Hypophysectomy for the treatment of oncologic pain in the radiosurgical era

Introduction: Cancer-related pain are common and debilitating conditions that can significantly affect the quality of life of patients. Opioids, NSAIDs, and antidepressants are among the first-line therapies, but their efficacy is limited or their use can be restricted due to serious side effects. Neuromodulation and lesioning techniques have also proven to be a valuable instrument for managing refractory pain. For patients who have exhausted all standard treatment options, hypophysectomy may be an effective alternative treatment

Methods: We conducted a comprehensive systematic review of the available literature on PubMed and Scielo databases on using hypophysectomy to treat cancer-related pain. Data extraction from included studies included study design, treatment model, number of treated patients, sex, age, Karnofsky Performance Status (KPS) score, primary cancer site, lead time from diagnosis to treatment, alcohol injection volume, treatment data, and clinical outcomes. Statistical analysis was reported using counts (N, %) and means (range).

Results: The study included data from 662 patients treated for cancer-related pain. A total of 329 patients were treated with NALP, 216 with TSS, 66 with RF, and 51 with Gamma Knife radiosurgery (GK). The median age for cancer-related pain was 58.5 years. The average follow-up time for cancer-related pain was 8.97 months. Good pain relief was observed in 504 out of 662 patients, with complete pain relief in 96 patients. Pain improvement onset was observed 24 hours after TSS, a few days after NALP, and a few days to 4 weeks after GK. Complications varied among treatment modalities, with diabetes insipidus (DI) being the most common complication.

Conclusion : Although mostly forgotten in modern neurosurgical practice, hypophysectomy is an attractive option for treating refractory cancer-related pain after failure of traditional therapies.