This is the case of a 53-year-old married male with children who sought consultation for progressive abdominal pain in April 2014. The pain had been present for 1 to 2 months prior to the consultation, and was previously diagnosed by other doctors as pain due to gastritis.
The patient described the pain as severe, giving it a score of 7 to 8 on a numerical rating scale of 1 to 10. Esophagogastroduodenoscopy was unremarkable, but CT scan revealed a pancreatic tumor with liver metastasis and mild ascites, which was inoperable due to celiac plexus infiltration and secondary lesions in the liver. Pain management was initiated using oxycodone 10 mg controlled-release (CR) tablets twice daily and oxycodone 5 mg capsules as needed.
The patient was informed of possible side effects such as dizziness, nausea, vomiting and constipation. Metoclopramide and a senna-based laxative were prescribed for nausea and vomiting, and constipation, respectively.
The patient then underwent intensity-modulated radiotherapy, receiving 3.0 Gy per fraction at the tumor area, 2.8 Gy at the 0.7 cm tumor margin, and 2.5 Gy at the 1.0 cm tumor margin for a total of 15 fractions given over 3 weeks. (Figure 1)
Pain intensity improved from a score of 7 to 8 initial consultation to 4 after 3 to 4 days of treatment with oxycodone. Two weeks after radiotherapy, pain intensity further reduced to a score of 2. The dose of oxycodone was reduced to one 10 mg CR tablet daily at night time. Oxycodone 5 mg capsule was discontinued and replaced by an NSAID taken as needed during daytime.
During follow-up visits every 1 to 2 months, the patient reported only mild pain. He is now receiving gemcitabine as single-agent chemotherapy at a public hospital.
Dr Leung-Cho Chan
Specialist in Clinical Oncology Private practice Hong Kong
Reference information: oncologytribune
The information aims to provide educational purpose only. Anyone reading it should consult Oncologist before considering treatment and should not rely on the information above.
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