Efficacy of Cingulotomy for Refractory Malignant Cancer Pain: A Case Series

Purpose: Poorly controlled pain is a significant quality of life issue for patients with advanced cancer. Patients often suffer from uncontrolled pain or intolerable side effects of treatment despite receiving multi-modal care with stepwise escalation of opioids. Interventional procedures impacting central pain pathways have demonstrated promise in treating pharmacologically intractable cancer pain and may be underutilized, especially in patients with escalating opioid use. The aim of this study was to assess effectiveness of bilateral anterior cingulotomy—a minimally invasive neurosurgical procedure—in patients with refractory malignant cancer pain through describing opioid use trends pre- and post-procedure and by comparing pain scores. Methods This is a retrospective review of a case series of six patients with refractory malignant pain who underwent bilateral anterior cingulotomy. Response to procedure was measured by percent change of pain scores and average daily opioid dose reduction. In addition, demographics, oncologic history, discharge disposition, survival time post-procedure, and complications were reported. Results Six unique patients underwent seven total procedures between 2019–2022. Average daily OME (oral morphine equivalent) dose 48 hours prior to procedure was 4411 mg. At discharge, average daily OME dose was 250 mg, an 89% dose reduction from 48 hours prior to procedure. Pain scores reduced by 43% during this same time period. Conclusion Cingulotomy effectively reduced pain scores with a concurrent reduction in opioid dosing in our cohort of patients with medically refractory malignant cancer pain. Further research is warranted to identify advanced cancer patients who may benefit most from this procedure and inform clinical adoption.