title: Primary pain palliation and local tumor control in bone metastases treated with magnetic resonance-guided focused ultrasound.
abstract: OBJECTIVE
  The objectives of this study were to evaluate the efficacy in pain management of magnetic resonance (MR)-guided focused ultrasound for the primary treatment of painful bone metastases and to assess its potential for local control of bone metastases.
  
  
  METHODS
  This was a prospective, single-arm research study with approval from the institutional review board. Eighteen consecutive patients (female, 8; male, 10; mean [SD] age, 62.7 [11.5] years) with painful bone metastases were enrolled. The patients were examined clinically for pain severity and pain interference in accordance with the Brief Pain Inventory-Quality of Life criteria before and at each follow-up visit. Computed tomography and MR imaging were performed before and at 1 and 3 months after the magnetic resonance-guided focused ultrasound treatment. The nonperfused volume (NPV) was calculated to correlate the extension of the ablated pathological tissue in the responder and nonresponder patients.
  
  
  RESULTS
  No treatment-related adverse events were recorded during the study. The evaluation of pain palliation revealed a statistically significant difference between baseline and follow-up values for pain severity and pain interference (P = 0.001, both evaluations). In the evaluation of local tumor control, we observed increased bone density with restoration of cortical borders in 5 of the 18 patients (27.7%). In accordance with the MD Anderson criteria, complete and partial responses were obtained in 2 of the 18 patients (11.1%) and 4 of the 18 patients (22.2%), respectively. Nonperfused volume values ranged between 20% and 93%. Mean NPV values remained substantially stable after the treatment (P = 0.08). There was no difference in the NPV values between the responder and nonresponder patients (46.7% [24.2%] [25%-90%] versus 45% [24.9%] [20%-93%]; P = 0.7).
  
  
  CONCLUSIONS
  Magnetic resonance-guided focused ultrasound can be safely and effectively used as the primary treatment of pain palliation in patients with bone metastases and has a potential role in local tumor control.
authors.affiliation: Department of Radiology, Oncology and Anatomic Pathology, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena, Rome, Italy. alessandro.napoli@uniroma1.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Napoli
authors.forename: Michele
authors.initials: M
authors.lastname: Anzidei
authors.forename: Beatrice Cavallo
authors.initials: BC
authors.lastname: Marincola
authors.forename: Giulia
authors.initials: G
authors.lastname: Brachetti
authors.forename: Federica
authors.initials: F
authors.lastname: Ciolina
authors.forename: Gaia
authors.initials: G
authors.lastname: Cartocci
authors.forename: Claudia
authors.initials: C
authors.lastname: Marsecano
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zaccagna
authors.forename: Luca
authors.initials: L
authors.lastname: Marchetti
authors.forename: Enrico
authors.initials: E
authors.lastname: Cortesi
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
mesh_terms: D001859:Bone Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D010166:Palliative Care / Q000379:methods*; D016896:Treatment Outcome