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To prospectively evaluate percutaneous image-guided nerve cryoablation for treatment of refractory phantom limb pain (PLP) in a pilot cohort for purposes of deriving parameters to design a larger, randomized, parallel-armed, controlled trial.From January 2015 to January 2016, 21 patients with refractory PLP underwent image-guided percutaneous cryoneurolysis procedures. Visual analog scale scores were documented at baseline and 7, 45, and 180 days after the procedure. Responses to a modified Roland Morris Disability Questionnaire were documented at baseline and 7 and 45 days after the procedure.Technical success rate of the procedures was 100%. There were 6 (29%) minor procedure-related complications. Disability scores decreased from a baseline mean of 11.3 to 3.3 at 45-day follow-up (95% confidence interval 5.8, 10.3; P.0001). Pain intensity scores decreased from a baseline mean of 6.2 to 2.0 at long-term follow-up (95% confidence interval 2.8, 5.6; P.0001).Image-guided percutaneous nerve cryoablation is feasible and safe and may represent a new efficacious therapeutic option for patients with phantom pains related to limb loss.

Purpose To demonstrate the safety and feasibility of an anterior approach for percutaneous fiducial marker placement for stereotactic beam radiation therapy of pancreatic head adenocarcinoma. Materials and Methods Five patients (age range, 53-70 years; mean age, 59 y) with borderline resectable pancreatic adenocarcinoma were enrolled for a phase II clinical trial (WCI-1998-11), which includes a combination of 5-Fluorouracil, Oxaliplatin, and Irinotecan (FOLFIRINOX) chemotherapy regiment, followed by stereotactic beam radiation therapy (SBRT), and then surgical resection with a Whipple procedure. For guidance of SBRT, we placed 1.2cm x 3mm soft tissue gold markers through a 17-gauge ETW x 20 cm needle in an orthogonal plane within 1-2 cm surrounding these tumors prior to SBRT under CT guidance. The route of placement of the fiducial markers was an anterior approach through several of the organs residing anterior to the pancreas, such as the stomach and liver. Technical success was assessed when post CT placement demonstrated all fiducial markers surrounding the mass resided 1-2 cm around the tumor in an orthogonal configuration without evidence of migration, as well as deemed appropriate for guidance of SBRT by Radiation Oncology. Patients were followed clinically and with labs, as well as imaging for post procedural complications. Results Percutaneous Fiducial Marker placement was technically successful in all 5 patients (100.0%). All patients tolerated the procedure well, without clinical or imaging evidence for post procedural complications, despite numerous transhepatic and transgastric approaches. Additionally, there were no evidence for migration of these markers and three of the five patients have been successfully treated with SBRT, which resulted in decrease of tumor size, allowing these patients to receive surgical resection Conclusion Percutaneous fiducial marker placement surrounding pancreatic head adenocarcinomas was deemed safe and feasible from an anterior approach, despite traversing through the liver and/or the stomach to obtain appropriate placement.