Introduction

Cancer is the 1^st leading cause of death in Western Europe and patients with cancer have a high prevalence of pain. Intrathecal analgesia is an important technique for complex cases refractory to comprehensive medical management. Analgesia using intrathecal drug delivery systems (IDDS) through cervical catheters has been poorly described on medical literature. CERVical Intrathecal Catheters for Cancer AnaLgesia (CERV-ICCAL) was a prospective follow up study designed to evaluate results of cervical IDDS for Cancer pain at the Institut de Cancérologie de L'Ouest, Paul Papin, a comprehensive Cancer Center in France.

Methods/Materials

Institutional ethics committee approval was granted. Patients were treated from January 2010 to November 2019. Patients were selected for IDDS based on multidisciplinary meeting discussion. All IDDS-treated patients were prescribed a combined intrathecal analgesics regimen (combining morphine and ziconotide) through a catheter placed in the cervical vertebral canal according to painful metameric level. Post-implant assessment of pain was determined using a numeric rating scale (NRS). Patients were followed via day-hospital visits and telephone calls at least monthly. Pain scores were compared using the Wilcoxon's signed rank test. Overall survival (OS) was estimated using the Kaplan-Meier method.

Results

68 patients were included in this study, all received high cervical IDDS and total therapy duration accounts for 6734 IDDS-days. Median age at surgery was 61.5 years. Implanted patients suffered from severe pain (mean presurgical NRS 8±1) despite a mean 575.4 mg oral morphine equivalent daily dose. Most common primary cancer were lung (33.8%), head and neck cancer (22.1%) and breast cancer (19.1%). Median survival time after intrathecal treatment start was 3.3 ± 6 months. IDDS provided pain relief compared to initial pain score with a significant statistical difference after 1 month and 2 months (p < 0.01). Complications did not exceed previous series.

Discussion

This is the largest study of Cervical IDDS published thus far. Our results are consistent with those from intrathecal catheters at other locations, this technique is a credible alternative to ablative treatments and has the advantage of adaptability over time.

Conclusions

Results suggest that long-term IDDS using a multidrug regimen for cancer related pain through cervical intrathecal catheters reduced pain intensity scores and was safe in our study population. We have demonstrated a clinically and statistically significant pain reduction in patients receiving IDDS through catheters placed in cervical intrathecal space using mainly a percutaneous lumbar approach.

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