Learning objectives
1.
To be updated on the current health burden of bone metastases;
2.
To have a comprehensive overview on the current treatment options offered,
their efficacy,
safety and limitations;
3.
To become acquainted with the basic principles of Magnetic Resonance-guided Focused Ultrasound (MRgFUS);
4.
To be informed on the current indications for MRgFUS treatment of bone metastases,
its efficacy,
safety and long-term outcomes.
Background
Bone metastases are a frequent complication of cancer, affecting up to 70% of patients with advanced breast or prostate disease and 15-30% of patients with carcinoma of the lung,
colon,
stomach,
bladder,
uterus,
rectum,
thyroid or kidney [1] (Figure 1).
Bone invasion isa poor prognostic sign,
as it usually indicates the presence of widespread disease.
Bone lesions have a significant impact on the quality of life of patients [2].
They can lead to complications,
including pathological fractures,
hypercalcemia and nerve compression syndrome [3].
Most importantly,...
Findings and procedure details
MRgFUS is composed of an extracorporeal transducer that focuses high-intensity ultrasound in a sharply demarcated region.
This induces an increase of temperature in the sonication spot that is monitored in real-time.
At 60-80°C,
coagulative necrosis occurs within the target while surrounding healthy tissue is not affected [7].
A series of sonications are performed until the target volume is ablated (Figure 2).
Pain palliation results from the destruction of nerve terminals in the highly-innervated periosteum and possibly from tumor debulking,
both consequences of the ultrasound-induced increase...
Conclusion
MRgFUS can be recommended as a second-line treatment after radiotherapy failure for pain palliation of non-spinal,
non-skull bone metastases or as first-line if radiotherapy is either contraindicated or refused by the patient [12].
The efficacy,
high safety,
and absence of radiations make MRgFUS an optimal therapy option for pain palliation of metastatic bone disease.
The non-toxicity and the fast,
durable pain response achieved with no need to interrupt the eventual concurrent chemotherapy are major advantages over radiotherapy.
Studies are undergoing to assess the possible role...
Personal information
Contact details:
Cristina Marrocchio
Department of Radiological Sciences,
Sapienza University of Rome,
School of Medicine.
V.le Regina Elena 324,
00180 Rome,
Italy
Email:
[email protected]
Susan Dababou
Department of Radiological Sciences,
Sapienza University of Rome,
School of Medicine.
V.le Regina Elena 324,
00180 Rome,
Italy
Email:
[email protected]
Hans-Peter Erasmus
Department of Radiological Sciences,
Sapienza University of Rome,
School of Medicine.
V.le Regina Elena 324,
00180 Rome,
Italy
Email:
[email protected]
Dr.
Roberto Scipione
Department of Radiological Sciences,
Policlinico Umberto I.
V.le Regina Elena 324,
00180 Rome,
Italy...
References
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Mechanisms of Bone Metastasis.
N Engl J Med.
2004;350(16):1655-1664.
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Selvaggi G,
Scagliotti G V.
Management of bone metastases in cancer: A review.
Crit Rev Oncol Hematol.
2005;56(3):365-378.
doi:10.1016/j.critrevonc.2005.03.011.
Macedo F,
Ladeira K,
Pinho F,
et al.
Bone Metastases: An Overview.Oncology Reviews.
2017;11(1):321.
doi:10.4081/oncol.2017.321.
Mercadante S.
Malignant bone pain: pathophysiology and treatment.
Pain.
1997;69(1-2):1-18.
doi:S0304-3959(96)03267-8 [pii].
Brown,
M.
R.
D.,
et al.
"The use of high-intensity focused ultrasound as a novel treatment for painful conditions—a description and narrative review of the literature." British...
