Faster Relief for Patients with Painful Bone Metastases
A technique that combines magnetic resonance (MR) imaging with high-intensity focused ultrasound hyperthermia provides faster pain relief than conventional radiation therapy (RT) for patients with a painful bone metastasis.
In the September 20, 2017 issue of JBJS, Lee et al. report on a matched-pair study of 63 patients with a painful bone metastasis who received either magnetic resonance-guided focused ultrasound (MRgFUS) or RT as first-line treatment. Both modalities were effective overall, yielding response rates of >70% at the three-month follow-up evaluation. However, MRgFUS was more efficient, providing a 71% response rate at 1 week after treatment, compared with 26% for RT at that same time point.
The total treatment time and cost of the two modalities were similar, and neither was associated with adverse events above grade 2. Among MRgFUS patients, there was a 14% rate of positioning-related pain and a 33% rate of sonication-related pain, which typically resolved within 1 day after treatment.
Lee et al. report that the median overall survival of patients in the study was 12.7 months in the MRgFUS group and 9.8 months in the RT group, a statistically nonsignificant difference. But the authors emphasize that the study was more about pain relief than extending life. “Reduc[ing] pain, restor[ing] function, and maintain[ing] quality of life is imperative” for those with bone metastasis, the authors conclude. They also caution that MRgFUS is not appropriate for bone metastases of the skull or most of the spine, or for any lesion that is not at least 1 cm away from “tissues at risk.”