International consensus on use of focused ultrasound for painful bone metastases: Current status and future directions

Abstract

Focused ultrasound surgery (FUS), in particular magnetic resonance guided FUS (MRgFUS), is an emerging non-invasive thermal treatment modality in oncology that has recently proven to be effective for the palliation of metastatic bone pain. A consensus panel of internationally recognised experts in focused ultrasound critically reviewed all available data and developed consensus statements to increase awareness, accelerate the development, acceptance and adoption of FUS as a treatment for painful bone metastases and provide guidance towards broader application in oncology. In this review, evidence-based consensus statements are provided for (1) current treatment goals, (2) current indications, (3) technical considerations, (4) future directions including research priorities, and (5) economic and logistical considerations.

Magnetic Resonance–Guided High-Intensity-Focused Ultrasound for Palliation of Painful Skeletal Metastases: A Pilot Study

“…23 In the current literature, an international consensus statement recognizes MRgFUS as a safe and effective secondary treatment option in radiation-refractory painful bone metastases outside the spine. 38 The MRgFUS may be considered in the setting where primary therapeutic modalities-namely, radiotherapy-are contraindicated or refused by the patient. Nonetheless, further evidence from large randomized control studies is needed to establish MRgFUS as an option for the primary treatment and palliation of bone metastases among other available treatment options.…”

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology

“…A further oncological application that is possible with currently available systems is the treatment of bone metastases [57]. However, in this application, not the complete destruction of the tumor but rather the treatment of pain in the palliative situation is the first priority.…”

MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

“…In patients with advanced disease and limited survival (6 months), local tumour control should not be pursued since the potential additional risks of more aggressive treatment strategies do not outweigh the benefits for these patients. 84 Important benefits of FUS compared with radiotherapy are (a) the absence of ionizing radiation, (b) the ability to induce pain relief within 3 days of treatment, whereas radiotherapy may have a delay in response of up to 4 weeks, (c) the higher response rate, longer response duration if compared with re-irradiation, (d) fewer side effects, (e) no need to interrupt chemotherapy for FUS, (f) generally only a single session is needed, although repeat exposures are possible. Disadvantages of FUS include (a) the common need for anaesthesia and (b) for patients to be able to undergo MRI for MRgFUS, and (c) potential positioning problems, to get full access and window to the target area (possible solutions with MRgFUS conformal bone system or USgFUS).…”

“…11 Recently, an article published by an international consensus held at the Focused Ultrasound Therapy Second European Symposium in Rome (2013), Italy, focused on the point about current treatment goals, current indications, technical considerations, future directions including research priorities, and economic and logistical considerations. 84 A…”