Looking to Reduce Bone Pain from Cancer? Consider MR-Guided HIFU

Adding MR-guided high intensity focused ultrasound (MR-HIFU) to existing cancer-induced bone pain (CIBP) control methods can result in better, faster pain management, according to the outcome of a recently published study.

Currently, external beam radiotherapy (EBRT), the CIBP standard-of-care, is effective for roughly 60 percent of patients. While it works, it can take up to three-to-four weeks to provide adequate pain relief, and as many as 50 percent of patients suffer a pain recurrence. These shortcomings leave the door open for improvements.

In a study from Clinical and Translational Radiation Oncology, investigators from the University Medical Center Utrecht in The Netherlands, tested whether adding MR-HIFU to EBRT would provide patients with a better result. According to the findings of their single-arm intervention study, it does.

“Our results show that combining these two treatment modalities is safe and feasible and may induce rapid pain relief in the first-line treatment of CIBP,” said the team led by Marcia M.T.J. Bartels, M.D., from the Utrecht radiology and radiation oncology departments.

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In fact, most patients experienced pain alleviation within a few days. At roughly a week after treatment, 83 percent of patients reported a pain reduction, and 60 percent indicated they benefitted from the combined treatment after 4 weeks.

This is the first study to combine both pain reduction methods, testing both safety and feasibility. The team enrolled six patients – five men – who had either prostate carcinoma, renal cell carcinoma, cholangiocarcinoma, or bladder cancer. All lesions were located in the pelvis or the extremities, and lesions averaged 56.5 mm in size. All patients reported a pain score of at least 4 on an 11-point scale.

After initially undergoing a single 8Gy dose or a five-session multi-fraction 20Gy dose regimen of EBRT, each patient also received MR-HIFU treatment via a 1.5T scanner. While patients were under sedation, they underwent a 1-second, 55-degree Celsius thermal dose. The team, then, collected their self-assessed pain levels after three days, as well as weekly for four weeks. A two-point drop in pain scores or a 25-percent reduction in use of analgesics indicated a positive pain response.

According to the team’s analysis, no study participant experienced any major adverse effects, and all patients said they were satisfied with the combined treatment, rating the dual therapy an 8.4 out of 10. Some patients achieved pain alleviation within three days, and, on average, pain relief scores fell by 3.5 points during the four weeks post-treatment.

Although larger studies are needed, the team said, this work is the first step toward broader research into using MR-HIFU as a first-line CIBP treatment.

“The biggest advantage of combining EBRT and MR-HIFU treatment could be that it achieves pain response as soon as three days after treatment, while also achieving the locoregional tumor control that EBRT sometimes strives for,” the team explained. “Moreover, the combined treatment could give better results as compared to either treatment modality separately due to complimentary and possible synergistic effects in the mechanisms of action.”

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