Noninvasive Therapy for Osteoid Osteoma: A Prospective Developmental Study with MR Imaging–guided High-Intensity Focused Ultrasound

Abstract

Purpose To demonstrate that magnetic resonance (MR) imaging-guided high-intensity focused ultrasound (HIFU) is a safe, effective, and durable treatment option for the management of osteoid osteoma in children and young adults. Materials and Methods This prospective study was institutional review board approved and is registered with clinicaltrials.gov (identification number NCT02302651). Written informed consent was obtained from patients or their parents. Patients who had both clinical and radiologic findings that were diagnostic for nonvertebral osteoid osteoma and no contraindications to MR imaging-guided HIFU were enrolled between June 2010 and June 2013. The feasibility, safety, and clinical effectiveness of MR imaging-guided HIFU were considered primary outcomes; tumor control at imaging was considered a secondary outcome. Analyses were conducted on a per-protocol basis. Results Forty-five of the 50 recruited patients underwent MR imaging-guided HIFU. All patients were discharged without treatment-related complications. The median visual analog scale (VAS) pain score (scale, 0-10) decreased from 8 before treatment to 0 at 1-week and 1- , 6- , 12- , 24- , and 36-month follow-up. Similarly, median VAS scores for the degree to which pain interfered with sleep and physical and daily activities decreased to 0 within the 1st month after treatment and remained stable at subsequent follow-up. Overall, 39 (87%) of the 45 patients achieved and maintained a VAS score of 0 during the 3-year observation period. Quality of life, as assessed by using Functional Assessment of Cancer Therapy-Bone Pain (FACT-BP) scores (scale, 0-60 points), improved, with the median FACT-BP score of 28 (points) before treatment increasing to a median score of 55 at 1-week follow-up and 60 at 6-month and subsequent follow-ups. At (final) 36-month follow-up, MR imaging depicted an absence of residual nidus vascularity in 32 (76%) of the 42 patients who were treated with MR imaging-guided HIFU only. Conclusion The durable clinical efficacy and safety of MR imaging-guided HIFU were demonstrated. These features are evidence of the potential of MR imaging-guided HIFU to be part of a routine strategy for the treatment of osteoid osteoma. RSNA, 2017.

Prolonged heating in nontargeted tissue during MR‐guided focused ultrasound of bone tumors

“…These findings may be especially relevant when treating large tumors by bone, and cases of direct treatment of intact bone, such as in osteoid osteoma. Users should be aware of the extended decay rates and spatial cumulative heating phenomenon by bone, considering an emerging clinical goal of MRgFUS is to move beyond periosteal ablation for pain palliation to tumor control …”

“…Users should be aware of the extended decay rates and spatial cumulative heating phenomenon by bone, considering an emerging clinical goal of MRgFUS is to move beyond periosteal ablation for pain palliation to tumor control. 3,30 To return to within 1 C of body temperature required by the system, and measured cooling times fit to a model for a fixed sonication energy in all patients. Out of nine patients, six in zone 1 and eight in zone 4 show the system predicted cooling time was not adequate to return to baseline.…”

“…MAGNETIC RESONANCE (MR)‐guided focused ultrasound surgery (MRgFUS) is a noninvasive treatment for a number of tumors in or near bone, including bone metastases, osteoid osteomas, and extraabdominal desmoid tumors . Clinical trials of MRgFUS for patients with bone metastases and osteoid osteomas have shown the treatment to be safe and effective, while case series have demonstrated promising preliminary results for the treatment of desmoid tumors in the extremities .…”

Small PLGA nanocapsules Co-encapsulating copper sulfide nanodots and fluorocarbon compound for photoacoustic imaging-guided HIFU synergistic therapy

“…They were then subjected to single irradiation HIFU treatments with output acoustic powers of 80 or 140 W for 10 s. The corresponding grey scale values before and aer HIFU ablation were recorded. The coagulative necrosis volume of the liver sample in each group was measured and calculated according to eqn (1). Parallel experiments were repeated three times for each sample to obtain an average necrosis volume value.…”

“…High intensity focused ultrasound (HIFU) is considered a promising minimally invasive therapeutic modality for various solid tumors, and has been the focus of numerous studies over the past decade. [1][2][3] By concentrating multiple intersecting beams of ultrasound (US) into the targeted tumor region, both hyperthermia and mechanical effects can be rapidly generated in order to efficiently induce regional coagulative necrosis and blood vessel damage. 4,5 However, this technique still has several limitations, which restricts its broad application for clinical cancer therapy.…”