Effect of ct-guided cordotomy on severe cancer pain

Objective: This study aims to evaluate the effectiveness and safety of computed tomography (CT)-guided percutaneous cordotomy in the management of severe, treatment-resistant cancer-related pain. Materials and Methods: A retrospective analysis was conducted on 21 patients who underwent CT-guided cordotomy at the Algology Clinic of Akdeniz University Hospital between 2019 and 2024 for intractable cancer pain. Pain levels were assessed using the Visual Analog Scale (VAS), performance status was evaluated via the Karnofsky Performance Scale (KPS), and opioid requirements were measured as morphine equivalent doses (MED) before and after the procedure. Results: Following the cordotomy procedure, patients showed a significant reduction in pain scores (mean VAS decreased from 10 to 1; p<0.001), a substantial reduction in opioid use (mean MED decreased from 870 mg/day to 205 mg/day; p<0.001), and a notable improvement in performance status (mean KPS increased from 38 to 69; p<0.001). Similar outcomes were observed in the subgroup of patients with lung cancer. Reported complications were minimal and transient. Conclusion: CT-guided percutaneous cordotomy is an effective and safe method for managing severe unilateral cancer pain that is unresponsive to conventional treatments. It significantly reduces pain and opioid consumption while improving quality of life. The procedure is especially valuable in palliative care for patients with limited life expectancy. Keywords: Cancer pain, cordotomy, computed tomography, opioid, palliative care, VAS, Karnofsky.