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Vienna, Austria

ESTRO 2023

Session Item

Mixed sites/palliation
6026
Poster (Digital)
Clinical
Can MR-guided HIFU replace palliative radiotherapy in the treatment of painful bone metastases?
Alice Zamagni, Italy
PO-1581

Abstract

Can MR-guided HIFU replace palliative radiotherapy in the treatment of painful bone metastases?
Authors:

Alice Zamagni1, Giambattista Siepe2, Martina Ferioli3, Milly Buwenge3,2, Maria Chiara Malato3,2, Chiara Gasperini4, Gabriella Macchia5, Francesco Deodato5,6, Savino Cilla7, Laura Campanacci8, Alberto Bazzocchi4, Silvia Cammelli2,3, Alessio G. Morganti2,3

1Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy; 2Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; 3Department of Experimental Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy; 4Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; 5Radiation Oncology Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy; 6Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy; 7Medical Physics Unit, Gemelli Molise Hospital – Università Cattolica del Sacro Cuore, Campobasso, Italy; 83rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

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Purpose or Objective

External beam radiotherapy (EBRT) is a well-established treatment option in the treatment of pain from bone metastases. However, not all patients (pts) experience pain relief after EBRT. Moreover, it can take up to six weeks before adequate pain relief is reached and approximately 50% of initial responders experience recurrent pain. Magnetic Resonance image-guided High-Intensity Focused Ultrasound (MRgHIFU), as an alternative or in addition to EBRT, may improve pain palliation in these pts by increasing the percentage of responders and decreasing the time to response. However, large datasets on the feasibility of MRgHIFU are not available; therefore, the rate of pts who can benefit from this therapy is unclear. Therefore, this analysis aims to report the preliminary results of patients screened in a radiotherapy centre for inclusion in a randomized study of MRgHIFU versus EBRT versus MRgHIFU plus EBRT (The FURTHER-trial, H2020, NCT04307914).

Material and Methods

The inclusion criteria of the trial were as follows: painful metastatic bone lesion (NRS ≥ 4), pain from target lesion distinguishable from other lesions, target lesion location is accessible for MRgHIFU and EBRT, pts able to fit in the MRI gantry, reasonable performance score (KPS ≥ 50%). Exclusion criteria were as follows: neurological symptoms due to nerve involvement of target lesion, previous surgery or need for surgery of targeted location due to pathological fracture, unavoidable critical structures in the target area, the curative intention of the treatment plan, and contraindications for MRI or sedation.

Results

From February 2021 to September 2022, 188 bone metastases (167 pts) were screened for inclusion and 186 lesions (98.9%) in 165 pts (98.8%) were considered not eligible for the trial for the following reasons: spine or skull lesions (96 lesions, 51.0%), NRS<4 or NRS=0 or non-distinguishable pain (38 lesions, 20.2%), target lesion non-accessible for MRgHIFU or MRI contraindications (31 lesions, 16.5%), previous surgery or pathological fractures (13 lesions, 6.9%), KPS < 50% (5 lesions, 2.7%), curative intent of EBRT (3 lesions, 1.6%).

Conclusion

MRgHIFU is a promising modality of palliation in pain from bone metastases, especially in pts with symptoms resistant to EBRT. However, the results of our analysis show that the percentage of pts enrolled in an MRgHIFU trial is only 1.2%, with about 75% of cases excluded due to the intrinsic limitations of this therapy. Therefore, the implementation of this technique could be justified only in a few centres with a high degree of expertise.