Monday, September 8, 2014

MR–guided Focused Ultrasound a Palliative Treatment for Painful Bone Metastases

In a study published by the Journal of National Cancer Institute Hurwitz et al report on findings of a multicenter phase III trial regarding the efficacy and safety of magnetic resonance-guided focused ultrasound (MRgFUS), for palliation of pain due to bone metastases.
One hundred forty-seven patients were enrolled, with 112 and 35 randomly assigned to MRgFUS and placebo treatments, respectively. The 147 patients were treated in 17 centers in the U.S., Canada, Israel, Italy and Russia. Response rate for the primary endpoint, improvement in self-reported pain score without increase of pain medication 3 months after treatment, was 64.3% in the MRgFUS arm and 20.0% in the placebo arm (P < .001). MRgFUS was also superior to placebo at 3 months on the secondary endpoints assessing worst score Numerical Rating Scale for pain (NRS) and morphine equivalent daily dose intake (P < .001) and Brief Pain Inventory (BPI-QoL), a measure of functional interference of pain on quality of life (P < .001). The most common treatment-related adverse event was sonication pain, which occurred in 32.1% of patients. Two patients had pathological fractures, one patient had third-degree skin burn, and one patient suffered from neuropathy. Overall 60.3% of all treatment-related adverse events resolved on same day the sonication treatment was delivered.

The authors concluded that MRgFUS, a non-invasive technique, can relieve pain and improve function in most patients with skeletal metastases who have failed standard treatment such as radiation therapy.

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