Multinational phase 2 trial of celiac plexus radiosurgery for main management in advanced cancer

Refractory upper abdominal pain or lower back pain related to celiac plexus involvement characterizes pancreatic cancer and upper gastrointestinal malignancies. A phase 2 study at 8 centers in 5 countries evaluated ablative a single fraction of 25 Gy external-beam photons delivered to the celiac plexus for this pain. At least a partial pain response at 3 weeks was seen in 53% of patients ( 95% CI 42-64). The most common grade 3 or 4 events were abdominal pain (28% of patients) and fatigue (18%). Grade 5 possibly treatment-related events were seen in 2 of 125 patients. The authors conclude that celiac plexus radiosurgery could potentially be a non-invasive palliative option for patients with retroperitoneal pain syndrome.