The authors analyse the results up to death in 103 followed-up patients undergoing unilateral percutaneous cervical
cordotomy for persistent cervico-thoracic malignant
pain (45 cases of
Pancoast syndrome and 58 cases of thoracic
pain associated with
lung cancer or
metastases). On the basis of epidemiological data, relationships emerge between onset of
pain, stage of
cancer, patient survival and lasting efficacy of
pain relief. Twenty (44%) of 45 patients with
Pancoast syndrome were
pain-free up to death as a result of
cordotomy alone, while only 13/58 patients (22%) with thoracic
pain were
pain-free as a result of
cordotomy alone owing to the very high incidence of mirror
pain in this group of patients (42/58 patients, 72%) compared to those with
Pancoast syndrome (14/45 patients, 31%). The type and intensity of mirror
pain, however, were of such a nature in both groups as to be amenable to control with
analgesic drugs. In both groups of patients, there was a low incidence of the causes of post-
cordotomy pain recurrence contralateral to the lesion, i.e.,
deafferentation pain, fading of
analgesia, and
pain above the levels up to which deep pin-prick
analgesia had been obtained.
Cordotomy alone or, as necessary, in conjunction with
analgesic drugs afforded complete
pain control in 34/45 patients (75%) with
Pancoast syndrome and in 50/58 patients (86%) with thoracic
pain. These data provide evidence of the unique usefulness of the procedure in controlling otherwise intractable persistent cervicothoracic malignant
pain, when the technique is correctly performed.