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

Abstract

Background: Bone is one of the most common sites of metastases, with bone metastases-related pain representing a significant source of morbidity among patients with cancer. Magnetic resonance-guided focused ultrasound is a noninvasive, outpatient modality with the potential for treating painful bone metastases. The aim of this study is to report our initial experience with magnetic resonance-guided focused ultrasound in the treatment of bone metastases and our preliminary analysis of urinary cytokine levels after therapy. Methods: This was a single-center pilot study of 10 patients with metastatic cancer to investigate the feasibility of magnetic resonance-guided focused ultrasound for primary pain control in device-accessible skeletal metastases. Treatments were performed on a clinical magnetic resonance-guided focused ultrasound system using a volumetric ablation technique. Primary efficacy was assessed using Brief Pain Inventory scores and morphine equivalent daily dose intake at 3 time points: before, day 14, and day 30 after the magnetic resonance-guided focused ultrasound treatment. Urine cytokines were measured 3 days before treatment and 2 days after the treatment. Results: Of the 10 patients, 8 were followed up 14 days and 6 were followed up 30 days after the treatment. At day 14, 3 patients (37.5%) exhibited partial pain response and 4 patients (50%) exhibited an indeterminate response, and at day 30 after the treatment, 5 patients (83%) exhibited partial pain response. No treatment-related adverse events were recorded. Of the urine cytokines measured, only Transforming growth factor alpha (TGFa) demonstrated an overall decrease, with a trend toward statistical significance (P ¼ .078). Conclusion: Our study corroborates magnetic resonance-guided focused ultrasound as a feasible and safe modality as a primary, palliative treatment for painful bone metastases and contributes to the limited body of literature using magnetic resonance-guided focused ultrasound for this clinical indication.

Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility

“…To our knowledge, there are only a few articles in the literature demonstrating the benefit of HIFU with MR guidance for the palliative treatment of bone metastases [ 16 , 22 , 23 ].…”

High-Intensity Focused Ultrasound for Pain Management in Patients with Cancer

“…Moreover, with the ablation of tumor, inflammatory, and bone cells, HIFU possibly reduces the local release of chemical mediators and the degree of osteoclast-mediated osteolysis (34). It may also induce skeletal remodeling, with fast resolution of the thermal-induced lesion and accelerated sclerosis in osteolytic lesions (26,(39)(40)(41)(42).…”

“…US-guided (43) and MR imaging-guided clinical examinations have been performed; however, the MR imaging procedure has been used more commonly (37)(38)(39)(40)(41)(42)44). MR imaging-guided HIFU is approved by the U.S. Food and Drug Administration for pain palliation in patients with bone metastases.…”

Modeling the interference between shear and longitudinal waves under high intensity focused ultrasound propagation in bone

“…HIFU treatment of uterine fibroids focuses on alleviating the pain by reducing the tumor size (Vaezy et al 2000, Stewart et al 2006, in a safe and effective manner (Lee et al 2015, Fischer et al 2015, with acceptable adverse events (Wang et al 2014). MR-guided HIFU (MR-HIFU) has also been used as an alternative treatment strategy for palliative treatment of bone metastases (Harding et al 2018, Chan et al 2016, Huisman et al 2015, Huisman et al 2014, Hurwitz et al 2014, Li et al 2010a . Bone metastases are associated with pain and reduced quality of life (Coleman 2006).…”

“…General treatments focus on alleviating the pain, and aim at improving the patients' life conditions. MR-HIFU procedures have been shown to be technically feasible (Chan et al 2016, Huisman et al 2014, effective (Harding et al 2018, Li et al 2010a, and safe with promising results (Huisman et al 2014). Clinical therapies with MR-HIFU have also been used recently for the treatment of osteoid osteoma (Sharma et al 2017, Yarmolenko et al 2018, Napoli et al 2017.…”