容积磁共振成像引导下高强度聚焦超声（MR-HIFU）治疗疼痛性骨转移瘤的可行性
Feasibility of volumetric MRI-guided high intensity focused ultrasound (MR-HIFU) for painful bone metastases.
作者信息
Huisman Merel, Lam Mie K, Bartels Lambertus W, Nijenhuis Robbert J, Moonen Chrit T, Knuttel Floor M, Verkooijen Helena M, van Vulpen Marco, van den Bosch Maurice A
机构信息
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
Image Sciences Institute, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
出版信息
J Ther Ultrasound. 2014 Oct 10;2:16. doi: 10.1186/2050-5736-2-16. eCollection 2014.
BACKGROUND
Magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) has recently emerged as an effective treatment option for painful bone metastases. We describe here the first experience with volumetric MR-HIFU for palliative treatment of painful bone metastases and evaluate the technique on three levels: technical feasibility, safety, and initial effectiveness.
METHODS
In this observational cohort study, 11 consecutive patients (7 male and 4 female; median age, 60 years; age range, 53-86 years) underwent 13 treatments for 12 bone metastases. All patients exhibited persistent metastatic bone pain refractory to the standard of care. Patients were asked to rate their worst pain on an 11-point pain scale before treatment, 3 days after treatment, and 1 month after treatment. Complications were monitored. All data were prospectively recorded in the context of routine clinical care. Response was defined as a ≥2-point decrease in pain at the treated site without increase in analgesic intake. Baseline pain scores were compared to pain scores at 3 days and 1 month using the Wilcoxon signed-rank test. For reporting, the STROBE guidelines were followed.
RESULTS
No treatment-related major adverse events were observed. At 3 days after volumetric MR-HIFU ablation, pain scores decreased significantly (p = 0.045) and response was observed in a 6/11 (55%) patients. At 1-month follow-up, which was available for nine patients, pain scores decreased significantly compared to baseline (p = 0.028) and 6/9 patients obtained pain response (overall response rate 67% (95% confidence interval (CI) 35%-88%)).
CONCLUSIONS
This is the first study reporting on the volumetric MR-HIFU ablation for painful bone metastases. No major treatment-related adverse events were observed during follow-up. The results of our study showed that volumetric MR-HIFU ablation for painful bone metastases is technically feasible and can induce pain relief in patients with metastatic bone pain refractory to the standard of care. Future research should be aimed at standardization of the treatment procedures and treatment of larger numbers of patients to assess treatment effectiveness and comparison to the standard of care.
背景
磁共振引导下的高强度聚焦超声（MR-HIFU）最近已成为治疗疼痛性骨转移瘤的一种有效治疗选择。我们在此描述了容积式MR-HIFU姑息治疗疼痛性骨转移瘤的首例经验，并从技术可行性、安全性和初步有效性三个层面评估了该技术。
方法
在这项观察性队列研究中，11例连续患者（7例男性，4例女性；中位年龄60岁；年龄范围53 - 86岁）因12处骨转移接受了13次治疗。所有患者均表现出对标准治疗无效的持续性转移性骨痛。要求患者在治疗前、治疗后3天和治疗后1个月，使用11分疼痛量表对其最严重疼痛进行评分。监测并发症。所有数据均在常规临床护理过程中进行前瞻性记录。缓解定义为治疗部位疼痛降低≥2分且镇痛药物摄入量未增加。使用Wilcoxon符号秩检验将基线疼痛评分与3天和1个月时的疼痛评分进行比较。报告时遵循STROBE指南。
结果
未观察到与治疗相关的重大不良事件。在容积式MR-HIFU消融术后3天，疼痛评分显著降低（p = 0.045），11例患者中有6例（55%）出现缓解。在1个月随访时（9例患者可进行随访），疼痛评分与基线相比显著降低（p = 0.028），9例患者中有6例获得疼痛缓解（总体缓解率67%（95%置信区间（CI）35% - 88%））。
结论
这是第一项报道容积式MR-HIFU消融治疗疼痛性骨转移瘤的研究。随访期间未观察到与治疗相关的重大不良事件。我们的研究结果表明，容积式MR-HIFU消融治疗疼痛性骨转移瘤在技术上是可行的，并且可以使对标准治疗无效的转移性骨痛患者的疼痛得到缓解。未来的研究应致力于治疗程序的标准化以及对更多患者的治疗，以评估治疗效果并与标准治疗进行比较。
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