Bilateral Cingulotomy as a Therapeutic Option for Intractable Cancer Pain: a Systematic Review

Cingulotomy, a stereotactic neurosurgical procedure targeting the anterior cingulate cortex, has been explored for various refractory pain and neuropsychiatric conditions. However, while prior reviews have largely focused on chronic non-cancer pain, there remains a significant knowledge gap regarding its role in managing intractable cancer-related pain. This systematic review therefore aimed to evaluate the efficacy and safety of bilateral cingulotomy as a therapeutic option for cancer-associated pain, addressing a highly underexplored but clinically relevant area of neurosurgical palliation.

A total of six studies were included, encompassing 172 patients with intractable or metastatic cancer pain who underwent bilateral cingulotomy. Procedures were performed using radiofrequency (RF) or radiofrequency ablation (RFA)-based lesioning at temperatures of approximately 75-80 °C for 60-80 s. Across studies, pain reduction was observed in 60-80% of patients, with variability in long-term durability of relief. Despite differences in technique, lesion parameters, and assessment scales, cingulotomy consistently demonstrated clinically meaningful pain improvement with a low rate of transient cognitive or behavioral side effects. These findings suggest that RFA-guided cingulotomy provides more precise lesioning and better short-term efficacy compared with earlier mechanical or thermocoagulation methods. Bilateral cingulotomy appears to be a safe and promising neurosurgical intervention for patients with intractable cancer pain refractory to conventional therapies. Nevertheless, variations in lesion temperature, duration, and number across studies contribute to heterogeneity in reported outcomes. Future research should focus on standardizing methodology, incorporating long-term neurocognitive monitoring, and expanding multicenter data to strengthen evidence for its clinical application.