Celiac plexus radiosurgery for refractory pain in metastatic pancreatic adenocarcinoma: first institutional report from Argentina
- Journal of Cancer Prevention & Current Research
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Gomez Palacios Ariel,<sup>1 </sup>Abate Daga Julieta,<sup>1</sup> Descamps Caroline,<sup>1</sup> Torres Luciano,<sup>2</sup> Espinosa Fernando,<sup>2</sup> Diaz-Vazquez Maria Fernanda,<sup>1</sup> Ferraris, Gustavo<sup>1</sup>
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Abstract
Background: Perineural
invasion in pancreatic ductal adenocarcinoma (PDAC) frequently results in
severe, refractory abdominal pain due to celiac plexus involvement. Conventional
analgesic strategies and neurolytic procedures often provide incomplete or
transient relief. Stereotactic body radiotherapy (SBRT) targeting the celiac
plexus has emerged as a non-invasive ablative alternative for pain control.
Case presentation: We report the case
of a 67-year-old man with metastatic PDAC and debilitating celiac
plexus–related pain refractory to high-dose opioids and prior celiac plexus
neurolysis. At presentation, the patient had a Karnofsky Performance Status
(KPS) of 40–50 and required a maximum daily oral morphine equivalent dose of 92
mg.
Intervention: The patient
underwent single-fraction SBRT (25 Gy) directed to the celiac plexus using
volumetric modulated arc therapy (VMAT) with dose-painting optimization to
spare adjacent bowel structures. Pain response was assessed using the Brief
Pain Inventory–Short Form (BPI-SF), and toxicity was graded according to
Radiation Therapy Oncology Group (RTOG) criteria. A complete analgesic response
was predefined as a pain score ≤2 without opioid requirement.
Results: SBRT resulted in a rapid and
progressive reduction in pain intensity, culminating in a complete analgesic
response by week 3. Pain scores decreased from 9–10/10 at baseline to complete
resolution, accompanied by full opioid discontinuation (from 92 mg to 0 mg
daily oral morphine equivalent). This response was sustained for three months
and was associated with marked functional recovery, with KPS improving from
40–50 to 90. Treatment was well tolerated, with only Grade 1 nausea and no
significant gastrointestinal toxicity.
Conclusion: Celiac plexus
SBRT appears to be a safe and effective non-invasive strategy for refractory
pancreatic cancer–related pain, even after failed neurolytic intervention. This
case supports its integration into multidisciplinary palliative care strategies
and warrants further prospective investigation.
Keywords
pancreatic ductal adenocarcinoma, progressive reduction,prospective investigation
