Patients often report intense upper body pain, thought to be from tumor pressing on nerves; MDs at Israeli hospital find radiotherapy has major benefit, following 4-year research

November 2, 2022 – Radiotherapy can help reduce the often-excruciating upper body pain experienced by people with pancreatic cancer, Israeli doctors say in new research.

Pain in the abdomen or the middle portion of the back is a common symptom of pancreatic cancer, thought to be caused by the tumor pressing onto and infiltrating a complex network of nerves located in the abdomen called the celiac plexus.

Doctors at Sheba Medical Center near Tel Aviv had the idea of administering radiotherapy to the celiac plexus as a pain management intervention. They have finished a four-year study that found that it reduced pain for half of participants.

Several institutions internationally are independently conducting studies on the approach, in the United States, Canada, Poland and Portugal.

“This treatment is not a curative, but being able to relieve the suffering of patients, many of whom are in the twilight of their lives, is very meaningful to me,” the physician leading the research, Dr. Yaacov Lawrence, told The Times of Israel.

He said that the approach shows such promise that it could enable doctors to scale back the use of painkillers like opioids for some patients.

Dr. Yaacov Lawrence of Sheba Medical Center (courtesy of Sheba Medical Center)

Other cancer specialists are responding optimistically.

“This is a very exciting new idea. Targeting the celiac plexus is a very interesting idea and the outcomes described in the study are very promising,” said Prof. Aron Popovtzer, head of oncology at Hadassah Medical Center, who was uninvolved in the research.

Radiotherapy, based on high-energy x-ray or other particles, is normally used as a treatment to kill cancer cells and shrink tumors.

It is sometimes also used for pain management, but in pancreatic cancer this has always been done by targeting the tumor to reduce its size. Lawrence’s study tests the use of radiotherapy to target a specific nerve and therefore prevent the tumor causing any pain. It is the first clinical validation of such a method.

Lawrence, who directs Sheba’s Center for Translational Radiation Oncology, just presented the study findings at the American Society for Radiation Oncology (ASTRO) Annual Meeting in San Antonio. They have not yet been peer reviewed or published online.

“Pancreatic cancer pain can be debilitating for patients, and few options are currently available for alleviating it,” he commented after his presentation. “The positive results of this study are encouraging, and we believe celiac plexus radio-surgery should become a standard treatment option for pain relief for patients in their advanced stages of pancreatic cancer and other cancers invading the celiac plexus nerve.”

He said that his team has detailed the technique so that any physician can adopt it. “We have created a series of resources that will go online so that physicians around the world can freely access, in order that this technique should be widely adopted,” Lawrence said.

He added: “It is an amazing thing to develop a new treatment at Sheba, and see it used around the world, in United States, Canada and Poland as well as other countries.”