• Claudio Pusceddu, Barbara Sotgia, Luca Melis, Rosa Maria Fele, and Giovanni Battista Meloni.
• Division of Interventional Radiology, Department of Oncologic Radiology, Businco Hospital, Regional Referral Center for Oncologic Disease, 09100, Cagliari, Italy, clapusceddu@gmail.com.
• Abdom Imaging. 2013 Dec 1; 38 (6): 1225-33.

PurposeTo retrospectively evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency thermal ablation (RFA) in reducing the pain in patients with painful pelvic recurrence of rectal cancer ineligible for surgical resection.Material And MethodsTwelve consecutive patients (10 men and 2 women; mean age 67 ± 10 years) with painful pelvic recurrence of rectal cancer underwent CT-guided RFA treatments under conscious sedation. At baseline, in all patients pelvic-sacral pain was classified as severe by Visual Analog Scale (VAS; VAS score ≥75 mm). The tumor density and carcinoembryionic antigen (CEA) serum level averages were 46 ± 7 HU and 15.7 ± 9.3 ng/mL, respectively. Clinical outcome was evaluated by VAS with a mean follow-up period of 23 months.ResultsAll RFA sessions were completed and well tolerated. Morbidity consisted of recto-vesical fistula (8 %) and rectal abscess (8 %). 1 month after RFA procedure, complete lack of enhancement was obtained in 7 cases (58 %). A significant difference in HU and CEA serum level averages between baseline and 1 month post-RFA was revealed (p < 0.000 and p < 0.002, respectively). A significant reduction in pain was obtained: VAS score was significantly different between baseline and the clinical evaluations at week 1 and month 3, 6, 12, and 22) (p < 0.000). At the end of follow-up, 11 patients (92 %) were symptom free.ConclusionsCT-guided RFA of painful pelvic recurrence of rectal cancer can be considered as a feasible and effective treatment for reducing the pain in selected cases.

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