Brachetti Giulia MD, Abstract Co-Author: Nothing to Disclose

Valeria De Soccio, Abstract Co-Author: Nothing to Disclose

Fabrizio Andrani, Abstract Co-Author: Nothing to Disclose

Gianluca Caliolo, Abstract Co-Author: Nothing to Disclose

Fulvio Zaccagna MD, Abstract Co-Author: Nothing to Disclose

Alessandro Napoli MD, Presenter: Nothing to Disclose

to evaluate the efficacy of MRgFUS for treatment of painful bone metastases and its potential for local tumor control.

after IRB approval 42 patients were scheduled for treatment using the Exablate system (InSightec). Before and 1, 2 and 3 months after MRgFUS treatment, pain scores were assessed according to Brief Pain Inventory-Quality of Life (BPI-QoL) criteria. Imaging (CT and ceMR: Bracco) follow-up was obtained at 1 and 3 months; in survivals, follow-up was extended at 6 and 12 months. For local tumor control, imaging changes were evaluated with the MD Anderson (MDA) criteria. Patients were classified in responder and non-responders. The extent of necrosis within the ablated metastasis was evaluated using non-perfused volume (NPV).

All 42 patients underwent MRgFUS (20 recurrence post-RT; 22 primary treatment). Statistically significant difference between baseline and follow-up values for both pain severity and pain interference scores was observed (p<0.05; no statistical difference between the post-RT and primary treatment group). Stable pain score (VAS<2) was observed in survival group at 6 (15 patients) and 12 (9 patients) month control. Increased bone density was observed in 10 (23,8%) patients. Complete response was found in 20 (47,6%) patients; partial response was found in 22 (52,3%) patients (pain recurrence in 3 patients), according to both the MDA and clinical criteria. NPV values ranged between 23% and 94%. There was no difference in non-perfused volume between responders and non-responders (p=0.7). No adverse events were recorded

MRgFUS is an effective and durable treatment for pain palliation of bone metastasis; moreover, a positive role in local tumor control and bone restoration was demonstrated.  

MRgFUS can be safely and effectively used as treatment for pain palliation of bone metastasis in patients who had exhausted EBRT and also in patients not  previously treated with EBRT. The treatment creates bone metastasis necrosis and so might have a positive role in local tumor control and bone restoration.The major advantages of the technique include its non-invasive nature. The treatment can be performed in a single session, does not use ionizing radiation and utilizes MR guidance for precise targeting and thermal control.    

Giulia, B, De Soccio, V, Andrani, F, Caliolo, G, Zaccagna, F, Napoli, A, Pain Palliation of Bone Metastases and Local Tumor Control with Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) Treatment.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014073.html