Medically
refractory pain in those with advanced
cancer significantly reduces one's quality of life. Therefore, palliative interventions to mitigate
cancer pain and reduce
opioid requirements are necessary to reduce patient suffering and
opioid-induced side effects.
Hypophysectomy, a largely forgotten
pain procedure with several technical variations, has been repeatedly studied in small series with encouraging results, though historically has been fraught with complications. As a result, the minimally invasive and more tolerable stereotactic radiosurgery (SRS)
hypophysectomy has resurfaced as a possible treatment for
cancer-related pain. While the mechanism of
pain relief is not entirely understood, the hypothalamohypophyseal axis appears to play an essential role in pain perception and transmission and involves C fiber signal processing and downstream modulation of the brainstem and spinal cord via the hypothalamus. This review highlights the role of
hypophysectomy in alleviating advanced
cancer pain, both in hormonal and nonhormonal
malignancy and the current mechanistic understanding of
pain relief for the three primary
hypophysectomy modalities used historically: surgical and chemical adenolysis, as well as the more recent, SRS
hypophysectomy. Given the lack of high-quality evidence for stereotactic radiosurgery
hypophysectomy, there is a need for further rigorous and prospective clinical studies despite its ideal and noninvasive approach.