Abstract
BackgroundTo evaluate the effectiveness and feasibility of high-intensity focused ultrasound (HIFU) for the treatment of bone metastases. MethodsA single-center prospective study was made involving 17 consecutive patients with symptomatic bone metastases. Patients were treated by Focused Ultrasound (FUs) performed with magnetic resonance (MR) guidance. Surgical treatment or radiotherapy treatment was not indicated for patients who underwent FUs. Lesions were located in the appendicular and axial skeleton and consisted of secondary symptomatic lesions. The clinical course of pain was evaluated using the Visual Analog Scale (VAS) before treatment, at 1 week, and at 1 month after treatment and the Oral Morphine Equivalent Daily Dose (OMEDD) was also recorded. We used Wilcoxon signed rank test to assess change in patient pain (R CRAN software V 3.1.1).ResultsWe observed a significant decrease in the pain felt by patients between pre- procedure and 1 week post-procedure (p = 2.9.10–4), and pre-procedure and 1 month post-procedure (p = 3.10–4). The proportion of responders according to the International Bone Metastases Consensus Working Party was: Partial Response 50% (8/16) and Complete Response 37.5% (6/16).ConclusionsHIFU under MR-guidance seems to be an effective and safe procedure in the treatment of symptomatic bone lesions for patients suffering from metastatic disease. A significant decrease of patient pain was observed.Trial registrationNCT01091883. Registered 24 March 2010. Level of evidence: Level 3.
Highlights
To evaluate the effectiveness and feasibility of high-intensity focused ultrasound (HIFU) for the treatment of bone metastases
The objective of our study was to describe our experience in the treatment of painful bone metastases using volumetric magnetic resonance (MR)-HIFU ablation and to assess the technical feasibility and safety of the procedure [20]
Exclusion criteria were the presence of > 3 painful bone metastases, metastases located in the spine, sternum, or skull, contraindications to MR imaging or procedural sedation and analgesia (PSA), presence of a potentially unstable fracture at the site of the lesion, and lesion inaccessibility (≤1 cm distance between the lesion and major nerves, joints, blood vessels or organs) [16]
Summary
To evaluate the effectiveness and feasibility of high-intensity focused ultrasound (HIFU) for the treatment of bone metastases. For 50 years, high-intensity focused ultrasound (HIFU) has been a subject of interest for medical research [1]. Its potential as a non-invasive thermal ablation treatment, using real-time imaging (magnetic resonance or ultrasound). Thanks to Magnetic Resonance Imaging (MRI) guidance, real-time thermal feedback of heated zones makes it possible to ablate targeted tissue in real time without damaging normal structures. HIFU treatment consists of multiple single focal point sonifications [8, 9]. In 2011, the Magnetic Resonance-guided Focus Ultrasound (MRgFUS) system received the European Compliance (CE) marking for the treatment of painful bone metastases [4]
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