Skip to main content
SpringerLink
Log in

Pain Palliation in Patients with Bone Metastases Using MR-Guided Focused Ultrasound Surgery: A Multicenter Study

  • Palliative Care
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Noninvasive thermal ablation using magnetic resonance (MR)-guided focused ultrasound (MRgFUS) has been shown to be clinically effective in uterine fibroids, and is being evaluated for ablation of breast, liver, and brain lesions. Recently MRgFUS has been evaluated for palliation of pain caused by bone metastases. We present the clinical results of a multicenter study using MRgFUS for palliation of bone metastases pain.

Methods

A multicenter study to evaluate the safety and efficacy of MRgFUS palliative treatment of bone metastases was conducted in patients suffering from painful metastatic bone lesions for which other treatments were either ineffective or not feasible.

Thirty-one patients with painful bone metastases underwent the MRgFUS procedure in three medical centers. Treatment safety was evaluated by assessing the device-related complications. Effectiveness of pain palliation was evaluated using the visual analog pain score (VAS), and measurable changes in the intake of opioid analgesics.

Results

Thirty-six procedures were performed on 31 patients. Mean follow-up time was 4 months. 25 patients underwent the planned treatment and were available for 3 months post-treatment follow-up. 72% of the patients (18/25) reported significant pain improvement. Average VAS score was reduced from 5.9 prior to treatment to 1.8 at 3 months post treatment. 67% of patients with recorded medication data reported a reduction in their opioid usage. No device-related severe adverse events were recorded.

Conclusion

The results suggest that MRgFUS has the ability to provide an accurate, effective, and safe noninvasive palliative treatment for patients with bone metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Selvaggi G, Scagliotti GV. Management of bone metastasis in cancer: a review. Crit Rev Oncol Hematol 2005 56:365–78

    Article  PubMed  Google Scholar 

  2. Lipton A. Management of bone metastasis in breast cancer, current treatment options. Oncology 2005; 6:161–71

    PubMed  Google Scholar 

  3. DeVita VT Jr, Hellman S, Rosenberg SA. Cancer. Principles & Practice of Oncology, 6th Edition. Lippincott Williams & Wilkins 2001. Section 4, Chapter 52.4, pp 2713–29

  4. Mundy GR. Metastasis to bone, causes, consequences, and therapeutic opportunities. Nat Rev Cancer 2002; 2:584–93

    Article  CAS  PubMed  Google Scholar 

  5. Clark PE, Torti FM. Prostate cancer and bone metastasis: medical treatment. Clin Ortho 2003; 415:148–57

    Article  Google Scholar 

  6. Falkmer U, Jarhult J, Wersall P, et al. A systematic overview of radiation therapy effects in skeletal metastases. Acta Oncol 2003; 42:620–33

    Article  PubMed  Google Scholar 

  7. Chow E, Hoskin P, van der Linden Y, et al. Quality of life and symptom end points in palliative bone metastases trials. Clin Oncol (R Coll Radiol) 2006;18:67–9

    Article  CAS  Google Scholar 

  8. Roodman GD. Mechanisms of bone metastasis. N Engl J Med 2004; 350:1655–64

    Article  CAS  PubMed  Google Scholar 

  9. Konski A. Radiotherapy is a cost-effective palliative treatment for patients with bone metastasis from prostate cancer. Int J Radiation Oncology Biol Phys 2004; 60:1373–8

    Article  Google Scholar 

  10. Frassica DA. General principles of external beam radiation therapy for sceletal metastases. Clin Orthopaed Related Res 2003; 415S:158–64s

    Article  Google Scholar 

  11. Sze WM, Shelley MD, Held I, et al. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy–a systematic review of randomised trials. Clin Oncol 2003;15:345–52

    Article  CAS  Google Scholar 

  12. Ahrar K. The role and limitations of radiofrequency ablation in treatment of bone and soft tissue tumors. Curr Oncol Rep 2004; 6:315–20

    Article  PubMed  Google Scholar 

  13. Callstrom MR, Charboneau JW, Goetz MP, et al. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem. Skeletal Radiol 2006; 35:1–15

    Article  PubMed  Google Scholar 

  14. Goetz MP, Callstrom MR, Charboneau JW, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 2004; 22:306

    Google Scholar 

  15. Saarti T, Janes R, Tenhunen M, et al. Palliative radiotherapy in treatment of skeletal metastasis. Eur J Pain 2002; 6:323–30

    Article  Google Scholar 

  16. Poullsen HS, Nielse OS, Klee M, et al. Palliative irradiation of bone metastasis. Cancer Treat Rev 1989; 16:41–8

    Article  Google Scholar 

  17. Lele PP. A simple method for production of trackless focal lesions with focused ultrasound: physical factors. J Physiol 1962; 160:494–512

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hynynen K, Darkazanli A, Unger E, et al. MRI-guided noninvasive ultrasound surgery. Med Phys 1993; 20:107–15

    Article  CAS  PubMed  Google Scholar 

  19. Cline HE, Schenck JF, Hynynen K, et al. MR-guided focused ultrasound surgery. J Comput Assisted Tomogr 1992; 16:956–65

    Article  CAS  Google Scholar 

  20. Stewart EA, Gostout B, Rabinovici J, et al., for the MRgFUS for Uterine Fibroids Group. Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 2007; 110:279–87

    Google Scholar 

  21. Fennessy FM, Tempany CM, McDannold NJ, et al. Uterine leiomyomas: MR imaging-guided focused ultrasound surgery–results of different treatment protocols. Radiology 2007; 243:885–93

    Article  PubMed  Google Scholar 

  22. Chapman A, Ter Haar G. Thermal ablation of uterine fibroids using MR-guided focused ultrasound–a truly non-invasive treatment modality. Eur Radiol 2007; 17:2505–11

    Article  PubMed  Google Scholar 

  23. Stewart EA, Rabinovici J, Tempany C, et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 2006; 85:22–9

    Article  PubMed  Google Scholar 

  24. Furusawa H, Namba K, Nakahara H, et al. The evolving non-surgical ablation of breast cancer: MR guided focused ultrasound (MRgFUS). Breast Cancer 2007; 14:55–8

    Article  PubMed  Google Scholar 

  25. Gianfelice D, Khiat A, Boulanger Y, et al. MR imaging-guided focused ultrasound surgery of breast cancer: correlation between dynamic contrast-enhanced MRI and histopathologic findings. Breast Cancer Res Treatment 2003; 82:93–101

    Article  Google Scholar 

  26. Gianfelice D, Khiat A, Boulanger Y, et al. A feasibility of magnetic resonance imaging-guided focused ultrasound surgery as an adjunct to tamoxifen therapy in high-risk surgical patients with breast carcinoma. J Vascul Intervent Radiol 2003 14:1275–82

    Article  Google Scholar 

  27. Kopelman D, Inbar Y, Hanannel A, et al. Magnetic resonance-guided focused ultrasound surgery (MRgFUS). Four ablation treatments of a single canine hepatocellular adenoma. HPB 2006; 8:292–8

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cohen ZR, Zaubermann J, Harnof S, et al. Magnetic resonance imaging-guided focused ultrasound for thermal ablation in the brain: a feasibility study in a swine model. Neurosurgery 2007; 60:593–600

    Article  PubMed  Google Scholar 

  29. Ram Z, Cohen ZR, Harnof S, et al. Magnetic resonance imaging-guided high-intensity focused ultrasound for brain tumor therapy. Neurosurgery 2006; 59:949–56

    PubMed  Google Scholar 

  30. Smith NB, Temkin JM, Shapiro F, et al. Thermal effects of focused ultrasound energy on bone tissue. Ultrasound Med Biol 2001; 27:1427–33

    Article  CAS  PubMed  Google Scholar 

  31. Catane R, Beck A, Inbar Y, et al. MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases-preliminary clinical experience. Ann Oncol 2007; 18:163–7

    Article  CAS  PubMed  Google Scholar 

  32. Farrar JT, Young JP Jr, LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001; 94:149–58

    Article  CAS  PubMed  Google Scholar 

  33. Chow E, Wu JS, Hoskin P, et al. International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases. Radiotherapy Oncol 2002; 64:275–80

    Article  Google Scholar 

  34. Jolesz F, Hynynen K, McDannold N, et al. (2005) MR imaging-controlled focused ultrasound ablation: a noninvasive image-guided surgery. In: Lewin JS (ed). Magnetic Resonance Imaging Clinics of North America, MR-Guided Interventions, 13:545–60

  35. Jolesz F, Hynynen K. (2005) Focused ultrasound. In: DeVita VT, Hellman S, Rosenberg SA (eds). Cancer Principles and Practice of Oncology (Chapter 64, 7th edition). pp 2883–90

  36. Jolesz FA, Hynynen K. Magnetic resonance image-guided focused ultrasound surgery. Cancer J 2002; 8:S100–12

    Article  PubMed  Google Scholar 

  37. Gedroyc WMW, Anstee A. MR-guided focused ultrasound. Expert Rev Med Dev 2007; 4:539–47

    Article  Google Scholar 

  38. Kopelman D, Papa M. Magnetic resonance-guided focused ultrasound surgery for the noninvasive curative ablation of tumors and palliative treatments: a review. Ann Surg Oncol 2007; 14:1540–50

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopedics, Sheba Medical Center, Tel-Hashomer, Israel

    Boaz Liberman MD & Aharon Chechick MD

  2. Department of Diagnostic Imaging, Toronto General Hospital, Toronto, ON, Canada

    David Gianfelice MD & Gupta Chander MD

  3. Department of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, Israel

    Yael Inbar MD & Noga Shabshin MD

  4. Department of Radiology, Charite Hospital, Berlin, Germany

    Alexander Beck MD & Suzanne Hengst MD

  5. Oncology Institute, Sheba Medical Center, Tel-Hashomer, Israel

    Tatiana Rabin MD, Raphael Pfeffer MD & Raphael Catane MD

  6. InSightec Ltd., Haifa, Israel

    Arik Hanannel MD & Osnat Dogadkin MD

Authors
  1. Boaz Liberman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Gianfelice MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yael Inbar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander Beck MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tatiana Rabin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Noga Shabshin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gupta Chander MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Suzanne Hengst MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Raphael Pfeffer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Aharon Chechick MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Arik Hanannel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Osnat Dogadkin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Raphael Catane MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Boaz Liberman MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liberman, B., Gianfelice, D., Inbar, Y. et al. Pain Palliation in Patients with Bone Metastases Using MR-Guided Focused Ultrasound Surgery: A Multicenter Study. Ann Surg Oncol 16, 140–146 (2009). https://doi.org/10.1245/s10434-008-0011-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-008-0011-2

Keywords

Search

Navigation