Abstract
BackgroundCancer induced bone pain (CIBP) strongly interferes with patient’s quality of life. Currently, the standard of care includes external beam radiotherapy (EBRT), resulting in pain relief in approximately 60% of patients. Magnetic Resonance guided High Intensity Focused Ultrasound (MR-HIFU) is a promising treatment modality for CIBP. MethodsA single arm, R-IDEAL stage I/IIa study was conducted. Patients presenting at the department of radiation oncology with symptomatic bone metastases in the appendicular skeleton, as well as in the sacrum and sternum were eligible for inclusion. All participants underwent EBRT, followed by MR-HIFU within 4 days. Safety and feasibility were assessed, and pain scores were monitored for 4 weeks after completing the combined treatment. ResultsSix patients were enrolled. Median age was 67 years, median lesion diameter was 56,5 mm. In all patients it was logistically possible to plan and perform the MR-HIFU treatment within 4 days after EBRT. All patients tolerated the combined procedure well. Pain response was reported by 5 out of 6 patients at 7 days after completion of the combined treatment, and stabilized on 60% at 4 weeks follow up. No treatment related serious adverse events occurred. ConclusionThis is the first study to combine EBRT with MR-HIFU. Our results show that combined EBRT and MR-HIFU in first-line treatment of CIBP is safe and feasible, and is well tolerated by patients. Superiority over standard EBRT, in terms of (time to) pain relief and quality of life need to be evaluated in comparative (randomized) study.
Highlights
Cancer induced bone pain (CIBP) strongly interferes with quality of life and daily functioning of cancer patients [1,2]
For patients suffering from bone metastases, it is crucial to provide fast and sufficient pain relief to optimize quality of life
Study design and patient selection. This single arm intervention study for the combination of external beam radiotherapy (EBRT) and Magnetic Resonance guided High Intensity Focused Ultrasound (MR-HIFU) was conducted in the University Medical Center Utrecht (UMCU) and Isala Hospital Zwolle, the Netherlands
Summary
Cancer induced bone pain (CIBP) strongly interferes with quality of life and daily functioning of cancer patients [1,2]. EBRT is a well-established treatment option, but usually takes about four weeks to induce adequate pain relief, and 30–40% of patients show no response at all [8–11]. The standard of care includes external beam radiotherapy (EBRT), resulting in pain relief in approximately 60% of patients. Pain response was reported by 5 out of 6 patients at 7 days after completion of the combined treatment, and stabilized on 60% at 4 weeks follow up. Our results show that combined EBRT and MR-HIFU in first-line treatment of CIBP is safe and feasible, and is well tolerated by patients. Superiority over standard EBRT, in terms of (time to) pain relief and quality of life need to be evaluated in comparative (randomized) study
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