A Study of Stereotactic Radiosurgery (SRS) to Treat Pain in the Chest and/or Stomach Wall

Inclusion Criteria:

• Patients must have a documented history of chronic (≥ 3 months) thoracoabdominalwall pain (TAWP) attributable to ≤ 3 unilateral spinal levels as confirmed bydiagnostic paravertebral nerve block or TENS (if results of the paravertebral nerveblock are inconclusive) performed by an attending anesthesiologist specializing inpain management prior to study enrollment.

• Patients must have TAWP that is inadequately relieved by a trial of conventionalpharmacologic therapy (defined as NRS pain score ≥ 4/10 while on treatment withconventional pharmacologic therapy for analgesia) as determined by an attendingphysician specializing in pain management.

• KPS ≥ 60%

• Age ≥ 18 years old

Exclusion Criteria:

• Patients with a life expectancy of < 6 months as predicted by the Adult ComorbidityIndex (ACE-27, see Appendix 1)

• Patients with active autoimmune connective tissue disease

• Patients with bilateral TAWP

• Patients with preexisting pneumothorax

• Patients with preexisting excessive pleural effusion (extending > 3 vertebrallevels)

• Systemic chemotherapy delivered or planned to be delivered within +/- 5 days of SRS

• Unable to undergo a diagnostic paravertebral nerve block

• Unable to undergo at least one of either a myelogram or spine MRI

• Patients for whom external beam treatment plans to deliver the prescription SRS doseto the lesion of interest cannot be safely designed as specified by the DoseConstraint Guidelines in Appendix 2

• Evaluation of any radiation doses previously delivered to spinal cord/caudaequina and other critical structures (bowel, esophagus, lungs, kidneys, rectum)will be taken into consideration

• If radiation dose from SRS would exceed any normal tissue constraint as notedin Appendix 2, the patient will be ineligible

• Abnormal complete blood count. Any of the following:

• Platelet count < 75 K/µL

• Hgb level < 9 g/dl

• WBC < 3.5 K/µl

• Abnormal coagulation profile: INR > 2.5 INR and/or APTT > 80 seconds. Patients whoare on anticoagulation medication that may not be safely held for the myelogramprocedure (≥ 5 days for antiplatelet agents and warfarin; ≥ 24 hours forlow-molecular weight heparin formulations) will be excluded.

• Allergy to local anesthestics

• Local infection at the site of injection of anesthetic

• Severe spinal deformities with anatomic distortion (severe scoliosis/kyphoscoliosis)

• Severe respiratory disease (i.e. oxygen dependent)