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McGill KC, Baal JD, Bucknor MD. Update on musculoskeletal applications of magnetic resonance-guided focused ultrasound. Skeletal Radiol 2024; 53:1869-1877. [PMID: 38363419 PMCID: PMC11303439 DOI: 10.1007/s00256-024-04620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive, incisionless, radiation-free technology used to ablate tissue deep within the body. This technique has gained increased popularity following FDA approval for treatment of pain related to bone metastases and limited approval for treatment of osteoid osteoma. MRgFUS delivers superior visualization of soft tissue targets in unlimited imaging planes and precision in targeting and delivery of thermal dose which is all provided during real-time monitoring using MR thermometry. This paper provides an overview of the common musculoskeletal applications of MRgFUS along with updates on clinical outcomes and discussion of future applications.
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Affiliation(s)
- Kevin C McGill
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA.
| | - Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA
| | - Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA
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Filippou A, Georgiou A, Nikolaou A, Evripidou N, Damianou C. Advanced software for MRgFUS treatment planning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107726. [PMID: 37480647 DOI: 10.1016/j.cmpb.2023.107726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Herein, a user-friendly software platform for 3-dimensional Focused Ultrasound treatment planning based on Magnetic Resonance Imaging (MRI) images is presented. METHODS The software directly retrieves and loads MRI images. Various design tools can be used on the MRI images to define the treatment area and the sonication parameters. Based on the treatment plan, the software controls the robotic motion and motion pattern of Magnetic Resonance guided Focused Ultrasound (MRgFUS) robotic systems to execute the treatment procedure. Real-time treatment monitoring is achieved through MRI images and thermometry. The software's functionality and performance were evaluated in both laboratory and MRI environments. Different treatment plans were designed on MRI images and sonications were executed on agar-based phantoms and polymer films. RESULTS Magnetic Resonance (MR) thermometry maps were acquired in the agar-based phantoms. An exceptional agreement was observed between the software-planned treatment area and the lesions produced on the polymer films. CONCLUSIONS The developed software was successfully integrated with the MRI and robotic system controls for performing accurate treatment planning and real-time monitoring during sonications. The software provides an extremely user-friendly interface, while in the future it could be enhanced by providing dynamic modulation of the ultrasonic parameters during the treatment process.
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Affiliation(s)
- Antria Filippou
- Cyprus University of Technology, Department of Electrical Engineering, Computer Engineering, and Informatics, 30 Archbishop Kyprianou Str., Limassol 3036, Cyprus.
| | - Andreas Georgiou
- Cyprus University of Technology, Department of Electrical Engineering, Computer Engineering, and Informatics, 30 Archbishop Kyprianou Str., Limassol 3036, Cyprus
| | - Anastasia Nikolaou
- Cyprus University of Technology, Department of Electrical Engineering, Computer Engineering, and Informatics, 30 Archbishop Kyprianou Str., Limassol 3036, Cyprus.
| | - Nikolas Evripidou
- Cyprus University of Technology, Department of Electrical Engineering, Computer Engineering, and Informatics, 30 Archbishop Kyprianou Str., Limassol 3036, Cyprus.
| | - Christakis Damianou
- Cyprus University of Technology, Department of Electrical Engineering, Computer Engineering, and Informatics, 30 Archbishop Kyprianou Str., Limassol 3036, Cyprus.
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Hu R, He P, Tian X, Guan H. Efficacy and safety of magnetic resonance-guided focused ultrasound for the treatment of osteoid osteoma: A systematic review and meta-analysis. Eur J Radiol 2023; 166:111006. [PMID: 37523874 DOI: 10.1016/j.ejrad.2023.111006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/27/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel noninvasive interventional technique for osteoid osteoma (OO). The purpose of this study was to evaluate the efficacy and safety of MRgFUS in the treatment of OO through a systematic review and meta-analysis of pain scores and post-treatment adverse events before and after MRgFUS treatment. MATERIALS AND METHODS A comprehensive literature search of PubMed, Embase, Web of science, and Cochrane Library databases was conducted to screen the study literature based on inclusion and exclusion criteria to extract and analyze pre- and post-treatment pain score data, success rates (complete pain relief with no recurrence until the last follow-up), recurrence rates, secondary intervention rates, and complications to evaluate the efficacy and/or safety of MRgFUS for OO. RESULTS A total of 113 studies published between 2012 and 2022were collected, resulting in a total sample size of 353 patients. The majority of the studies were prospective and had a follow-up period of 4 weeks or more, and overall, the quality of evidence ranged from low to high. Pain scores at 1 week and 1 month after the merger were 0.62 (9.5% CI:0.28-0.96) and 0.37 (9.5% CI:0.07-0.68), respectively. The success rate of the combination was 92.8% (95% CI: 89.8%-95.7%), the incidence of minor complications (thermal injury at the ablation site) was 0.85%, and no major complications were recorded in any of the included literature. CONCLUSION MRgFUS is an effective procedure that is able to treat pain for patients with OO with satisfying efficacy and safety. PROSPERO No.CRD42023415573.
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Affiliation(s)
- Rongrui Hu
- Eighth Clinical School of Guangzhou University of Chinese Medicine, Foshan, China
| | - Peicong He
- Eighth Clinical School of Guangzhou University of Chinese Medicine, Foshan, China
| | - Xiaona Tian
- Eighth Clinical School of Guangzhou University of Chinese Medicine, Foshan, China
| | - Honggang Guan
- Orthopedic and Traumatology Center, Foshan City Hospital of Traditional Chinese Medicine, Foshan, China.
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Ferreira Felloni Borges Y, Cheyuo C, Lozano AM, Fasano A. Essential Tremor - Deep Brain Stimulation vs. Focused Ultrasound. Expert Rev Neurother 2023; 23:603-619. [PMID: 37288812 DOI: 10.1080/14737175.2023.2221789] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Essential Tremor (ET) is one of the most common tremor syndromes typically presented as action tremor, affecting mainly the upper limbs. In at least 30-50% of patients, tremor interferes with quality of life, does not respond to first-line therapies and/or intolerable adverse effects may occur. Therefore, surgery may be considered. AREAS COVERED In this review, the authors discuss and compare unilateral ventral intermedius nucleus deep brain stimulation (VIM DBS) and bilateral DBS with Magnetic Resonance-guided Focused Ultrasound (MRgFUS) thalamotomy, which comprises focused acoustic energy generating ablation under real-time MRI guidance. Discussion includes their impact on tremor reduction and their potential complications. Finally, the authors provide their expert opinion. EXPERT OPINION DBS is adjustable, potentially reversible and allows bilateral treatments; however, it is invasive requires hardware implantation, and has higher surgical risks. Instead, MRgFUS is less invasive, less expensive, and requires no hardware maintenance. Beyond these technical differences, the decision should also involve the patient, family, and caregivers.
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Affiliation(s)
- Yuri Ferreira Felloni Borges
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
- Department of Parkinson's Disease & Movement Disorders Rehabilitation, Moriggia-Pelascini Hospital, Gravedona Ed Uniti, Como, Italy
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Dalili D, Dalili DE, Isaac A, Martel-Villagrán J, Fritz J. Treatment of Osteoid Osteoma. Semin Intervent Radiol 2023; 40:100-105. [PMID: 37152792 PMCID: PMC10159722 DOI: 10.1055/s-0043-1767692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Danoob Dalili
- Department of Radiology, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom
| | - Daniel E. Dalili
- Department of Radiology, Mid and South Essex NHS Foundation Trust, Southend, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | | | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
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Mid-term efficacy grading evaluation and predictive factors of magnetic resonance-guided focused ultrasound surgery for painful bone metastases: a multi-center study. Eur Radiol 2023; 33:1465-1474. [PMID: 36074263 DOI: 10.1007/s00330-022-09118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/04/2022] [Accepted: 08/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES MR imaging-guided focused ultrasound surgery (MRgFUS) is an emerging non-invasive treatment. It is helpful in investigating the mid-term grading efficacy and safety of MRgFUS, and possible risk factors in participants with painful bone metastases. METHODS This four-center prospective study enrolled 96 participants between June 2016 and May 2019 with painful bone metastases. The Numerical Rating Scale (NRS), Brief Pain Inventory-Quality of Life (BPI-QoL) score, morphine equivalent daily dose (MEDD), and the adverse events (AEs) were recorded before and at 1 week, 1 month, 2 months, and 3 months after MRgFUS. The repeated ANOVA tests were used to analyze the change in NRS and BPI-QoL, and logistic regression analysis was used to analyze the possible risk factors. RESULTS A total of 82 participants completed the 3-month follow-up period. And 16 (19.5%) participants were complete responders (CR), 46 (56.1%) participants were effective responders (ER), and the other 20 (24.4%) participants were non-responders (NR). The NRS (2.67 ± 2.47 at 3 months compared to 6.38 ± 1.70 before treatment) and BPI-QoL score (3.11 ± 2.51 at 3 months compared to 5.40 ± 1.85 before treatment) significantly decreased after the treatment at all time points (p < 0.001). Eleven adverse events were recorded and they were all cured within 1 to 52 days after treatment. The non-perfused volume (NPV) ratio (p = 0.001) and the bone metastases lesion type (p = 0.025) were the key risk factors. CONCLUSIONS MRgFUS can be used as a non-invasive, effective, and safe modality to treat painful bone metastases. NPV ratio and the lesion type may be used as affecting factors to predict the mid-term efficacy of MRgFUS. KEY POINTS • MRgFUS can be considered a non-invasive, effective, and safe modality to treat painful bone metastases. • The NRS and BPI-QoL score at 1 week, 1 month, 2 months, and 3 months all decreased significantly (p < 0.001) after receiving MRgFUS. Among 82 participants, 16 (19.5%) were complete responders, 46 (56.1%) were effective responders, and the other 20 (24.4%) were non-responders. • According to logistic regression analysis, non-perfused volume ratio and the bone metastases lesion type were the affecting factors to predict the mid-term efficacy of MRgFUS. The adjusted OR of non-perfused volume ratio was 0.86 (p = 0.001), and osteoblastic lesion type was 0.06 (p = 0.025).
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Affiliation(s)
- Alexis Kelekis
- From the 2nd Radiology and Radiation Therapy Department, National and Kapodistrian University of Athens, Attikon General University Hospital, Rimin 1, Haidari, Athens 12467, Greece
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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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9
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Slotman DJ, Bartels MMTJ, Ferrer CJ, Bos C, Bartels LW, Boomsma MF, Phernambucq ECJ, Nijholt IM, Morganti AG, Siepe G, Buwenge M, Grüll H, Bratke G, Yeo SY, Blanco Sequeiros R, Minn H, Huhtala M, Napoli A, De Felice F, Catalano C, Bazzocchi A, Gasperini C, Campanacci L, Simões Corrêa Galendi J, Müller D, Braat MNGJA, Moonen C, Verkooijen HM. Focused Ultrasound and RadioTHERapy for non-invasive palliative pain treatment in patients with bone metastasis: a study protocol for the three armed randomized controlled FURTHER trial. Trials 2022; 23:1061. [PMID: 36582001 PMCID: PMC9798627 DOI: 10.1186/s13063-022-06942-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/17/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cancer-induced bone pain (CIBP), caused by bone metastases, is a common complication of cancer and strongly impairs quality of life (QoL). External beam radiotherapy (EBRT) is the current standard of care for treatment of CIBP. However, approximately 45% of patients have no adequate pain response after EBRT. Magnetic resonance image-guided high-intensity focused ultrasound (MR-HIFU) may improve pain palliation in this patient population. The main objective of this trial was to compare MR-HIFU, EBRT, and MR-HIFU + EBRT for the palliative treatment of bone metastases. METHODS/DESIGN The FURTHER trial is an international multicenter, three-armed randomized controlled trial. A total of 216 patients with painful bone metastases will be randomized in a 1:1:1 ratio to receive EBRT only, MR-HIFU only, or combined treatment with EBRT followed by MR-HIFU. During a follow-up period of 6 months, patients will be contacted at eight time points to retrieve information about their level of pain, QoL, and the occurrence of (serious) adverse events. The primary outcome of the trial is pain response at 14 days after start of treatment. Secondary outcomes include pain response at 14 days after trial enrolment, pain scores (daily until the 21st day and at 4, 6, 12 and 24 weeks), toxicity, adverse events, QoL, and survival. Cost-effectiveness and cost-utility analysis will be conducted. DISCUSSION The FURTHER trial aims to evaluate the effectiveness and cost-effectiveness of MR-HIFU-alone or in combination with EBRT-compared to EBRT to relieve CIBP. The trial will be performed in six hospitals in four European countries, all of which are partners in the FURTHER consortium. TRIAL REGISTRATION The FURTHER trial is registered under the Netherlands Trials Register number NL71303.041.19 and ClinicalTrials.gov registration number NCT04307914. Date of trial registration is 13-01-2020.
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Affiliation(s)
- Derk J. Slotman
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands ,grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Marcia M. T. J. Bartels
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cyril J. Ferrer
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Clemens Bos
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lambertus W. Bartels
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martijn F. Boomsma
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands ,grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Erik C. J. Phernambucq
- grid.452600.50000 0001 0547 5927Department of Radiation Oncology, Isala Hospital, Zwolle, The Netherlands
| | - Ingrid M. Nijholt
- grid.452600.50000 0001 0547 5927Department of Radiology, Isala Hospital, Zwolle, The Netherlands
| | - Alessio G. Morganti
- grid.6292.f0000 0004 1757 1758DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giambattista Siepe
- grid.6292.f0000 0004 1757 1758Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Milly Buwenge
- grid.6292.f0000 0004 1757 1758DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy
| | - Holger Grüll
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Grischa Bratke
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sin Yuin Yeo
- grid.6190.e0000 0000 8580 3777Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roberto Blanco Sequeiros
- grid.410552.70000 0004 0628 215XDepartment of Radiology, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- grid.1374.10000 0001 2097 1371Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Mira Huhtala
- grid.1374.10000 0001 2097 1371Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland
| | - Alessandro Napoli
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca De Felice
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- grid.7841.aDepartment of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Alberto Bazzocchi
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Chiara Gasperini
- grid.419038.70000 0001 2154 6641Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Laura Campanacci
- grid.419038.70000 0001 2154 66413Rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Julia Simões Corrêa Galendi
- grid.6190.e0000 0000 8580 3777Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Dirk Müller
- grid.6190.e0000 0000 8580 3777Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Manon N. G. J. A. Braat
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Chrit Moonen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Helena M. Verkooijen
- grid.7692.a0000000090126352Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
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10
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Yeo SY, Bratke G, Grüll H. High Intensity Focused Ultrasound for Treatment of Bone Malignancies-20 Years of History. Cancers (Basel) 2022; 15:cancers15010108. [PMID: 36612105 PMCID: PMC9817683 DOI: 10.3390/cancers15010108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022] Open
Abstract
High Intensity Focused Ultrasound (HIFU) is the only non-invasive method for percutaneous thermal ablation of tissue, with treatments typically performed either under magnetic resonance imaging or ultrasound guidance. Since this method allows efficient heating of bony structures, it has found not only early use in treatment of bone pain, but also in local treatment of malignant bone tumors. This review of 20 years of published studies shows that HIFU is a very efficient method for rapid pain relief, can provide local tumor control and has a very patient-friendly safety profile.
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Affiliation(s)
- Sin Yuin Yeo
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Correspondence:
| | - Grischa Bratke
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Holger Grüll
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
- Department of Chemistry, Faculty of Mathematics and Natural Sciences, University of Cologne, Greinstr. 6, 50939 Cologne, Germany
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11
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Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review. Curr Oncol 2022; 29:4155-4177. [PMID: 35735441 PMCID: PMC9221897 DOI: 10.3390/curroncol29060332] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Metastases are the main type of malignancy involving bone, which is the third most frequent site of metastatic carcinoma, after lung and liver. Skeletal-related events such as intractable pain, spinal cord compression, and pathologic fractures pose a serious burden on patients’ quality of life. For this reason, mini-invasive treatments for the management of bone metastases were developed with the goal of pain relief and functional status improvement. These techniques include embolization, thermal ablation, electrochemotherapy, cementoplasty, and MRI-guided high-intensity focused ultrasound. In order to achieve durable pain palliation and disease control, mini-invasive procedures are combined with chemotherapy, radiation therapy, surgery, or analgesics. The purpose of this review is to summarize the recently published literature regarding interventional radiology procedures in the treatment of cancer patients with bone metastases, focusing on the efficacy, complications, local disease control and recurrence rate.
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12
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Sgalambro F, Zugaro L, Bruno F, Palumbo P, Salducca N, Zoccali C, Barile A, Masciocchi C, Arrigoni F. Interventional Radiology in the Management of Metastases and Bone Tumors. J Clin Med 2022; 11:3265. [PMID: 35743336 PMCID: PMC9225477 DOI: 10.3390/jcm11123265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/10/2023] Open
Abstract
Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone metastases are the most common target of IR palliative treatments; however, in selected cases of bone metastases, IR may play a curative role, also in combination with other techniques (surgery, radiation and oncology therapies, etc.). Primary malignant bone tumors are extremely rare compared with secondary bone lesions: osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common; however, the role of interventional radiology in this fiels is marginal. In this review, the main techniques used in interventional radiology were examined, and advantages and limitations illustrated. Techniques of ablation (Radiofrequency, Microwaves, Cryoablation as also magnetic resonance imaging-guided high-intensity focused ultrasound), embolization, and Cementoplasty will be described. The techniques of ablation work by destruction of pathological tissue by thermal energy (by an increase of temperature up to 90 °C with the exception of the Cryoablation that works by freezing the tissue up to -40 °C). Embolization creates an ischemic necrosis by the occlusion of the arterial vessels that feed the tumor. Finally, cementoplasty has the aim of strengthening bone segment weakened by the growth of pathological tissue through the injection of cement. The results of the treatments performed so far were also assessed and presented focused the attention on the management of bone metastasis.
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Affiliation(s)
- Ferruccio Sgalambro
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.S.); (A.B.); (C.M.)
| | - Luigi Zugaro
- San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.B.); (P.P.)
| | - Federico Bruno
- San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.B.); (P.P.)
| | - Pierpaolo Palumbo
- San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.B.); (P.P.)
| | - Nicola Salducca
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (N.S.); (C.Z.)
| | - Carmine Zoccali
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (N.S.); (C.Z.)
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.S.); (A.B.); (C.M.)
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.S.); (A.B.); (C.M.)
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13
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Pagnotti GM, Trivedi T, Mohammad KS. Translational Strategies to Target Metastatic Bone Disease. Cells 2022; 11:1309. [PMID: 35455987 PMCID: PMC9030480 DOI: 10.3390/cells11081309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Metastatic bone disease is a common and devastating complication to cancer, confounding treatments and recovery efforts and presenting a significant barrier to de-escalating the adverse outcomes associated with disease progression. Despite significant advances in the field, bone metastases remain presently incurable and contribute heavily to cancer-associated morbidity and mortality. Mechanisms associated with metastatic bone disease perpetuation and paralleled disruption of bone remodeling are highlighted to convey how they provide the foundation for therapeutic targets to stem disease escalation. The focus of this review aims to describe the preclinical modeling and diagnostic evaluation of metastatic bone disease as well as discuss the range of therapeutic modalities used clinically and how they may impact skeletal tissue.
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Affiliation(s)
- Gabriel M. Pagnotti
- Department of Endocrine, Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA; (G.M.P.); (T.T.)
| | - Trupti Trivedi
- Department of Endocrine, Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA; (G.M.P.); (T.T.)
| | - Khalid S. Mohammad
- Department of Anatomy and Genetics, Alfaisal University, Riyadh 11533, Saudi Arabia
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14
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CIRSE Standards of Practice on Thermal Ablation of Bone Tumours. Cardiovasc Intervent Radiol 2022; 45:591-605. [PMID: 35348870 PMCID: PMC9018647 DOI: 10.1007/s00270-022-03126-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/28/2022] [Indexed: 02/03/2023]
Abstract
Background Percutaneous thermal ablation is an effective, minimally invasive means of treating a variety of focal benign and malignant osseous lesions. To determine the role of ablation in individual cases, multidisciplinary team (MDT) discussion is required to assess the suitability and feasibility of a thermal ablative approach, to select the most appropriate technique and to set the goals of treatment i.e. curative or palliative. Purpose This document will presume the indication for treatment is clear and approved by the MDT and will define the standards required for the performance of each modality. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of thermal ablation of bone tumours. Methods The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in thermal ablation of bone tumours. The writing group reviewed the existing literature on thermal ablation of bone tumours, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects from 2009 to 2019. Selected studies published in 2020 and 2021 during the course of writing these standards were subsequently included. The final recommendations were formulated through consensus. Results Recommendations were produced for the performance of thermal ablation of bone tumours taking into account the biologic behaviour of the tumour and the therapeutic intent of the procedure. Recommendations are provided based on lesion characteristics and thermal modality, for the use of tissue monitoring and protection, and for the appropriately timed application of adjunctive procedures such as osseus consolidation and transarterial embolisation. Results Percutaneous thermal ablation has an established role in the successful management of bone lesions, with both curative and palliative intent. This Standards of Practice document provides up-to-date recommendations for the safe performance of thermal ablation of bone tumours.
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15
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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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16
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Han X, Huang R, Meng T, Yin H, Song D. The Roles of Magnetic Resonance-Guided Focused Ultrasound in Pain Relief in Patients With Bone Metastases: A Systemic Review and Meta-Analysis. Front Oncol 2021; 11:617295. [PMID: 34458131 PMCID: PMC8387143 DOI: 10.3389/fonc.2021.617295] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/19/2021] [Indexed: 01/06/2023] Open
Abstract
Objective Cancer pain, the most common skeleton-related event of bone metastases, significantly disturbs patients' life. MRI-guided focused ultrasound (MRgFUS) is a therapeutic option to relieve pain; however, its efficacy and safety have not been fully explored. Therefore, we aim to conduct a meta-analysis on studies reporting MRgFUS for patients with bone metastases. Methods Randomized controlled trials (RCT) and non-RCTs on MRgFUS treatment for patients with bone metastases were collected using PubMed, MEDLINE In-Process (US National Library of Medicine), National Institutes of Health (US National Library of Medicine), Embase (Elsevier), Web of Science, CINAHL, and the Cochrane Library between August 2007 and September 2019. Data on quantitative pain assessment before/after MRgFUS, response rate, and complication were extracted and analyzed. Results Fifteen eligible studies with 362 patients were selected in this meta-analysis. The average pain score was 6.74 (95% CI: 6.30-7.18) at baseline, 4.15 (95% CI: 3.31-4.99) at 0-1 week, 3.09 (95% CI: 2.46-3.72) at 1-5 weeks, and 2.28 (95% CI: 1.37-3.19) at 5-14 weeks. Compared with baseline, the pain improvement at 0-1 week was 2.54 (95% CI: 1.92-3.16, p < 0.01), at 1-5 weeks was 3.56 (95% CI: 3.11-4.02, p < 0.01), and at 5-14 weeks was 4.22 (95% CI: 3.68-4.76, p < 0.01). Change from baseline in OMEDD at 2 weeks after treatment was -15.11 (95% CI: -34.73, 4.50), at 1 month after treatment was -10.87 (95% CI: -26.32, 4.58), and at 3 months after treatment was -5.53 (95% CI: -20.44, 9.38). The overall CR rate was 0.36 (95% CI: 0.24-0.48), PR rate was 0.47 (95% CI: 0.36-0.58), and NR rate was 0.23 (95% CI: 0.13-0.34). Among 14 studies including 352 patients, 93 (26.4%) patients with minor complications and 5 (1.42%) patients with major complications were recorded. Conclusion This meta-analysis identifies MRgFUS as a reliable therapeutic option to relieve cancer pain for patients with metastatic bone tumors with controllable related complications.
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Affiliation(s)
- Xiaying Han
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Runzhi Huang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Division of Spine, Department of Orthopedics, Tongji Hospital affiliated to Tongji University School of Medicine, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
| | - Tong Meng
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huabin Yin
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dianwen Song
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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17
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Cross CG, Payne AH, Hawryluk GW, Haag-Roeger R, Cheeniyil R, Brady D, Odéen H, Minoshima S, Cross DJ, Anzai Y. Technical Note: Quantification of blood-spinal cord barrier permeability after application of magnetic resonance-guided focused ultrasound in spinal cord injury. Med Phys 2021; 48:4395-4401. [PMID: 33999427 DOI: 10.1002/mp.14947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To demonstrate that magnetic resonance-guided focused ultrasound (MRgFUS) facilitates blood-spinal cord barrier (BSCB) permeability and develop observer-independent MRI quantification of BSCB permeability after MRgFUS for spinal cord injury (SCI). METHODS Noninjured Sprague-Dawley rats (n = 3) underwent MRgFUS and were administered Evans blue post-MRgFUS to confirm BSCB opening. Absorbance was measured by spectrophotometry and correlated with its corresponding image intensity. Rats (n = 21) underwent T8-T10 laminectomy and extradural compression of the spinal cord (23g weighted aneurysm-type clip, 1 min). The intervention group (n = 11) was placed on a preclinical MRgFUS system, administered microbubbles (Optison, 0.2 mL/kg), and received 3 MRgFUS sonications (25 ms bursts, 1 Hz pulses for 3 min, 3 acoustic W, approximately 1.0-2.1 MPa peak pressure as measured via hydrophone). The sham group (n = 10) received equivalent procedures with no sonications. T1w MRI was obtained both pre- and post-MRgFUS BSCB opening. Spinal cords were segmented manually or semiautomatically and a Pearson correlation with P ≤ 0.001 was used to correlate the two segmentation methods. MRgFUS sonication and control regions intensity values were evaluated with a paired t-test with a P ≤ 0.01. RESULTS Semiautomatic segmentation reduced computational time by 95% and was correlated with manual segmentation (Pearson = 0.92, P < 0.001, n = 71 regions). In the noninjured rat group, Evans blue absorbance correlated with image intensity in the MRgFUS and control regions (Pearson = 0.82, P = 0.02, n = 6). In rats that underwent the SCI procedure, an increase in signal intensity in the MRgFUS targeted region relative to control was seen in all SCI rats (10.65 ± 12.4%, range: 0.96-43.9%, n = 11, P = 0.002). SCI sham MRgFUS revealed no change (0.63 ± 0.52%, 95% CI 0.320.95, n = 10). This result was significant between both groups (P = 0.003). CONCLUSION The implemented semiautomatic segmentation procedure improved data analysis efficiency. Quantitative methods using contrast-enhanced MRI with histological validation are sensitive for detection of blood-spinal cord barrier opening induced by magnetic resonance-guided focused ultrasound.
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Affiliation(s)
- Chloe G Cross
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Allison H Payne
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Riley Haag-Roeger
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Rahul Cheeniyil
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Dalton Brady
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Henrik Odéen
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Donna J Cross
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Yoshimi Anzai
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
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Aginsky R, LeBlang S, Hananel A, Chen J, Gofeld M, Perez J, Shir Y, Aubry JF. Tolerability and Feasibility of X-ray Guided Non-Invasive Ablation of the Medial Branch Nerve with Focused Ultrasound: Preliminary Proof of Concept in a Pre-clinical Model. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:640-650. [PMID: 33261908 DOI: 10.1016/j.ultrasmedbio.2020.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/02/2020] [Accepted: 10/28/2020] [Indexed: 06/12/2023]
Abstract
Four to six million patients a year in the United States suffer from chronic pain caused by facet joint degeneration. Thermal ablation of the affected facet joint's sensory nerve using radiofrequency electrodes is the therapeutic standard of care. High-intensity focused ultrasound (HIFU) is a novel technology enabling image-guided non-invasive thermal ablation of tissue. Six pigs underwent fluoroscopy-guided HIFU of the medial branch nerve and were followed up for 1 wk (two pigs), 1 mo (two pigs) and 3 mo (two pigs). At the end of each follow-up period, the animals were sacrificed, and targeted tissue was excised and evaluated with computed tomography scans as well as by macro- and micropathology. No significant adverse events were recorded during the procedure or follow-up period. All targets were successfully ablated. X-Ray-guided HIFU is a feasible and promising alternative to radiofrequency ablation of the lumbar facet joint sensory nerve.
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Affiliation(s)
| | - Suzanne LeBlang
- Focused Ultrasound Foundation, Charlottesville, Virginia, USA.
| | | | | | | | | | | | - Jean-Francois Aubry
- Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Paris France
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19
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Bitton RR, Rosenberg J, LeBlang S, Napoli A, Meyer J, Butts Pauly K, Hurwitz M, Ghanouni P. MRI-Guided Focused Ultrasound of Osseous Metastases: Treatment Parameters Associated With Successful Pain Reduction. Invest Radiol 2021; 56:141-146. [PMID: 32858582 DOI: 10.1097/rli.0000000000000721] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A phase 3 multicenter trial demonstrated that magnetic resonance imaging (MRI)-guided focused ultrasound (US) is a safe, noninvasive treatment that alleviated pain from bone metastases. However, outcomes varied among institutions (from 0%-100% treatment success). PURPOSE The aim of this study was to identify patient selection, technical treatment, and imaging parameters that predict successful pain relief of osseous metastases after MRI-guided focused US. MATERIALS AND METHODS This was a secondary analysis of a phase 3 clinical study that included participants who received MRI-guided focused US treatment for painful osseous metastases. Noncontrast CT was obtained before treatment. T2-weighted and T1-weighted postcontrast MRIs at 1.5 T or 3 T were obtained before, at the time of, and at 3 months after treatment. Numerical Rating Scale pain scores and morphine equivalent daily dose data were obtained over a 3-month follow-up period. At the 3-month endpoint, participants were categorized as pain relief responders or nonresponders based on Numerical Rating Scale and morphine equivalent daily dose data. Demographics, technical parameters, and imaging features associated with pain relief were determined using stepwise univariable and multivariable models. Responder rates between the subgroup of participants with all predictive parameters and that with none of the parameters were compared using Fisher exact test. RESULTS The analysis included 99 participants (mean age, 59 ± 14 years; 56 women). The 3 variables that predicted successful pain relief were energy density on the bone surface (EDBS) (P = 0.001), the presence of postprocedural periosteal devascularization (black band, BB+) (P = 0.005), and female sex (P = 0.02). The subgroup of participants with BB+ and EDBS greater than 5 J/mm2 had a larger decrease in mean pain score (5.2; 95% confidence interval, 4.6-5.8) compared with those without (BB-, EDBS ≤ 5 J/mm2) (1.1; 95% confidence interval, 0.8-3.0; P < 0.001). Participants with all 3 predictive variables had a pain relief responder rate of 93% compared with 0% in participants having none of the predictive variables (P < 0.001). CONCLUSIONS High EDBS during treatment, postprocedural periosteal devascularization around the tumor site (BB+), and female sex increased the likelihood of pain relief after MRI-guided focused US of osseous metastasis.
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Affiliation(s)
- Rachel R Bitton
- From the Department of Radiology, Stanford University, Stanford, CA
| | | | | | - Alessandro Napoli
- Department of Radiological Sciences, University of Rome, Rome, Italy
| | - Joshua Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center
| | - Kim Butts Pauly
- From the Department of Radiology, Stanford University, Stanford, CA
| | - Mark Hurwitz
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Pejman Ghanouni
- From the Department of Radiology, Stanford University, Stanford, CA
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20
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Dalili D, Isaac A, Bazzocchi A, Åström G, Bergh J, Lalam R, Weber MA, Fritz J, Mansour R. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation. Semin Musculoskelet Radiol 2020; 24:692-709. [PMID: 33307585 DOI: 10.1055/s-0040-1719103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.
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Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital Stockholm, Sweden
| | - Radhesh Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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21
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Cost-effectiveness analysis of magnetic resonance-guided focused ultrasound ablation for palliation of refractory painful bone metastases. Int J Technol Assess Health Care 2020; 37:e30. [PMID: 33267915 DOI: 10.1017/s0266462320001907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to determine if magnetic resonance-guided focused ultrasound (MRgFUS) is cost-effective compared with medication, for refractory pain from bone metastases in the United States. METHODS We constructed a Markov state transition model using TreeAge Pro software (TreeAge Software, Inc., Williamstown, MA, USA) to model costs, outcomes, and the cost-effectiveness of a treatment strategy using MRgFUS for palliative treatment of painful bone metastases compared with a Medication Only strategy (Figure 1). Model transition state probabilities, costs (in 2018 US$), and effectiveness data (quality-adjusted life-years [QALYs]) were derived from available literature, local expert opinion, and reimbursement patterns at two U.S. tertiary academic medical centers actively performing MRgFUS. Costs and QALYs, discounted at three percent per year, were accumulated each month over a 24-month time horizon. One-way and probabilistic sensitivity analyses were performed. RESULTS In the base-case analysis, the MRgFUS treatment strategy costs an additional $11,863 over the 2-year time horizon to accumulate additional 0.22 QALYs, equal to a $54,160/QALY ICER, thus making MRgFUS the preferred strategy. One-way sensitivity analyses demonstrate that for the base-case analysis, the crossover point at which Medication Only would instead become the preferred strategy is $23,341 per treatment. Probabilistic sensitivity analyses demonstrate that 67 percent of model iterations supported the conclusion of the base case. CONCLUSIONS Our model demonstrates that MRgFUS is cost-effective compared with Medication Only for palliation of painful bone metastases for patients with medically refractory metastatic bone pain across a range of sensitivity analyses.
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22
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Lorton O, Guillemin P, Holman R, Desgranges S, Gui L, Crowe LA, Terraz S, Nastasi A, Lazeyras F, Contino-Pépin C, Salomir R. Enhancement of HIFU thermal therapy in perfused tissue models using micron-sized FTAC-stabilized PFOB-core endovascular sonosensitizers. Int J Hyperthermia 2020; 37:1116-1130. [PMID: 32990101 PMCID: PMC8352380 DOI: 10.1080/02656736.2020.1817575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND High intensity focused ultrasound (HIFU) is clinically accepted for the treatment of solid tumors but remains challenging in highly perfused tissue due to the heat sink effect. Endovascular liquid-core sonosensitizers have been previously suggested to enhance the thermal energy deposition at the focal area and to lower the near-/far-field heating. We are investigating the therapeutic potential of PFOB-FTAC micro-droplets in a perfused tissue-mimicking model and postmortem excised organs. METHOD A custom-made in vitro perfused tissue-mimicking model, freshly excised pig kidneys (n = 3) and liver (n = 1) were perfused and subjected to focused ultrasound generated by an MR-compatible HIFU transducer. PFOB-FTAC sonosensitizers were injected in the perfusion fluid up to 0.235% v/v ratio. Targeting and on-line PRFS thermometry were performed on a 3 T MR scanner. Assessment of the fluid perfusion was performed with pulsed color Doppler in vitro and with dynamic contrast-enhanced (DCE)-MRI in excised organs. RESULTS Our in vitro model of perfused tissue demonstrated re-usability. Sonosensitizer concentration and perfusion rate were tunable in situ. Differential heating under equivalent HIFU sonications demonstrated a dramatic improvement in the thermal deposition due to the sonosensitizers activity. Typically, the energy deposition was multiplied by a factor between 2.5 and 3 in perfused organs after the administration of micro-droplets, while DCE-MRI indicated an effective perfusion. CONCLUSION The current PFOB-FTAC micro-droplet sonosensitizers provided a large and sustained enhancement of the HIFU thermal deposition at the focal area, suggesting solutions for less technological constraints, lower risk for the near-/far- field heating. We also report a suitable experimental model for other MRgHIFU studies.
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Affiliation(s)
- Orane Lorton
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pauline Guillemin
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ryan Holman
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Laura Gui
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lindsey A Crowe
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Sylvain Terraz
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Antonio Nastasi
- Visceral and Transplantation Division, University Hospitals, Geneva, Switzerland
| | - François Lazeyras
- Radiology Department, University Hospitals of Geneva, Geneva, Switzerland.,Center for Biomedical Imaging (CIBM), Geneva, Switzerland
| | | | - Rares Salomir
- Image Guided Interventions Laboratory (GR-949), Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Radiology Department, University Hospitals of Geneva, Geneva, Switzerland
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23
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Lau LW, Eranki A, Celik H, Kim A, Kim PCW, Sharma KV, Yarmolenko PS. Are Current Technical Exclusion Criteria for Clinical Trials of Magnetic Resonance-Guided High-Intensity Focused Ultrasound Too Restrictive?: Early Experiences at a Pediatric Hospital. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1849-1855. [PMID: 32227606 DOI: 10.1002/jum.15259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/04/2020] [Accepted: 02/16/2020] [Indexed: 06/10/2023]
Abstract
Certain technical criteria must be met to ensure the treatment safety of magnetic resonance-guided high-intensity focused ultrasound. We retrospectively reviewed how our enrollment criteria were applied from 2014 to 2017 in a clinical trial of magnetic resonance-guided high-intensity focused ultrasound ablation of recurrent malignant and locally aggressive benign solid tumors. Among the 36 screened patients between 2014 and 2017, more than one-third were excluded for technical exclusion criteria such as the anatomic location and proximity to prosthetics. Overall, patients were difficult to accrue for this trial, given the incidence of these tumors. To increase potential accrual, screening exclusion criteria could be more generalized and centered on the ability to achieve an acceptable treatment safety margin, rather than specifically excluding on the basis of general anatomic areas.
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Affiliation(s)
- Lung W Lau
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Avinash Eranki
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Haydar Celik
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
- Center for Interventional Oncology, Radiology, and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - AeRang Kim
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Peter C W Kim
- Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Karun V Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Pavel S Yarmolenko
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
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24
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Valenzuela RF, Kundra V, Madewell JE, Costelloe CM. Advanced Imaging in Musculoskeletal Oncology: Moving Away From RECIST and Embracing Advanced Bone and Soft Tissue Tumor Imaging (ABASTI) - Part I - Tumor Response Criteria and Established Functional Imaging Techniques. Semin Ultrasound CT MR 2020; 42:201-214. [PMID: 33814106 DOI: 10.1053/j.sult.2020.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
According to the Revised Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, the majority of bone metastases are considered to be nonmeasurable disease. Traditional response criteria rely on physical measurements. New criteria would be valuable if they incorporated newly developed imaging features in order to provide a more comprehensive assessment of oncological status. Advanced magnetic resonance imaging (MRI) sequences such as diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) with dynamic contrast-enhanced (DCE) perfusion imaging are reviewed in the context of the initial and post-therapeutic assessment of musculoskeletal tumors. Particular attention is directed to the pseudoprogression phenomenon in which a successfully treated tumor enlarges from the pretherapeutic baseline, followed by regression without a change in therapy.
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Affiliation(s)
- Raul Fernando Valenzuela
- The University of Texas MD Anderson Cancer Center, Department of Musculoskeletal Imaging, Houston, Texas.
| | - Vikas Kundra
- The University of Texas MD Anderson Cancer Center, Department of Musculoskeletal Imaging, Houston, Texas
| | - John E Madewell
- The University of Texas MD Anderson Cancer Center, Department of Musculoskeletal Imaging, Houston, Texas
| | - Colleen M Costelloe
- The University of Texas MD Anderson Cancer Center, Department of Musculoskeletal Imaging, Houston, Texas
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25
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Napoli A, Alfieri G, Scipione R, Leonardi A, Fierro D, Panebianco V, De Nunzio C, Leonardo C, Catalano C. High-intensity focused ultrasound for prostate cancer. Expert Rev Med Devices 2020; 17:427-433. [PMID: 32275187 DOI: 10.1080/17434440.2020.1755258] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
High-intensity focused ultrasound (HIFU) is a noninvasive procedure that has shown promising results in a wide range of malignant and nonmalignant conditions, including localized prostate cancer (PCa). This review aims to describe the application of HIFU in the management of patients with PCa, explaining its basic therapeutic principles, going through the main phases during aHIFU session, and providing an overview of the main available pieces of evidence from literature. HIFU treatment for prostate cancer is increasingly performed with high success and safety. MR guidance (MR-guided HIFU) has the advantage of real-time intraprocedural thermometric feedback that ensures that the whole region of interest has been covered by critical thermal damage (and that all surrounding healthy tissues have been spared). The absence of comparative long-term trials prevents HIFU from being considered as afirst choice for the treatment of patients with PCa.
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Affiliation(s)
- Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Giulia Alfieri
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Roberto Scipione
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Andrea Leonardi
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Davide Fierro
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Valeria Panebianco
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
| | - Cosimo De Nunzio
- UOC Urologia, Ospedale Sant'Andrea, Sapienza, University of Rome, Italy
| | - Costantino Leonardo
- Department of Gynecology-Obstetrics and Urology, Sapienza University of Rome; Rome (RM), Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome; Rome (RM), Italy
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26
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Qiao W, Yu Y, Huang Y, Gao W, Liu Z. Impact of focused ultrasound on the ethanol ablation of VX2 liver tumours in rabbits. Eur Radiol 2020; 30:5862-5870. [PMID: 32533238 DOI: 10.1007/s00330-020-06941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES In this study, a treatment combining ethanol ablation (EA) and focused ultrasound (FUS) was performed to investigate its synergistic ablation effect on normal liver and VX2 liver tumours in rabbits. METHODS A total of 59 healthy New Zealand white rabbits were included. For normal liver ablation, 39 animals were treated with FUS alone (n = 12), EA alone (n = 12), EA+FUS combination treatment (n = 12), or the control treatment (n = 3). The other 20 rabbits with implanted VX2 liver tumours were treated with EA alone (n = 10) or EA+FUS (n = 10). For FUS, the liver was exposed to 1 MHz FUS with an intensity of 33.0 W/cm2 (ISPTA) for 20 s. The EA group received an injection of absolute ethanol in the liver or liver tumours. For EA+FUS combination therapy, FUS was focused at the EA injection site, and both methods were carried out at the same time. RESULTS In normal liver tissues, the ablated volume treated by FUS combined with EA (1.46 ± 0.30 cm3) was approximately 3 times larger than that of EA alone (0.51 ± 0.17 cm3); in VX2 liver tumours, the tumour necrosis rate of the combination therapy was 90.27%, which was much higher than that of EA treatment (63.55%). CONCLUSION The combination of EA and FUS could effectively increase the liver ablation volume and induce more complete tumour necrosis. KEY POINTS • This study demonstrated a novel method for enhancing ethanol ablation and elucidated its potential to enhance percutaneous ethanol ablation (PEA) in a simple non-invasive way. • Ethanol excited by focused ultrasound (FUS) exposure tended to accumulate at the injection site, which could prevent ethanol from being washed out by the bloodstream. • The combination of EA and FUS could effectively increase the liver ablation volume and induce more complete tumour necrosis.
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Affiliation(s)
- Wei Qiao
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Yanlan Yu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Ye Huang
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Wenhong Gao
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China
| | - Zheng Liu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, 400037, China.
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Filippiadis DK, Tselikas L, Bazzocchi A, Efthymiou E, Kelekis A, Yevich S. Percutaneous Management of Cancer Pain. Curr Oncol Rep 2020; 22:43. [DOI: 10.1007/s11912-020-00906-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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28
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Izadifar Z, Izadifar Z, Chapman D, Babyn P. An Introduction to High Intensity Focused Ultrasound: Systematic Review on Principles, Devices, and Clinical Applications. J Clin Med 2020; 9:jcm9020460. [PMID: 32046072 PMCID: PMC7073974 DOI: 10.3390/jcm9020460] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 12/22/2022] Open
Abstract
Ultrasound can penetrate deep into tissues and interact with human tissue via thermal and mechanical mechanisms. The ability to focus an ultrasound beam and its energy onto millimeter-size targets was a significant milestone in the development of therapeutic applications of focused ultrasound. Focused ultrasound can be used as a non-invasive thermal ablation technique for tumor treatment and is being developed as an option to standard oncologic therapies. High-intensity focused ultrasound has now been used for clinical treatment of a variety of solid malignant tumors, including those in the pancreas, liver, kidney, bone, prostate, and breast, as well as uterine fibroids and soft-tissue sarcomas. Magnetic resonance imaging and Ultrasound imaging can be combined with high intensity focused ultrasound to provide real-time imaging during ablation. Magnetic resonance guided focused ultrasound represents a novel non-invasive method of treatment that may play an important role as an alternative to open neurosurgical procedures for treatment of a number of brain disorders. This paper briefly reviews the underlying principles of HIFU and presents current applications, outcomes, and complications after treatment. Recent applications of Focused ultrasound for tumor treatment, drug delivery, vessel occlusion, histotripsy, movement disorders, and vascular, oncologic, and psychiatric applications are reviewed, along with clinical challenges and potential future clinical applications of HIFU.
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Affiliation(s)
- Zahra Izadifar
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada
- Correspondence: ; Tel.: +1-306-966-7827; Fax: +1-306-966-4651
| | - Zohreh Izadifar
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Dean Chapman
- Anatomy & Cell Biology, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Paul Babyn
- Department of Medical Imaging, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
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29
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Gennaro N, Sconfienza LM, Ambrogi F, Boveri S, Lanza E. Thermal ablation to relieve pain from metastatic bone disease: a systematic review. Skeletal Radiol 2019; 48:1161-1169. [PMID: 30627778 DOI: 10.1007/s00256-018-3140-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review the efficacy of percutaneous thermal ablation (TA) of bone metastases (radiofrequency ablation [RFA], microwave ablation [MWA], cryoablation [CA], and MR-guided focused ultrasound [MRgFUS]) in reducing pain in patients with advanced stage cancer. MATERIALS AND METHODS We searched MEDLINE/PubMed, MEDLINE In-Process, BIDS ISI, Embase, CINAHL, and the Cochrane database using the keywords "ablation," "painful," "bone," and "metastases" combined in multiple algorithms. Inclusion criteria were: original clinical studies published between 2001 and 2018; performance of RFA, MWA, CA or MRgFUS; and quantitative pain assessment before/after TA of bone metastasis. RESULTS Eleven papers (3 on RFA, 1 on MWA, 2 on CA, and 5 on MRgFUS) involving 364 patients were reviewed. A technical success rate of 96-100% was reported, with follow-up for up to 6 months. At baseline, pain scores ranged from 5.4 to 8, at 1-4 weeks from 0.5 to 5, and at 12 weeks from 0.3 to 4.5. Mean pain reduction compared with baseline ranged from 26 to 91% at 4 weeks and from 16% to 95% at 12 weeks. MWA treatments caused no complications, whereas MRgFUS showed the highest complication rate. The number of minor complications observed ranged from 0 to 59 (complication ratio 0-1.17), whereas the number of significant adverse effects ranged from 0 to 4 (complication ratio 0-0.04). CONCLUSION All techniques achieved pain relief after 1 and 3 months, in up to 91% and 95% of patients respectively. MWA showed a negligible complication rate, whereas MRgFUS is associated with a noteworthy rate of adverse events. Future studies should adopt a standardized pain reporting scale to allow for meta-analysis.
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Affiliation(s)
- Nicolò Gennaro
- Specialization School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Italy.
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milano, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milano, Italy
| | - Sara Boveri
- Direzione Scientifica, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Ezio Lanza
- Dipartimento di Radiologia Diagnostica e Interventistica, Humanitas Research Hospital, Rozzano, Italy
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Filippiadis DK, Cornelis FH, Kelekis A. Interventional oncologic procedures for pain palliation. Presse Med 2019; 48:e251-e256. [DOI: 10.1016/j.lpm.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/11/2019] [Indexed: 01/05/2023] Open
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Concurrent Osteosarcoma Theranostic Strategy Using Contrast-Enhanced Ultrasound and Drug-Loaded Bubbles. Pharmaceutics 2019; 11:pharmaceutics11050223. [PMID: 31071997 PMCID: PMC6571587 DOI: 10.3390/pharmaceutics11050223] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 12/02/2022] Open
Abstract
Osteosarcoma (OS) is the most common bone tumor in children and teenagers. The multidrug resistant property of OS produces a major obstacle to chemotherapy, since the effective drug dose cannot be achieved via conventional drug delivery routes without serious systemic cytotoxicity. Microbubbles in conjunction with ultrasound (US) has recently been shown to spatially and temporally permeabilize the cellular membrane, promoting drug penetration into tumors. Here, we investigated whether drug (doxorubicin, DOX)-loaded bubbles (DOX-bubbles) can serve as drug-loaded carriers in combination with US in order to facilitate tumor drug delivery. The proposed bubbles have a high payload capacity (efficiency of 69.4 ± 9.1%, payload of 1.4 mg/mL) for DOX. In vitro data revealed that when used in combination with US (1-MHz), these DOX-bubbles facilitate DOX entering into tumor cells. In tumor-bearing animals, DOX-bubbles + US could provide 3.7-fold suppression of tumor growth compared with the group without insonation (1.8 ± 0.9 cm3 vs. 8.5 ± 2.2 cm3) because of the acceleration of DOX-induced tumor necrosis. In the meantime, the tumor perfusion and volume can be monitored by DOX-bubbles with contrast-enhanced ultrasound imaging. Our data provide useful information in support of translating the use of theranostic US-responsive bubbles for regulated tumor drug delivery into clinical use.
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Bitton RR, Webb TD, Pauly KB, Ghanouni P. Prolonged heating in nontargeted tissue during MR‐guided focused ultrasound of bone tumors. J Magn Reson Imaging 2019; 50:1526-1533. [DOI: 10.1002/jmri.26726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- Rachel R. Bitton
- School of Medicine, Department of RadiologyStanford University Stanford California USA
| | - Taylor D. Webb
- Department of Electrical EngineeringStanford University Stanford California USA
| | - Kim Butts Pauly
- School of Medicine, Department of RadiologyStanford University Stanford California USA
| | - Pejman Ghanouni
- School of Medicine, Department of RadiologyStanford University Stanford California USA
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Bertrand AS, Iannessi A, Natale R, Beaumont H, Patriti S, Xiong-Ying J, Baudin G, Thyss A. Focused ultrasound for the treatment of bone metastases: effectiveness and feasibility. J Ther Ultrasound 2018; 6:8. [PMID: 30519467 PMCID: PMC6267064 DOI: 10.1186/s40349-018-0117-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022] Open
Abstract
Background To evaluate the effectiveness and feasibility of high-intensity focused ultrasound (HIFU) for the treatment of bone metastases. Methods A single-center prospective study was made involving 17 consecutive patients with symptomatic bone metastases. Patients were treated by Focused Ultrasound (FUs) performed with magnetic resonance (MR) guidance. Surgical treatment or radiotherapy treatment was not indicated for patients who underwent FUs. Lesions were located in the appendicular and axial skeleton and consisted of secondary symptomatic lesions. The clinical course of pain was evaluated using the Visual Analog Scale (VAS) before treatment, at 1 week, and at 1 month after treatment and the Oral Morphine Equivalent Daily Dose (OMEDD) was also recorded. We used Wilcoxon signed rank test to assess change in patient pain (R CRAN software V 3.1.1). Results We observed a significant decrease in the pain felt by patients between pre- procedure and 1 week post-procedure (p = 2.9.10-4), and pre-procedure and 1 month post-procedure (p = 3.10-4). The proportion of responders according to the International Bone Metastases Consensus Working Party was: Partial Response 50% (8/16) and Complete Response 37.5% (6/16). Conclusions HIFU under MR-guidance seems to be an effective and safe procedure in the treatment of symptomatic bone lesions for patients suffering from metastatic disease. A significant decrease of patient pain was observed. Trial registration NCT01091883. Registered 24 March 2010. Level of evidence: Level 3.
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Affiliation(s)
- Anne-Sophie Bertrand
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Antoine Iannessi
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Romain Natale
- Department of Radiotherapy, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Hubert Beaumont
- 3Department of Statistics, University of Nice Sophia Antipolis, 28 Avenue Valrose, 06000 NICE, France
| | - Sebastien Patriti
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Jiang Xiong-Ying
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Guillaume Baudin
- Department of Interventional Radiology, Centre de Lutte contre le Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
| | - Antoine Thyss
- Department of Oncology, Centre de Lutte anti-Cancer Antoine Lacassagne, 33 Avenue de Valombrose, 06100 NICE, France
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Scipione R, Anzidei M, Bazzocchi A, Gagliardo C, Catalano C, Napoli A. HIFU for Bone Metastases and other Musculoskeletal Applications. Semin Intervent Radiol 2018; 35:261-267. [PMID: 30402009 DOI: 10.1055/s-0038-1673363] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
High-intensity focused ultrasound (HIFU) is a totally noninvasive procedure that has shown promising results in the management of numerous malignant and nonmalignant conditions. Under magnetic resonance or ultrasound guidance, high-intensity ultrasound waves are focused on a small, well-defined target region, inducing biologic tissue heating and coagulative necrosis, thus resulting in a precise and localized ablation. This treatment has shown both great safety and efficacy profiles, and may offer a multimodal approach to different diseases, providing pain palliation, potential local tumor control, and, in some cases, remineralization of trabecular bone. In musculoskeletal field, HIFU received FDA approval for treating bone metastasis, but its application has also been extended to other conditions, such as osteoid osteoma, desmoid tumor, low-flow vascular malformation, and facet joint osteoarthritis. This article illustrates the basic principles of HIFU and its main effects on biologic tissues with particular attention on bone, provides a step-by-step description of the HIFU procedure, and discusses the commonly treated conditions, in particular bone metastases.
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Affiliation(s)
- Roberto Scipione
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Michele Anzidei
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alberto Bazzocchi
- Department of Radiology, Rizzoli Orthopedic Institute, University of Bologna, Bologna, Italy
| | - Cesare Gagliardo
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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Percutaneous Minimally Invasive Thermal Ablation of Musculoskeletal Lesions: Usefulness of PET-Computed Tomography. PET Clin 2018; 13:579-585. [PMID: 30219189 DOI: 10.1016/j.cpet.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article discusses the role of PET-computed tomography in percutaneous minimally invasive ablation of osseous metastases including diagnosis and preprocedural factors related to patient selection and procedure planning, intraprocedural imaging guidance, and posttreatment imaging assessment.
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Bing F, Vappou J, de Mathelin M, Gangi A. Targetability of osteoid osteomas and bone metastases by MR-guided high intensity focused ultrasound (MRgHIFU). Int J Hyperthermia 2018; 35:471-479. [DOI: 10.1080/02656736.2018.1508758] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fabrice Bing
- Radiology Department, Hôpital d’Annecy, Metz-Tessy, France
- ICube, University of Strasbourg, Strasbourg, France
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Afshin Gangi
- ICube, University of Strasbourg, Strasbourg, France
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Cazzato RL, Arrigoni F, Boatta E, Bruno F, Chiang JB, Garnon J, Zugaro L, Giordano AV, Carducci S, Varrassi M, Beomonte Zobel B, Bazzocchi A, Aliprandi A, Basile A, Marcia S, Masala S, Grasso RF, Squarza S, Floridi C, Ierardi AM, Burdi N, Cioni R, Napoli A, Niola R, Rossi G, Rossi UG, Venturini M, De Cobelli F, Carotti M, Gravina GL, Di Staso M, Zoccali C, Biagini R, Tonini G, Santini D, Carrafiello G, Cariati M, Silvestri E, Sconfienza LM, Giovagnoni A, Masciocchi C, Gangi A, Barile A. Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med 2018; 124:34-49. [DOI: 10.1007/s11547-018-0938-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
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Chen ZQ, Wang CR, Ma XJ, Sun W, Shen JK, Sun MX, Fu ZZ, Hua YQ, Cai ZD. Evaluation of Quality of Life Using EORTC QLQ-BM22 in Patients with Bone Metastases after Treatment with Magnetic Resonance Guided Focused Ultrasound. Orthop Surg 2018; 10:264-271. [PMID: 30019516 DOI: 10.1111/os.12383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/01/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To reveal the alterations in quality of life (QOL) in bone metastases patients after magnetic resonance guided focused ultrasound (MRgFUS). METHODS This retrospective study enrolled 26 patients diagnosed with bone metastases. Patients had various primary malignant tumors and tumor lesions in different locations. All patients received MRgFUS for bone metastasis. Each focal spot sonication pulse that was applied to create energy deposition lasted 20 s and was performed at a frequency of 1.05 MHz. The visual analog scale (VAS) was used to measure pain level and the EORTC QLQ-BM22 was applied to evaluate QOL for 12 months. The lower the QLQ-BM22 score, the better the QOL of patients. RESULTS The painful site subscale of the EORTC QLQ-BM22 was observed without significant change. Significant reductions in the functional subscales were observed after therapy compared with the baseline. The functional interference was reduced significantly during the first 12 months. From the 2-month time point onwards, the pain characteristics subscale also decreased significantly. VAS scores had decreased by 40.8% 1 month after the operation and had decreased 10.9% compared with VAS scores preoperation. Scores for pain characteristics decreased by 28.8% after the operation and the scores were still down by 10.8% 1 year after the treatment. VAS scores indicated a significant reduction in pain over the course of the research until the 12-month time point follow-up compared with the baseline. CONCLUSION MRgFUS therapy improved the QOL of patients with bone metastasis by relieving bone pain.
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Affiliation(s)
- Zheng-Qi Chen
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chong-Ren Wang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Jun Ma
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Sun
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia-Kang Shen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng-Xiong Sun
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ze-Ze Fu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Qi Hua
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng-Dong Cai
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Jondal DE, Wang J, Chen J, Gorny KR, Felmlee J, Hesly G, Laughlin-Tommaso S, Stewart EA, Ehman R, Woodrum DA. Uterine fibroids: correlations between MRI appearance and stiffness via magnetic resonance elastography. Abdom Radiol (NY) 2018; 43:1456-1463. [PMID: 28952003 DOI: 10.1007/s00261-017-1314-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance elastography has proven to be a valuable tool in the diagnosis of liver fibrosis, breast and cervical cancer, but its application in uterine fibroids requires further characterization. The aim of the present study was to examine the relationship between uterine fibroid stiffness by MRE and MR imaging characteristics. MATERIALS AND METHODS An IRB-approved, HIPAA compliant review was performed of prospectively collected pelvic MRI and 2D-MRE data in patients with symptomatic uterine fibroids (N = 102). T1 and T2 weighted pelvic MRI with gadolinium enhancement were performed. In a small patient subset, fibroid stiffness was assessed by both 2D and 3D MRE. Fibroid stiffness by modality or imaging characteristics was analyzed using one-way analysis of variance followed by Student t test. RESULTS Four fibroid groups were identified based on T2 appearance: Isointense (N = 7), bright (N = 6), dark with minimal heterogeneity (N = 69), and dark with substantial heterogeneity (N = 20). Mean fibroid stiffness was 4.81 ± 2.12 kPa. Comparison of fibroid stiffness by T2 signal intensity showed that T2 bright fibroids were significantly less stiff than fibroids appearing T2 dark with minimal heterogeneity (mean stiffness difference = 2.38 kPa; p < 0.05) and T2 dark fibroids with substantial heterogeneity were significantly less stiff than T2 dark fibroids with minimal heterogeneity (mean difference = 1.25 kPa; p < 0.05). There was no significant association between fibroid stiffness and T1 signal characteristics or gadolinium enhancement. There was no significant difference in stiffness values obtained by either 2D vs. 3D MRE. CONCLUSIONS These data suggest differences in fibroid stiffness are associated with different T2 imaging characteristics with less stiff fibroids being T2 bright and more stiff fibroids being T2 dark. Further studies are needed to determine if fibroid stiffness by MRE may serve as an imaging biomarker to help predict MR-guided treatment response.
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Affiliation(s)
- Danielle E Jondal
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jin Wang
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jun Chen
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Krzysztof R Gorny
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joel Felmlee
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gina Hesly
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shannon Laughlin-Tommaso
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth A Stewart
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Richard Ehman
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David A Woodrum
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Arrigoni F, Bruno F, Zugaro L, Splendiani A, Di Cesare E, Barile A, Masciocchi C. Role of interventional radiology in the management of musculoskeletal soft-tissue lesions. Radiol Med 2018; 124:253-258. [PMID: 29687209 DOI: 10.1007/s11547-018-0893-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/09/2018] [Indexed: 12/13/2022]
Abstract
The lesions of the soft tissues are rare and extremely heterogeneous; even if the surgical treatment is usually the standard therapy, the role of the interventional radiology (IR) in this field is growing up for multiple reasons. First, because the imaging alone usually is not able to ensure a definitive diagnosis, IR has a basic role in the staging: the percutaneous biopsy is infact an irreplaceable step. Moreover, biopsy is necessary not only for histologic evaluations but also for the biochemical and molecular studies. Furthermore, the proved safety and effectiveness of IR in a multiple oncologial applications prompt a wider use also in this field.
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Affiliation(s)
- Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Luigi Zugaro
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy.
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
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Haller J, Wilkens V. Determination of Acoustic Cavitation Probabilities and Thresholds Using a Single Focusing Transducer to Induce and Detect Acoustic Cavitation Events: II. Systematic Investigation in an Agar Material. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:397-415. [PMID: 29195755 DOI: 10.1016/j.ultrasmedbio.2017.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 05/05/2023]
Abstract
In the accompanying article (Part I), a method is described to determine acoustic cavitation probabilities in tissue-mimicking materials (TMMs) using a high-intensity focused ultrasound (HIFU) transducer for both inducing and detecting the acoustic cavitation events, and its suitability for different sonication modes like continuous wave, single pulses (with pulse lengths from microseconds to milliseconds) and repeated burst signals is discussed. In Part II, the use of the method for a systematic study of the dependence of the acoustic cavitation thresholds in 3% (by weight) agar phantoms on the temporal sonication parameters is discussed. The values obtained at a frequency of 1.06 MHz, ranging from (0.58 ± 0.12) MPa for a 3-s continuous wave mode sonication to (5.2 ± 1.0) MPa for single shots with a length of 10 wave cycles, are discussed and interpreted on the basis of literature values and their self-consistency.
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Affiliation(s)
- Julian Haller
- Physikalisch-Technische Bundesanstalt, Braunschweig, Germany
| | - Volker Wilkens
- Physikalisch-Technische Bundesanstalt, Braunschweig, Germany.
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44
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Dababou S, Marrocchio C, Scipione R, Erasmus HP, Ghanouni P, Anzidei M, Catalano C, Napoli A. High-Intensity Focused Ultrasound for Pain Management in Patients with Cancer. Radiographics 2018; 38:603-623. [PMID: 29394144 DOI: 10.1148/rg.2018170129] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cancer-related pain affects up to 80% of patients with malignancies. Pain is an important distressing symptom that diminishes the quality of life and negatively affects the survival of patients. Opioid analgesics are generally the primary therapy for cancer-related pain, with surgery, radiation therapy, chemotherapy, and other interventions used in cases of treatment-resistant pain. These treatments, which can be associated with substantial side effects and systemic toxicity, may not be effective. High-intensity focused ultrasound is an entirely noninvasive technique that is approved for treatment of uterine fibroids, bone metastases, and essential tremors. With magnetic resonance imaging or ultrasonographic guidance, high-intensity ultrasound waves are focused on a small well-demarcated region to result in precise localized ablation. This treatment may represent a multimodality approach to treating patients with malignant diseases-facilitating pain palliation, enhanced local drug delivery and radiation therapy effects, and stimulation of anticancer specific immune responses, and potentially facilitating local tumor control. Focused ultrasound can be used to achieve pain palliation by producing several effects, including tissue denervation, tumor mass reduction, and neuromodulation, that can influence different pathways at the origin of the pain. This technology has several key advantages compared with other analgesic therapies: It is completely noninvasive, might be used to achieve rapid pain control, can be safely repeated, and can be used in combination with chemotherapy and radiation therapy to enhance their effects. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Susan Dababou
- From the Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, V.le Regina Elena 324, 00180 Rome, Italy (S.D., C.M., R.S., H.P.E., M.A., C.C., A.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.G.)
| | - Cristina Marrocchio
- From the Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, V.le Regina Elena 324, 00180 Rome, Italy (S.D., C.M., R.S., H.P.E., M.A., C.C., A.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.G.)
| | - Roberto Scipione
- From the Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, V.le Regina Elena 324, 00180 Rome, Italy (S.D., C.M., R.S., H.P.E., M.A., C.C., A.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.G.)
| | - Hans-Peter Erasmus
- From the Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, V.le Regina Elena 324, 00180 Rome, Italy (S.D., C.M., R.S., H.P.E., M.A., C.C., A.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.G.)
| | - Pejman Ghanouni
- From the Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, V.le Regina Elena 324, 00180 Rome, Italy (S.D., C.M., R.S., H.P.E., M.A., C.C., A.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.G.)
| | - Michele Anzidei
- From the Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, V.le Regina Elena 324, 00180 Rome, Italy (S.D., C.M., R.S., H.P.E., M.A., C.C., A.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.G.)
| | - Carlo Catalano
- From the Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, V.le Regina Elena 324, 00180 Rome, Italy (S.D., C.M., R.S., H.P.E., M.A., C.C., A.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.G.)
| | - Alessandro Napoli
- From the Department of Radiological Sciences, Sapienza University of Rome, School of Medicine, V.le Regina Elena 324, 00180 Rome, Italy (S.D., C.M., R.S., H.P.E., M.A., C.C., A.N.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.G.)
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Arrigoni F, Bruno F, Zugaro L, Natella R, Cappabianca S, Russo U, Papapietro VR, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Developments in the management of bone metastases with interventional radiology. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:166-174. [PMID: 29350645 PMCID: PMC6179078 DOI: 10.23750/abm.v89i1-s.7020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/08/2023]
Abstract
Interventional radiology has known an exponential growth in the last years. Technological advances of the last decades, have made it possible to use new treatments on a larger scale, with safe and effective results. They could be considered as palliative treatments for painful lesions but also curative procedures, as single treatment or specially in combination with other techniques (surgery, radiation and oncology therapies, etc.).The main diffuse techniques are those of thermal ablation that destroy the target lesion through the heat; however there are also endovascular therapies that destroy the target tissue thanks to devascularization. Finally the is also the possibility to stabilize pathological fractures or impending fractures. In this paper all the most diffuse and effective techniques are reviewed and also a discussion of the main indications is done, with an analisys of the success and complications rates.
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Kelekis A, Cornelis FH, Tutton S, Filippiadis D. Metastatic Osseous Pain Control: Bone Ablation and Cementoplasty. Semin Intervent Radiol 2017; 34:328-336. [PMID: 29249856 PMCID: PMC5730439 DOI: 10.1055/s-0037-1608747] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-guided treatments appear as an interesting alternative for localized metastatic lesions of the peripheral skeleton.
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Affiliation(s)
- Alexis Kelekis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
| | - Francois H. Cornelis
- Department of Radiology, Université Pierre et Marie Curie, Sorbonne Université, Tenon Hospital, Paris, France
| | - Sean Tutton
- Division of Vascular and Interventional Radiology, Department of Radiology and Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dimitrios Filippiadis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
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Mougenot C, Moonen C. Magnetic Resonance-guided High Intensity Focused Ultrasound in the presence of biopsy markers. J Ther Ultrasound 2017; 5:25. [PMID: 28944056 PMCID: PMC5607585 DOI: 10.1186/s40349-017-0103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/08/2017] [Indexed: 01/31/2023] Open
Abstract
Background Magnetic Resonance guided High Intensity Focused ultrasound (MR-HIFU) offers precise non-invasive thermotherapy for clinical applications such as the treatment of breast lesions. However, patients with a biopsy marker are usually not eligible for MR-HIFU treatment. This study investigates the interaction of some MR-compatible markers with MR-HIFU thermotherapy. Methods The MR-HIFU compatibility of 14 markers (6 Gold Anchor and 4 Visicoil markers in gold, 1 Visicoil marker in brass, 3 BiomarC markers in carbon coated) were tested using the Sonalleve breast MR-HIFU platform at 1.5 T. The impact of these markers was assessed by counting the number of voxels with low signal intensity on MR thermal maps and by comparing temperature increases induced by the HIFU beam. Results Most markers were visible on thermal maps with an apparent size 4.2 ± 3.1 and 2 ± 1.8 times larger than their respective actual width and length. The volume of masked voxels was for most of the markers much larger than the actual volume of the marker (up to a factor 65.1). However, it represents only a small fraction of the 12 mm diameter targeted region (up to 8.8 voxels which represents 19% of this targeted region). Some differences in the maximal temperature increase were observed especially for BiomarC 1 × 3 and BiomarC 2 × 4 markers enhancing the heating. These differences were less pronounced at the edge of the targeted region. Conclusion All markers had a minimal impact on the volume above the thermal dose threshold of 240 EM since the differences measured were smaller than the in-plane image resolution of 1.56 mm.
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Affiliation(s)
- Charles Mougenot
- University Medical Center Utrecht, Heidelberglaan 100, Room Q03.4.21, 3584 CX Utrecht, The Netherlands
| | - Chrit Moonen
- University Medical Center Utrecht, Heidelberglaan 100, Room Q03.4.21, 3584 CX Utrecht, The Netherlands
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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Lee HL, Kuo CC, Tsai JT, Chen CY, Wu MH, Chiou JF. Magnetic Resonance-Guided Focused Ultrasound Versus Conventional Radiation Therapy for Painful Bone Metastasis: A Matched-Pair Study. J Bone Joint Surg Am 2017; 99:1572-1578. [PMID: 28926387 DOI: 10.2106/jbjs.16.01248] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) is an alternative local therapy for patients with painful bone metastasis for whom standard conventional radiation therapy (RT) has failed. However, the therapeutic effects of MRgFUS as a first-line treatment for bone metastasis remain uncertain. METHODS A matched-pair study was conducted to compare the therapeutic effects of MRgFUS with those of conventional RT as a first-line treatment for patients with painful bone metastasis. The MRgFUS and RT-treated groups were matched 1:2 by age, sex, primary cancer, pretreatment pain score, and treated site. RESULTS According to the criteria for patient eligibility and matching, 21 and 42 patients (total, 63 patients) with bone metastasis treated with MRgFUS and conventional RT, respectively, were enrolled for analyses. The median ages of the MRgFUS and RT-treated patients were 59 and 61 years, respectively. Among the enrolled patients, 52% were male and 48% were female. The results showed that both MRgFUS and RT were effective. However, MRgFUS was more efficient than RT in terms of the time course of pain palliation as it yielded a significantly higher response rate at 1 week after treatment (71% versus 26%, p = 0.0009). CONCLUSIONS MRgFUS provides a similar overall treatment response rate but faster pain relief compared with conventional RT and has the potential to serve as the first-line treatment for painful bone metastasis in selected patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hsin-Lun Lee
- 1Departments of Radiation Oncology (H.-L.L. and J.-F.C.) and Orthopaedic Surgery (M.-H.W.), Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan 2The Ph.D. Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei Medical University, Taipei, Taiwan 3Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan 4Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Pain management: The rising role of interventional oncology. Diagn Interv Imaging 2017; 98:627-634. [DOI: 10.1016/j.diii.2017.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/27/2017] [Indexed: 02/06/2023]
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