Pain Palliation in Patients with Bone Metastases Using Magnetic Resonance-Guided Focused Ultrasound with Conformal Bone System: A Preliminary Report

Purpose We evaluated the safety and effectiveness of the Magnetic Resonance-guided Focused Ultrasound (MRgFUS) with the ExAblate Conformal Bone System for the palliation of painful bone metastases. Materials and Methods Our Institutional Review Board approved this study, and all patients gave informed consent prior to enrollment. A total of six painful metastatic bone lesions in five patients were treated using MRgFUS with the ExAblate Conformal Bone System for pain palliation. The follow-up sessions were at 3 days, 2 weeks, 1, 2, and 3 months, and 1 year after treatment. Efficacy was evaluated by the changes in visual analog scale (VAS) scores. At 3-months and 1-year follow-ups, unenhanced computed tomography and contrast-enhanced MR imaging examinations were performed. All adverse events were assessed to evaluate treatment safety. Results All patients showed significant pain relief within 2 weeks. Two patients experienced complete pain reduction that lasted for 1 year. Two other patients showed pain relief measured as VAS scores of 2 and 4 on their last follow-up. Although the remaining patient had experienced significant pain relief in two lesions, the VAS score re-increased on his last follow-up. The size of the enhancing soft tissue mass in metastatic lesions decreased, and new bone formation was seen on follow-up images. Although adverse events were not serious, non-specific leg pain and second degree skin burn were noted. Conclusion MRgFUS was demonstrated to be effective palliative treatment within 2 weeks in selected patients with painful bone metastases.

[1]  K. Hynynen,et al.  The use of quantitative temperature images to predict the optimal power for focused ultrasound surgery: in vivo verification in rabbit muscle and brain. , 2002, Medical physics.

[2]  N. Shabshin,et al.  Pain Palliation in Patients with Bone Metastases Using MR-Guided Focused Ultrasound Surgery: A Multicenter Study , 2008, Annals of Surgical Oncology.

[3]  J. Leon-Villapalos,et al.  Full thickness abdominal burn following magnetic resonance guided focused ultrasound therapy. , 2005, Burns : journal of the International Society for Burn Injuries.

[4]  D. Cole A randomized trial of a single treatment versus conventional fractionation in the palliative radiotherapy of painful bone metastases. , 1989, Clinical oncology (Royal College of Radiologists (Great Britain)).

[5]  W. Kucharczyk,et al.  Palliative treatment of painful bone metastases with MR imaging--guided focused ultrasound. , 2008, Radiology.

[6]  J. Yarnold 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-upOn behalf of the Bone Pain Trial Working Party , 1999 .

[7]  F. Zaccagna,et al.  Primary Pain Palliation and Local Tumor Control in Bone Metastases Treated With Magnetic Resonance-Guided Focused Ultrasound , 2013, Investigative radiology.

[8]  F. Fulfaro,et al.  Malignant bone pain: Pathophysiology and treatments , 2000, Current review of pain.

[9]  K. Kuroda,et al.  A precise and fast temperature mapping using water proton chemical shift , 1995, Magnetic resonance in medicine.

[10]  8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up. Bone Pain Trial Working Party. , 1999, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[11]  Matthew P. Goetz,et al.  Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem , 2005, Skeletal Radiology.

[12]  G. Y. Wong,et al.  Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  Matthias David,et al.  Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. , 2003, American journal of obstetrics and gynecology.

[14]  T. Jessell PAIN , 1982, The Lancet.

[15]  G. Roodman Mechanisms of bone metastasis. , 2004, Discovery medicine.

[16]  M. Mason,et al.  Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomised trials. , 2003, The Cochrane database of systematic reviews.

[17]  D. Rades,et al.  Treatment of painful bone metastases , 2010, Nature Reviews Clinical Oncology.

[18]  F A Jolesz,et al.  Thermal dosimetry of a focused ultrasound beam in vivo by magnetic resonance imaging. , 1999, Medical physics.

[19]  Jean-François Geschwind,et al.  MRI guidance of focused ultrasound therapy of uterine fibroids: early results. , 2004, AJR. American journal of roentgenology.

[20]  M. Tenhunen,et al.  Palliative radiotherapy in the treatment of skeletal metastases , 2002, European journal of pain.