The investigators propose to conduct a study in medically refractory cancer pain patients utilizing radiosurgery to ablate the pituitary hypophysis, as well as neuromodulate the centromedian and parafascicular complexes within the thalami - the so-called triple target. This involves treating the pituitary hypophysis and thalamus to a dose of 90 Gy. These patients will have previously failed to achieve adequate pain control with opioid pain regimens and interventional approaches. The trial will involve a multidisciplinary approach involving radiation oncology, neurosurgery, palliative care, and medical oncology colleagues across UCLA.
Refractory pain is one of the most debilitating challenges in oncology patients, particularly at the end of life. Over 60% of cancer patients experience pain, with 30% of these patients becoming refractory to opioid pain medication. Interventional techniques such as nerve blocks and pain pumps only transiently relieve pain and are often not viable for advanced cancer patients. In patients with diffuse metastatic disease with less than 3-6 months survival, there is a pressing need for a rapid and thorough relief of pain sensation. Recently, using highly focused radiation delivered to very unique targets in the brain, patients can have marked reduction in perceived pain. There are centers in the brain dubbed as gateways of pain, including the pituitary hypophysis1 and the centromedian and parafascicular complexes2, with some preliminary data also involving the anterior cingulum. Ablation or neuromodulation of these targets with focused high doses of radiation have been shown in small series to provide pain relief in \~3.5 days with a 50% reduction of perceived pain. The investigators propose to conduct a study in medically refractory cancer pain patients utilizing radiosurgery to ablate the pituitary hypophysis, as well as neuromodulate the centromedian and parafascicular complexes within the thalami - the so-called “triple target.†3 This involves treating the pituitary hypophysis and thalamus to a dose of 90 Gy. These patients will have previously failed to achieve adequate pain control with opioid pain regimens and interventional approaches. This trial will involve a multidisciplinary approach involving radiation oncology, neurosurgery, palliative care, and medical oncology colleagues across UCLA.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
intracranial functional stereotactic radiosurgery (FnSRS) to the triple target: centromedian-parafasciular complex bilaterally, and the hypophysis
UCLA / Jonsson Comprehensive Cancer Center
Los Angeles, California, United States
Pain Inventory
For each patient, investigator will measure the Brief Pain Inventory (BPI) (score range: 0-10) at the following days. Higher score indicates greater pain perception.
Time frame: - Baseline: Daily measurements on three separate days prior to treatment (Day -7 +/- 3 days, Day -3 +/- 1 day, Day -2 +/- 1 day)- Post-baseline: Days +1, 2, 3, 4, 7, 14, 21, 28
Opioid Usage Quantification
(1) To describe opioid daily consumption pre- and post-treatment
Time frame: o Pre-study (screening visit) and Baseline (Day-7, Day-3, & Day-2)o Days +1, 2, 3, 4, 7, 14, 21, 28
functional stereotactic radiosurgery (FnSRS) treatment side effects
To characterize the side effect profile of FnSRS for treatment of intracranial triple targets
Time frame: 28 days post treatment
Pain anxiety symptom scale (PASS-20)
To evaluate the changes in neuropsychiatric metrics, quality of life and executive function after FnSRS for modulation of intracranial triple targets. Assesses fear, avoidance, and anxiety related to pain. (0-5, 0=Never, 5=Always); higher scores indicate a worse assessment.
Time frame: Baseline visit (Day -7) Day +28 after treatment.
17-item Hamilton Depression Rating Scale:
Evaluates the severity of depressive symptoms. (0-4, 0=Absent, 4=Very Severe); higher scores indicate a worse assessment.
Time frame: Baseline visit (Day -7) Day +28 after treatment.
Hamilton Anxiety Rating Scale
Measures the severity of anxiety symptoms. (0-4, 0=Not Present, 4=Very Severe); higher scores indicate a worse assessment.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
SUPPORTIVE_CARE
Masking
NONE
Enrollment
19
Time frame: Baseline visit (Day -7) Day +28 after treatment.
Pittsburgh Sleep Quality Index
Assesses sleep quality and disturbances over a one-month period. (0-3, 0=Not During the past month, 3=Three or more times a week); higher scores indicate a worse assessment.
Time frame: Baseline visit (Day -7) Day +28 after treatment.
Social disability screening schedule/WHO disability assessment schedule
Measures social functioning and disability in various life domains. (0-4, 0=None, 4=Extreme or Cannot Do); higher scores indicate a worse assessment.
Time frame: Baseline visit (Day -7) Day +28 after treatment.
Activity of Daily Living Scale
Evaluates the ability to perform basic self-care and everyday activities. (0-3 or NA, 0=Appropriate, 3=Cannot do by self alone at all; Not Applicable); higher scores indicate a worse assessment.
Time frame: Baseline visit (Day -7) Day +28 after treatment.
36-item Short Form-Health Survey/RAND-36
Assesses health-related quality of life across multiple dimensions, including physical, mental, and social well-being. (0=2, 0=No, not limited at all; 2=Yes, Limited a lot); higher scores indicate a worse assessment.
Time frame: Baseline visit (Day -7) Day +28 after treatment.