Type:
Educational Exhibit
Keywords:
Metastases, Education and training, Education, Ablation procedures, Ultrasound, MR, Musculoskeletal system, Interventional non-vascular, Bones
Authors:
C. Marrocchio, A. Napoli, R. Scipione, S. Dababou, H.-P. Erasmus, C. Catalano; Rome/IT
DOI:
10.1594/ecr2018/C-2721
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 is a 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,
bone metastases are the most common cause of cancer-related pain,
resulting in an intense,
debilitating condition [4].
The mechanism mediating the pain onset is not completely understood,
but the release of chemical mediators,
micro-fractures,
stretching of the periosteum from increased pressure within the bone,
and amplification of the stimulus by the sprouting of nociceptive fibers in the periosteum are all possible contributing factors [5].
- The current standard of care for symptomatic bone metastases is external beam radiotherapy.
However:
-It uses radiations that can have substantial toxic effects;
-It fails to control symptoms in 20-30% of patients;
-It is associated to a 25% recurrence rate with often no possibility to
repeat the therapy for dose accumulation concerns.
-The onset of palliation has a long latency (up to 4 weeks) in a
population of patients that may have a relatively short survival [6].
- MRgFUS is a totally non-invasive technique that uses high-intensity focused ultrasound under magnetic resonance guidance (3T system) to induce an increase of temperature in a sharply demarcated region of a few millimetres in size,
resulting into tissue ablation.