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Pituitary neuroadenolysis was performed 136 times on 102 terminally ill patients with intractable cancer pain. Through the aid of televised fluoroscopy, one or two needles were inserted manually through a nostril into the sella turcica, and 1.0-2.4 ml of pure ethanol was instilled. Excellent relief of cancer pain was ultimately obtained almost instantaneously in 82 (80%) out of 102 cases; 95% in 43 cases with hormone-dependent tumors and 69% in 59 cases with non-hormone-dependent tumors. In some cases, pain relief continued over a period of more than 2 years.<BR> Tumor regression was also observed in three cases (6.9%) with carcinoma of the breast and prostate gland. Visual field defects were complained of in 10 cases, and temporary ophthalmoplegia was observed in four. Diabetes insipidus was documented in half of the cases. Euphoria and increased appetite were observed in most cases, which suggested hypothalamic involvement. There was no death ascribed to NALP. Transsphenoidal surgical hypophysectomy was also performed on 18 other cases with carcinoma of the breast and prostate gland. Cancer pain relief was obtained in 88% of 16 cases with intractable pain, and objective tumor regression was achieved in 55% out of 18 cases. Subsequent to surgery, diabetes insipidus (16 cases), mental changes (4 cases), cerebrospinal fluid rhinorrhea (4 cases), and meningitis (2 cases) were documented in the early postoperative stage. The operative mortality rate was 5.6%. The results indicate that NALP is favorably indicated for the relief of intractable cancer pain in the terminally ill, even in high-risk patients who suffer from hormone-dependent, as well as non-dependent, malignant tumors. Surgical hypophysectomy should be performed in low-risk patients when the treatment is aimed at the regression of hormone-dependent tumors.

Cancer Pain Relief and Tumor Regression by Means of Pituitary Neuroadenolysis and Surgical Hypophysectomy