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REVIEW article

Front. Neurol.
Sec. Neuro-Oncology and Neurosurgical Oncology
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1529944

Hypophysectomy, Pituitary Neuroadenolysis and Pituitary Radiosurgery for the Treatment of Refractory Cancer Pain: a Historical Review and Mechanism Investigation

Provisionally accepted
Yuchen Hu Yuchen Hu Wanghao Zhang Wanghao Zhang Zijian Chen Zijian Chen Xiaoyan Wu Xiaoyan Wu Shuaishuai Xue Shuaishuai Xue Yangqi Mao Yangqi Mao Peiyao Yi Peiyao Yi Jiezuo Wei Jiezuo Wei Dadi Qian Dadi Qian Xingqin Wang Xingqin Wang Peidong Zhang Peidong Zhang *Hao Long Hao Long *
  • Nanfang Hospital, Southern Medical University, Guangzhou, China

The final, formatted version of the article will be published soon.

    Refractory cancer pain affects 10-20% of patients with advanced malignancies and is not adequately controlled by opioids. The intrathecal therapy is an effective interventional procedure for referral, but the implanted infusion pumps are costly and the refilling requires technical expertise. Hypophysectomy, in its three stages—surgical, chemical, and radiosurgical—has emerged as an alternative for managing this pain. However, the underlying mechanism remains elusive, with existing hypotheses unable to comprehensively account for both the initial and long-term analgesic effects. This literature review explores the historical evolution, clinical outcomes, and hypothesized mechanisms of hypophysectomy for pain relief. Surgical hypophysectomy initially demonstrated an 85.5% success rate but carried significant risks like diabetes insipidus and hypopituitarism. Chemical hypophysectomy reduced invasiveness, achieving 75.1% pain relief with fewer complications. Modern pituitary radiosurgery has improved safety while maintaining high efficacy (initial relief: 95.9%, long-term: 73.5%).The mechanisms underlying pain relief remain unclear but include tumor regression, increased β-endorphins, neuroendocrine modulation, and hypothalamic involvement. A new hypothesis suggests that radiosurgery induces hormone redistribution (e.g., oxytocin, vasopressin) through hypothalamic-pituitary modulation, contributing to both immediate and long-term analgesia. Despite its potential, unresolved issues such as optimal radiation dose, pain assessment standardization, and precise mechanisms limit widespread adoption. This review underscores the need for larger, homogenous studies to validate the safety and efficacy of hypophysectomy in treating refractory cancer pain. These findings offer a promising avenue for improving palliative care in oncology.

    Keywords: Analgesic effects, cancer pain, gamma knife radiosurgery, Hypophysectomy, Pituitary, Pain Management

    Received: 18 Nov 2024; Accepted: 27 Dec 2024.

    Copyright: © 2024 Hu, Zhang, Chen, Wu, Xue, Mao, Yi, Wei, Qian, Wang, Zhang and Long. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Peidong Zhang, Nanfang Hospital, Southern Medical University, Guangzhou, China
    Hao Long, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.