BACKGROUND: Pain management is the primary goal of treatment of patients with bone metastases' Curre - PowerPoint PPT Presentation

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BACKGROUND: Pain management is the primary goal of treatment of patients with bone metastases' Curre

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Title: BACKGROUND: Pain management is the primary goal of treatment of patients with bone metastases' Curre


1
MRI Guided Focused Ultrasound, A Novel Treatment
for Palliation of bone Metastases in Radiation
Therapy Failure Patients
Raphael Pfeffer1, Tatiana Rabin1, David
Gianfelice2, Alexander Beck3, Yael Inbar1, Boaz
Liberman1, Nogah Shabshin1, Susanna Hengst3,
Chander Gupta2, Arik Hanannel4, Osnat Dogadkin4,
Raphael Catane1  1Sheba Medical Center,
Tel-Hashomer, Israel, 2Toronto General Hospital,
Toronto, ON, Canada, 3Department of Radiology,
Charite Hospital, Berlin, Germany, 4InSightec
LTD, Haifa, Israel.
  • BACKGROUND Pain management is the primary
    goal of treatment of patients with bone
    metastases. Currently existing palliative
    treatments such as localized irradiation,
    chemotherapy, oral bisphosphonates, strontium 89,
    radiofrequency ablation or surgery have either
    efficacy problems or significant unwanted side
    effects. Magnetic Resonance guided Focused
    Ultrasound (MRgFUS) uses focused acoustic energy
    to create, non-invasively, a heat-coagulated
    lesion deep within the body while treatment
    monitoring is done as a closed loop using MR real
    time thermal imaging. Thus physician can
    correctly localize tumors, deliver acoustic
    energy ("sonicate"), monitor energy deposition in
    real time and accurately control the deposited
    thermal dose.
  • PURPOSE Evaluate the safety and efficacy of
    MRgFUS for the palliation of pain due to bone
    metastatic lesions in patients for whom other
    available treatments were considered either not
    effective or not feasible.
  • MATERIAL AND METHODS 32 lesions in 31
    patients (aged 40-85) were treated by MRgFUS in 3
    medical centers Sheba Medical Center
    (Tel-Hashomer, Israel), Toronto General Hospital
    (Toronto, Ontario, Canada), and Charite Hospital
    (Berlin, Germany), using ExAblate2000 system
    (InSightec Ltd. Haifa, Israel). A total of 36
    treatments were performed, 4 lesions were treated
    twice. Patients were followed for a period of at
    least 3 months. Effectiveness of pain palliation
    was evaluated using Visual Analog Scale (VAS)
    pain questionnaires and changes in dosage of
    patients medications.
  • RESULTS An efficacy analysis was conducted
    on 25 patients, who received adequate treatment
    and reached 3 month follow up. 72 of patients
    (18/25) had a significant reduction in pain (gt 2
    points on VAS scale, p-valuelt0.003) at the
    3-month follow up. Of these 50 (9/18) reported a
    VAS score of zero. 24 had no response and 1
    patient (4) experienced worsened pain levels.
    Average VAS score dropped from 5.9 prior to
    treatment to 1.8 three months post treatment. 52
    of patients reported substantial pain relief as
    early as 3 days post treatment. 67 of patients
    with recorded medication data decreased their use
    of opioid analgesics.
  • No severe device related adverse events were
    recorded in any of the patients.

Fig 2 Patients position during treatment. Left
schematic display, Right MR Axial T2w planning
image with ultrasound beam overlay (blue)
Fig 1 System overview
Fig 3 Visual Analog Scale (VAS) for pain
evaluation
Fig 4 Average pain score (VAS) graph, showing
significant symptoms improvement
Conclusion MRgFUS produces a controlled,
well-localized ablation of the impaired bone and
soft tissue in close proximity to bone. This can
be achieved without significant damage to the
bone or other tissue in the vicinity. MRgFUS
provides durable palliative benefits while
avoiding side effects of traditional therapy.
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