Efficacy of Cryotherapy Combined or Not With Analgesics in Uncontrolled Painful Musculoskeletal Metastasis (CRYO)

This is an interventional supportive care trial for Musculoskeletal Pain focused on measuring Randomized controlled trial, Musculoskeletal metastasis, Cancer pain, Percutaneous cryotherapy, Medical supportive care Read More

Inclusion Criteria:

• Age ≥ 18 years at the day of consenting to the study;
• Patient with at least 1 painful metastasis with a musculoskeletal involvement;
• Patient referred to a Pain Management Unit to optimize the analgesic strategy;

• Painful metastatic lesion that fulfils with all the following :

  • Pain must be correlated with an identifiable lesion on imaging (Computed Tomography, Magnetic Resonance Imaging or Ultrasonography)
  • Level of mean pain within the past 24 hours of at least 4/10 (numeric rating scale)
  • Painful metastasis suitable for a procedure of percutaneous cryotherapy
• Life-expectancy longer than 6 months;
• Performance Status of the ECOG ≤2;
• Neutrophils count > 1 Gi/l within the past 14 days;
• Adequate coagulation panel (as per the investigator judgement);
• Ability to understand and willingness for follow-up visits;
• Covered by a medical insurance;
• Signed and dated informed consent document indicating that the patient has been informed of all the pertinent aspects of the trial prior to enrolment.

Exclusion Criteria:

• Patient with a primary tumor of leukemia, lymphoma or myeloma;
• Tumor involving a weight bearing long bone of the lower limbs with the tumor causing more than 50% of cortical bone;
• Lesion amenable to any curative intervention;
• Formal indication for local analgesic procedure other than percutaneous cryotherapy;
• Prior radiotherapy on the targeted lesion within the 3 weeks prior to randomization;
• Patient with any contraindication for the procedure of percutaneous cryotherapy, including treatment requiring ice ball formation within 0.5 cm of the spinal cord, brain, other critical nerve, structure, large abdominal vessels such as the aorta or inferior vena cava, bowel or bladder (except if active or passive thermic protection can be performed);
• Uncontrolled coagulopathy or bleeding disorders;
• Evidence of pregnancy, breast-feeding, or patient wishing to become pregnant during the study;
• Active, uncontrolled infection;
• Any cognitive impairment or any disease that may restrain the use of numeric scales and the administration of quality of life questionnaires;
• Clinically significant unrelated systemic illness (e.g., serious infection or significant cardiac, pulmonary, hepatic, or other organ dysfunction) that would likely interfere with study procedures or results;
• Concurrent participation in other experimental studies that could interfere with the primary endpoint assessment.