title: Magnetic Resonance-Guided High-Intensity-Focused Ultrasound for Palliation of Painful Skeletal Metastases: A Pilot Study.
abstract: Bone is one of the most common sites of metastases, with bone metastases-related pain representing a significant source of morbidity among patients with cancer. Magnetic resonance-guided focused ultrasound is a noninvasive, outpatient modality with the potential for treating painful bone metastases. The aim of this study is to report our initial experience with magnetic resonance-guided focused ultrasound in the treatment of bone metastases and our preliminary analysis of urinary cytokine levels after therapy.
  
  
  
  This was a single-center pilot study of 10 patients with metastatic cancer to investigate the feasibility of magnetic resonance-guided focused ultrasound for primary pain control in device-accessible skeletal metastases. Treatments were performed on a clinical magnetic resonance-guided focused ultrasound system using a volumetric ablation technique. Primary efficacy was assessed using Brief Pain Inventory scores and morphine equivalent daily dose intake at 3 time points: before, day 14, and day 30 after the magnetic resonance-guided focused ultrasound treatment. Urine cytokines were measured 3 days before treatment and 2 days after the treatment.
  
  
  
  Of the 10 patients, 8 were followed up 14 days and 6 were followed up 30 days after the treatment. At day 14, 3 patients (37.5%) exhibited partial pain response and 4 patients (50%) exhibited an indeterminate response, and at day 30 after the treatment, 5 patients (83%) exhibited partial pain response. No treatment-related adverse events were recorded. Of the urine cytokines measured, only Transforming growth factor alpha (TGFα) demonstrated an overall decrease, with a trend toward statistical significance ( P = .078).
  
  
  
  Our study corroborates magnetic resonance-guided focused ultrasound as a feasible and safe modality as a primary, palliative treatment for painful bone metastases and contributes to the limited body of literature using magnetic resonance-guided focused ultrasound for this clinical indication.
authors.affiliation: 1 Department of Medical Imaging, University of Toronto, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Chan
authors.affiliation: 2 Division of Radiation Oncology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Dennis
authors.affiliation: 3 Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Medical Biophysics, University of Toronto, Toronto, Canada.
authors.forename: Yuexi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: 4 Philips Healthcare, Markham, Ontario, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: Mougenot
authors.affiliation: 5 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
authors.affiliation: 6 Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Carlo
authors.initials: C
authors.lastname: DeAngelis
authors.affiliation: 5 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Coccagna
authors.affiliation: 5 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.affiliation: 3 Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Medical Biophysics, University of Toronto, Toronto, Canada.
authors.forename: Kullervo
authors.initials: K
authors.lastname: Hynynen
authors.affiliation: 3 Physical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Medical Biophysics, University of Toronto, Toronto, Canada.|5 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Gregory
authors.initials: G
authors.lastname: Czarnota
authors.affiliation: 5 Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Chu
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000556:secondary*; D000072716:Cancer Pain / Q000209:etiology* / Q000628:therapy*; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000379:methods; D010865:Pilot Projects; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Brief Pain Inventory; bone metastases; high-intensity-focused ultrasound; magnetic resonance thermometry; magnetic resonance–guided focused ultrasound