Thermal Radiofrequency Versus Neurolytic Saddle Rhizotomyfor Severe Pereneal Cancer Pain

NCT ID: NCT03084575

Last Updated: 2017-03-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-02-29

Study Completion Date

2017-06-30

Brief Summary

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The control of perineal malignant pain is difficult and challenging for pain physicians. Different modalities have been tried to treat this complex pain syndrome including pharmacotherapy and interventional therapy.

Neuroaxial phenol rhizolysis is simple and cheap option. However; for patients with pelvic or rectal neoplasms and intact bowel and bladder sphincteric functions, there are neurosurgical recomendations of selective sacral nerve roots rhizotomy blockade "as an alternative to chemical saddle rhizotomy".

Detailed Description

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40 selected patients were randomly allocated into 2 groups "20 patients each"

Group 1 "RF group": in which patients underwent thermal radio Frequency, selective (unilateral S3, bilateral S4 and S5) saddle rhizotomy.

Group 2 "phenol group": in which patients underwent hyperbaric chemical saddle rhizotomy using 6% phenol in glycerin.

Conditions

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Interactable Malignant Perineal Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

randomization was done using a computer-generated random numbers with proper concealment in opaque sealed envelopes .
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors
assessment will be done by junior stuff who is blind to the technique of intervention

Study Groups

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Thermal Radiofrequency group

Group 1 "RF group": in which patients will receive thermal radio Frequency, selective (unilateral S3, bilateral S4 and S5) saddle rhizotomy.

Group Type ACTIVE_COMPARATOR

Thermal radio Frequency, selective (unilateral S3, bilateral S4 and S5) saddle rhizotomy

Intervention Type PROCEDURE

Thermal RF lesioning is done using Bailys RF generator. TRF parameters are 80 C, 120 seconds the TRF lesion is repeated after 180 rotation of the needle tip again after sensory and motor pre-stimulation.

Thermal RF lesioning is done using Bailys RF generator

Intervention Type DEVICE

phenol group

Group 2 "phenol group": in which patients will recieve hyperbaric chemical saddle rhizotomy using 6% phenol in glycerin.

Group Type ACTIVE_COMPARATOR

hyperbaric chemical saddle Rhizotomy (6 % pherol in glycerin)

Intervention Type DRUG

L5-S1 intrathecal injection of 0.5-1 ml of 6 % pherol in glycerin. The patient is seated in the sitting position with 30-45o leaning backwards to make the posterior sensory roots lowermost.

Interventions

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Thermal radio Frequency, selective (unilateral S3, bilateral S4 and S5) saddle rhizotomy

Thermal RF lesioning is done using Bailys RF generator. TRF parameters are 80 C, 120 seconds the TRF lesion is repeated after 180 rotation of the needle tip again after sensory and motor pre-stimulation.

Intervention Type PROCEDURE

hyperbaric chemical saddle Rhizotomy (6 % pherol in glycerin)

L5-S1 intrathecal injection of 0.5-1 ml of 6 % pherol in glycerin. The patient is seated in the sitting position with 30-45o leaning backwards to make the posterior sensory roots lowermost.

Intervention Type DRUG

Thermal RF lesioning is done using Bailys RF generator

Intervention Type DEVICE

Other Intervention Names

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6 % pherol in glycerin

Eligibility Criteria

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Inclusion Criteria

* Cancer patients with moderate to severe perineal pain (VAS \> 40mm over 100 mm scale).
* Intractable pain not responding to adequate tolerated opioid therapy + adjuvant therapy after reasonable period of time for at least 4 weeks (Rad and Kallmes, 2011).
* Limited life expectancy \< 12 months (Slatakin etal 2003).
* Patients are continent to urine and stool (no stomas).

Exclusion Criteria

* Uncorrected coagulopathy.
* Local or systemic sepsis.
* Known allergy to the used medications.
* Distorted local anatomy e.g. by advanced local neoplastic growth rendering the procedure technically difficult or hazardous.
* Sign of increased intracranial tension (Mintzer and Devarajan, 2012).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Cairo University

OTHER

Sponsor Role lead

Responsible Party

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Dina Nabil Abbas

Assistant professor of anethesia and pain management

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Dina N Abbas, MD

Role: PRINCIPAL_INVESTIGATOR

National Cancer Institute,Cairo University

Other Identifiers

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IRB No.201516026.2

Identifier Type: -

Identifier Source: org_study_id

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