “In many patients, we observe the benefits of this treatment and, most importantly, it is a completely new approach to pain therapy. We are dealing with functional radiosurgery in palliative analgesic treatment, so far associated with the administration of low single doses of irradiation that in fact have mainly anti-inflammatory action.”

After celiac plexus radiosurgery, complete pain relief was achieved in 1/3 of patients, with significant or complete discontinuation of painkillers. In another 1/3 there was a partial pain reduction by at least 2 points compared to baseline. In practice, this means that 65-70 percent patients benefit from this method, although it will ultimately be possible to evaluate it once the final results are obtained from all centres participating in the experiment.

Miszczyk said: “From a technical point of view, this is a completely different method than surgical neurolysis or celiac plexus blockage. It is important for us to be able to assess which patients could benefit from one or the other method, because they are not mutually exclusive and can be used alternately. It has great potential in the treatment of pain in extremely difficult patients, such as people with severe neuropathic and celiac pains in the course of pancreatic cancer.”

At the beginning of this year, the initial assessment of the effectiveness of this therapy was published in Contemporary Oncology (Contemporary Oncology No. 2, 2021) in the form of a case study. The study is supported by the Gateway for Cancer Research (G-17-100) and the Israel Cancer Association through a donation from Irma and Simon Gross. (PAP)

author: Anna Gumułka

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