综述发现，冷冻消融对癌症疼痛有效

　　根据5月7日在线发表在PAIN Practice上的综述，冷冻消融可有效控制癌症疼痛，且没有很多副作用。

　　来自西班牙巴塞罗那的L'Hospitalet de Llobregat的Laura Ferrer-Mileo及其同事进行了系统文献回顾，以确定评估冷冻消融治疗癌症疼痛疗效的文章。

　　纳入了22项研究(共496名患者)，研究人员发现，冷冻消融后的24小时内平均疼痛评分降低了62.5%，3个月时降低70%，6个月时降低80.9%。相对地，冷冻消融与四周后的生活质量提高44.2%、八周后改善59.6%相关。在24小时内，阿片类药物的需求减少了75%，在三个月减少了61.7%。冷冻消融与放疗、或椎体成形术或双膦酸盐的组合似乎优于单独的冷冻消融。任何研究都没有报告致命的并发症。

　　作者写道：“需要国际标准来标准化用于评估疼痛和治疗反应的措施。”

　　原文链接

　　Efficacy of cryoablation to control cancer pain. A systematic review

　　Laura Ferrer‐Mileo,Ana Isabel Luque Blanco,Jesús González‐Barboteo

　　Context

　　The use of opioids to control cancer pain could be insufficient. Interventional techniques such as a cryoablation have emerged as alternatives to opioids.

　　Objectives

　　To summarize the current scientific evidence on the use of cryoablation to control cancer pain.

　　Methods

　　A systematic search of the Scopus, Pubmed, and Cochrane databases was performed. All articles published before December 31, 2015 whose title or abstract specified cancer pain control as endpoint were selected. Articles without abstract and all non‐systematic reviews were excluded.

　　Results

　　22 articles were included: one randomized clinical trial (RCT); two non‐RCTs; one ambispective study; 9 retrospective studies; two non‐specified cohort studies; three case series and four case reports. 496 patients with 580 lesions were treated. Lung cancer was the most common primary tumour. 82.8% of the metastases were bone metastases, with or without soft tissue involvement. Cryoablation decreased mean pain scores by 62.5% at 24 hours post‐cryoablation, by 70% at 3 months, and by 80.9% at 6 months. Cryoablation was associated with a 44.2% improvement in quality of life (QoL) after 4 weeks and a 59.6% at 8 weeks. The need for opioids decreased by 75% at 24 h and by 61.7% at 3 months. Cryoablation in combination with radiotherapy, vertebroplasty or bisphosphonates appears to be better than cryoablation alone. Complications were highly variable among the studies, but no fatal complications were reported.

　　Conclusions

　　Cryoablation is effective in controlling cancer pain without relevant side effects. However, more studies are needed to confirm these results.

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