Evaluation of Quality of Life Outcomes Following Palliative Treatment of Bone Metastases with Magnetic Resonance-guided High Intensity Focused Ultrasound: An International Multicentre Study

D Harding,S.L Giles,M.R.D Brown,G.R Ter Haar,M Van Den Bosch,L.W Bartels,Y.-S Kim,M Deppe,N.M Desouza

doi:10.1016/j.clon.2017.12.023

Abstract

AimsTo determine quality of life (QoL) outcomes after palliation of pain from bone metastases using magnetic resonance-guided high intensity focused ultrasound (MR-guided HIFU), measured using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL and the QLQ-BM22 questionnaires. Materials and methodsTwenty patients undergoing MR-guided HIFU in an international multicentre trial self-completed the QLQ-C15-PAL and QLQ-BM22 questionnaires before and on days 7, 14, 30, 60 and 90 post-treatment. Descriptive statistics were used to represent changes in symptom and functional scales over time and to determine their clinical significance. QoL changes were compared in pain responders and non-responders (who were classified according to change in worst pain score and analgesic intake, between baseline and day 30). ResultsEighteen patients had analysable QoL data. Clinically significant improvements were seen in the QoL scales of physical functioning, fatigue, appetite loss, nausea and vomiting, constipation and pain in the 53% of patients who were classified as responders at day 30. No significant changes were seen in the 47% of patients who were non-responders at this time point. ConclusionLocal treatment of pain from bone metastases with MR-guided HIFU, even in the presence of disseminated malignancy, has a substantial positive effect on physical functioning, and improves other symptomatic QoL measures. This indicated a greater response to treatment over and above pain control alone. MR-guided HIFU is non-invasive and should be considered for patients with localised metastatic bone pain and poor QoL.

Highlights

Advances in cancer treatment confer increased survival on patients with bony metastatic disease, but often leaveAuthor for correspondence: S
Significant improvements were seen in the quality of life (QoL) scales of physical functioning, fatigue, appetite loss, nausea and vomiting, constipation and pain in the 53% of patients who were classified as responders at day 30
One patient had not completed the psychosocial aspects scale from the QLQ-BM22 at day 14, and another patient had not completed the second side of the QLQ-C15PAL questionnaire at baseline and so their data were not available for the constipation, fatigue, emotional functioning and overall QoL scales at this time point, and was not included in the determination of clinical significance

Summary

Introduction

Advances in cancer treatment confer increased survival on patients with bony metastatic disease, but often leaveAuthor for correspondence: S. Them experiencing chronic metastatic bone pain, which can impact significantly on their quality of life (QoL) [1]. When systemic therapies are inadequate for controlling metastatic bone pain, external beam radiotherapy (EBRT) is offered as a local palliative treatment [2]. This is a well-established and effective treatment that can be delivered non-invasively in an outpatient setting, without immediate side-effects.

Results

Discussion

Conclusion