I have a 64 y/o male patient with metastatic pancreatic cancer, currently receiving palliative mFOLFIRINOX. He continues to have significant abdominal pain related to his cancer despite using his fentanyl patch, Oxycodone PRN, and gabapentin. I was considering palliative RT for relief of symptoms but have seen mixed opinions in literature. Would you recommend RT or another form of therapy (e.g. celiac nerve block?).
I would go with nerve block first. Typically after 2-3 doses of mFFX the pain should subside if patient is responding. Sometimes this is a clinically the first sign of lack of response. Other things to consider would be pancreatitis. That being said if it is indeed tumor pain, palliative RT can be utilized if celiac block or pain pump. low dose palliative RT is well tolerated and does provide temporary relief in refractory cases.
