Randomized Pilot Study of 20 Gy in 5 Fractions versus 27 Gy in 3 Fractions Radiotherapy for Treating Painful Bone Metastases: A Single Institution Experience

Background: Bone is one of the most common sites of metastases, with bone metastases-related pain representing a significant source of morbidity among patients with cancer. Magnetic resonance–guided focused ultrasound is a noninvasive, outpatient modality with the potential for treating painful bone metastases. The aim of this study is to report our initial experience with magnetic resonance–guided focused ultrasound in the treatment of bone metastases and our preliminary analysis of urinary cytokine levels after therapy. Methods: This was a single-center pilot study of 10 patients with metastatic cancer to investigate the feasibility of magnetic resonance–guided focused ultrasound for primary pain control in device-accessible skeletal metastases. Treatments were performed on a clinical magnetic resonance–guided focused ultrasound system using a volumetric ablation technique. Primary efficacy was assessed using Brief Pain Inventory scores and morphine equivalent daily dose intake at 3 time points: before, day 14, and day 30 after the magnetic resonance–guided focused ultrasound treatment. Urine cytokines were measured 3 days before treatment and 2 days after the treatment. Results: Of the 10 patients, 8 were followed up 14 days and 6 were followed up 30 days after the treatment. At day 14, 3 patients (37.5%) exhibited partial pain response and 4 patients (50%) exhibited an indeterminate response, and at day 30 after the treatment, 5 patients (83%) exhibited partial pain response. No treatment-related adverse events were recorded. Of the urine cytokines measured, only Transforming growth factor alpha (TGFα) demonstrated an overall decrease, with a trend toward statistical significance ( P = .078). Conclusion: Our study corroborates magnetic resonance–guided focused ultrasound as a feasible and safe modality as a primary, palliative treatment for painful bone metastases and contributes to the limited body of literature using magnetic resonance–guided focused ultrasound for this clinical indication.

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Percutaneous image-guided cryoablation of painful bone metastases: A single institution experience

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2019.01.001 ◽

2019 ◽

Vol 105 (2) ◽

pp. 369-374 ◽

Cited By ~ 8

Author(s):

Nicolas Gallusser ◽

Patrick Goetti ◽

Fabio Becce ◽

Frédéric Vauclair ◽

Hannes A. Rüdiger ◽

...

Keyword(s):

Bone Metastases ◽

Single Institution ◽

Image Guided ◽

Painful Bone Metastases

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Treatment of painful bone metastases in prostate and breast cancer patients with the therapeutic radiopharmaceutical rhenium-188-HEDP

Nuklearmedizin ◽

10.3413/nukmed-0828-16-05 ◽

2016 ◽

Vol 55 (05) ◽

pp. 188-195 ◽

Cited By ~ 16

Author(s):

Floor Overbeek ◽

John de Klerk ◽

Pieternel Pasker-de Jong ◽

Alexandra van den Berk ◽

Rob ter Heine ◽

...

Keyword(s):

Bone Metastases ◽

Clinical Benefit ◽

Response Rate ◽

Clinical Care ◽

Pain Response ◽

Pain Palliation ◽

Breast Cancer Patients ◽

Routine Clinical Care ◽

Painful Bone Metastases

Summary Aim: Rhenium-188-HEDP (188Re-HEDP) is an effective radiopharmaceutical for the palliative treatment of osteoblastic bone metastases. However, only limited data on its routine use are available and its effect on quality of life (QoL) has not been studied. Therefore, we evaluated the clinical benefit of 188Re-HEDP in routine clinical care. Patients and methods: Prostate or breast cancer patients with painful bone metastases receiving 188Re-HEDP as a routine clinical procedure were eligible for evaluation. Clinical benefit was assessed in terms of efficacy and toxicity. Pain palliation and QoL were monitored using the visual analogue scale (VAS), corrected for opioid intake, and the EORTC QLQ-C30 Global health status/QoL-scale. Thrombocyte and leukocyte nadirs were used to assess haematological toxicity. Results: 45 and 47 patients were evaluable for pain palliation and QoL, respectively. After a single injection of 188Re-HEDP, the overall pain response rate was 69% and mean VAS-scores decreased relevantly and significantly (p < 0.05). Repeated treatment resulted in similar pain response. The overall QoL response rate was 68% and mean Global health status/QoL-scores increased relevantly and significantly. Haematological side effects were mild and transient. Conclusion: The clinically relevant response on pain and quality of life and the limited adverse events prove clinical benefit of treatment with 188Re-HEDP and support its use in routine clinical care. Its effectiveness appears comparable to that of external beam radiotherapy.

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