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Simões Corrêa Galendi J, Siefen AC, Moretti DM, Yeo SY, Grüll H, Bratke G, Morganti AG, Bazzocchi A, Gasperini C, De Felice F, Blanco Sequeiros R, Huhtala M, Nijholt IM, Boomsma MF, Bos C, Verkooijen HM, Müller D, Stock S. Factors Influencing the Adoption of Magnetic Resonance-Guided High-Intensity Focused Ultrasound for Painful Bone Metastases in Europe, A Group Concept Mapping Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1084. [PMID: 36673840 PMCID: PMC9858703 DOI: 10.3390/ijerph20021084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) is an innovative treatment for patients with painful bone metastases. The adoption of MR-HIFU will be influenced by several factors beyond its effectiveness. To identify contextual factors affecting the adoption of MR-HIFU, we conducted a group concept mapping (GCM) study in four European countries. The GCM was conducted in two phases. First, the participants brainstormed statements guided by the focus prompt "One factor that may influence the uptake of MR-HIFU in clinical practice is...". Second, the participants sorted statements into categories and rated the statements according to their importance and changeability. To generate a concept map, multidimensional scaling and cluster analysis were conducted, and average ratings for each (cluster of) factors were calculated. Forty-five participants contributed to phase I and/or II (56% overall participation rate). The resulting concept map comprises 49 factors, organized in 12 clusters: "competitive treatments", "physicians' attitudes", "alignment of resources", "logistics and workflow", "technical disadvantages", "radiotherapy as first-line therapy", "aggregating knowledge and improving awareness", "clinical effectiveness", "patients' preferences", "reimbursement", "cost-effectiveness" and "hospital costs". The factors identified echo those from the literature, but their relevance and interrelationship are case-specific. Besides evidence on clinical effectiveness, contextual factors from 10 other clusters should be addressed to support adoption of MR-HIFU.
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Affiliation(s)
- Julia Simões Corrêa Galendi
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Ann-Cathrine Siefen
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Debora M. Moretti
- Institute for Food and Resource Economics, Chair for Technology, Innovation Management and Entrepreneurship, University of Bonn, 53115 Bonn, Germany
| | - Sin Yuin Yeo
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Holger Grüll
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, University of Cologne, 50939 Cologne, Germany
| | - Grischa Bratke
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero, Universitaria of Bologna, 40138 Bologna, Italy
- Radiation Oncology, DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Chiara Gasperini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Mira Huhtala
- Department of Oncology, Turku University Hospital, University of Turku, 20521 Turku, Finland
| | - Ingrid M. Nijholt
- Department of Radiology, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Martijn F. Boomsma
- Department of Radiology, Isala Hospital, 8025 AB Zwolle, The Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Clemens Bos
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Helena M. Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50935 Cologne, Germany
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Napoli A, De Maio A, Alfieri G, Gasperini C, Scipione R, Campanacci L, Siepe G, De Felice F, Siniscalchi B, Chiurchioni L, Tombolini V, Donati DM, Morganti AG, Ghanouni P, Catalano C, Bazzocchi A. Focused Ultrasound and External Beam Radiation Therapy for Painful Bone Metastases: A Phase II Clinical Trial. Radiology 2023; 307:e211857. [PMID: 36594834 DOI: 10.1148/radiol.211857] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Recent consensus statements and clinical trials have assessed the value of MRI-guided focused ultrasound surgery for pain palliation of bone metastases; however, a comparison with external beam radiation therapy (EBRT) has not been performed. Purpose To compare safety and effectiveness data of MRI-guided focused ultrasound and EBRT in the treatment of bone metastases. Materials and Methods Participants with painful bone metastases, excluding skull and vertebral bodies, were enrolled in a prospective open-label nonrandomized phase II study between January 2017 and May 2019 and underwent either MRI-guided focused ultrasound or EBRT. The primary end point was the overall response rate at 1-month following treatment, assessed via the numeric rating scale (NRS) for pain (0-10 scale, with zero meaning "no pain" and 10 meaning "the worst pain imaginable"). Secondary end points were improvements at 12-month follow-up in NRS and quality of life (QoL) measures, including the Brief Pain Inventory (BPI), QoL-Questionnaire Cancer-15 Palliative Care (QLQ-C15-PAL), and QoL-Questionnaire Bone Metastases-22 (QLQ-BM22) and analysis of adverse events. Statistical analyses, including linear regression, χ2 test, and Student t test followed the per-protocol principle. Results Among 198 participants, 100 underwent MRI-guided focused ultrasound (mean age, 63 years ± 13 [SD]; 51 women), and 98 underwent EBRT (mean age, 65 years ± 14; 52 women). The overall response rates at 1-month follow-up were 91% (91 of 100) and 67% (66 of 98), respectively, in the focused ultrasound and EBRT arms (P < .001), and complete response rates were 43% (43 of 100) and 16% (16 of 98) (P < .001). The mean baseline NRS score was 7.0 ± 2.1 for focused ultrasound and 6.6 ± 2.4 for EBRT (P = .16); at 1-month follow-up, they were reduced to 3.2 ± 0.3 and 5.1 ± 0.3 (P < .001), respectively. QLQ-C15-PAL for physical function (P = .002), appetite (P < .001), nausea and vomiting (P < .001), dyspnea (P < .001), and QoL (P < .001) scores were lower in the focused ultrasound group. The overall adverse event rates were 15% (15 of 100) after focused ultrasound and 24% (24 of 98) after EBRT. Conclusion MRI-guided focused ultrasound surgery and external beam radiation therapy showed similar improvements in pain palliation and quality of life, with low adverse event rates. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Kelekis in this issue.
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Affiliation(s)
- Alessandro Napoli
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Alessandro De Maio
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Giulia Alfieri
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Chiara Gasperini
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Roberto Scipione
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Laura Campanacci
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Giambattista Siepe
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Francesca De Felice
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Benedetta Siniscalchi
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Lorenzo Chiurchioni
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Vincenzo Tombolini
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Davide Maria Donati
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Alessio Giuseppe Morganti
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Pejman Ghanouni
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Carlo Catalano
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
| | - Alberto Bazzocchi
- From the Department of Radiological, Pathological, and Oncological Sciences, Sapienza University of Rome, v.le Regina Elena 324, 00100 Rome, Italy (A.N., A.D.M., G.A., R.S., F.D.F., B.S., L. Chiurchioni, V.T., C.C.); Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (C.G., A.B.); Orthopaedic Service, Department of Musculoskeletal Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (L. Campanacci, D.M.D.); Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (G.S., A.G.M.); DIMES, Alma Mater Studiorum Bologna University, Bologna, Italy (G.S., A.G.M.); and Department of Radiology, Stanford University, Stanford, Calif (P.G.)
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