Non-invasive magnetic resonance-guided focused ultrasound treatment (MRgFUS) that relieves pain and improves function for most patients with bone-related cancer pain when other treatment options are limited, according to a study published in the Journal of the National Cancer Institute.
“This is the first phase 3 study to use this technology in the treatment of cancer,” said lead author Mark Hurwitz, MD, Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Although radiation therapy is commonly used to treat bone-related pain and effective for most patients, not all patients experience pain relief and over time those who do may have recurrence of pain. In addition, it’s possible for a patient to receive the maximum radiation dose that can be safely delivered without fully controlling the pain. In situations where radiation therapy is not an option, alternative treatments are required.
For the study, 147 patients from 17 centres in the US, Canada, Israel, Italy, and Russia were enrolled in the study and randomised to undergo MRgFUS or a sham treatment.
Patients in the treatment group received focused ultrasound precisely targeted to their bone tumours to heat the tumour tissue to between 65 and 85 degrees Celsius, resulting in its destruction. During each treatment, the patients were monitored real-time via magnetic resonance imaging (MRI) to ensure the right tissue was targeted and the right temperatures were reached while ensuring heat in surrounding normal tissues and organs remained at safe levels. The control group underwent the same procedure but without the ultrasound device turned on.
Patients who did not respond to the placebo treatment within 2 weeks were allowed to be unblinded and offered MRgFUS.
Patients responded well to treatment, with 64% experiencing either no pain or a significant reduction in their pain at 3 months as measured by a 2 point or greater decrease in the numeric rating score (NRS) for pain. Many patients were able to reduce or stop use of opiod medications. Notably, most patients experienced pain relief and improved functioning within several days of treatment.
“It’s clear that for many of these patients, pain has a major impact on their everyday lives,” said Dr. Hurwitz. “This approach offers a new way to help alleviate that pain via an out-patient non-invasive procedure.”
He said that the next steps in this line of research is to refine the treatment technique to get an even greater response rate, and to apply radiation and thermal therapy together in treatment of bone metastases noting the established clinical benefits for other malignant conditions with this combination.