Current Overview of Treatment for Metastatic Bone Disease

The number of patients with bone metastasis increases as medical management and surgery improve the overall survival of patients with cancer. Bone metastasis can cause skeletal complications, including bone pain, pathological fractures, spinal cord or nerve root compression, and hypercalcemia. Before initiation of treatment for bone metastasis, it is important to exclude primary bone malignancy, which would require a completely different therapeutic approach. It is essential to select surgical methods considering the patient’s prognosis, quality of life, postoperative function, and risk of postoperative complications. Therefore, bone metastasis treatment requires a multidisciplinary team approach, including radiologists, oncologists, and orthopedic surgeons. Recently, many novel palliative treatment options have emerged for bone metastases, such as stereotactic body radiation therapy, radiopharmaceuticals, vertebroplasty, minimally invasive spine stabilization with percutaneous pedicle screws, acetabuloplasty, embolization, thermal ablation techniques, electrochemotherapy, and high-intensity focused ultrasound. These techniques are beneficial for patients who may not benefit from surgery or radiotherapy.

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Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MR-HIFU): Overview of Emerging Applications (Part 2)

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-0817-5686 ◽

2019 ◽

Vol 191 (06) ◽

pp. 531-539 ◽

Cited By ~ 2

Author(s):

Florian Siedek ◽

Sin Yuin Yeo ◽

Edwin Heijman ◽

Olga Grinstein ◽

Grischa Bratke ◽

...

Keyword(s):

Prostate Cancer ◽

Magnetic Resonance ◽

High Intensity ◽

Focused Ultrasound ◽

Treatment Options ◽

Local Treatment ◽

Review Literature ◽

High Intensity Focused Ultrasound ◽

Malignant Tissue ◽

Safe Alternative

Background High-intensity focused ultrasound (HIFU) allows noninvasive heating of deep-seated tissues. Guidance under magnetic resonance imaging (MR-HIFU) offers spatial targeting based on anatomical MR images as well as MR-based near-real-time temperature maps. Temperature feedback allows delivery of a well-defined thermal dose enabling new applications such as the ablation of malignant tissue. Methods Peer-reviewed publications on MR-HIFU were studied and are summarized in this review. Literature was restricted to applications in oncology. Results Several MR-HIFU-based applications for the treatment of malignant diseases are currently part of clinical trials or translational research. Recent trials regarding the treatment of prostate cancer with MR-HIFU have already shown this to be a safe and patient-friendly method. For the treatment of breast cancer and malignancies within abdominal organs, MR-HIFU has been applied so far only in proof of concept studies. Conclusion MR-HIFU is currently being investigated for the ablative treatment of malignant tissue in a variety of oncological applications. For example, the transrectal as well as transurethral ablation of prostate cancer using MR-HIFU was shown to be a patient-friendly, safe alternative to other local treatment options with low side effects. Key points: Citation Format

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New Perspectives for Eye-Sparing Treatment Strategies in Primary Uveal Melanoma

Cancers ◽

10.3390/cancers14010134 ◽

2021 ◽

Vol 14 (1) ◽

pp. 134

Author(s):

Krzysztof Bilmin ◽

Kamil J. Synoradzki ◽

Anna M. Czarnecka ◽

Mateusz J. Spałek ◽

Tamara Kujawska ◽

...

Keyword(s):

Drug Delivery ◽

Uveal Melanoma ◽

Focused Ultrasound ◽

Early Stage ◽

Treatment Options ◽

Treatment Strategies ◽

High Intensity Focused Ultrasound ◽

Local Concentration ◽

Proton Beam Radiotherapy ◽

Stage Of Development

Uveal melanoma is the most common intraocular malignancy and arises from melanocytes in the choroid, ciliary body, or iris. The current eye-sparing treatment options include surgical treatment, plaque brachytherapy, proton beam radiotherapy, stereotactic photon radiotherapy, or photodynamic therapy. However, the efficacy of these methods is still unsatisfactory. This article reviews several possible new treatment options and their potential advantages in treating localized uveal melanoma. These methods may be based on the physical destruction of the cancerous cells by applying ultrasounds. Two examples of such an approach are High-Intensity Focused Ultrasound (HIFU)—a promising technology of thermal destruction of solid tumors located deep under the skin and sonodynamic therapy (SDT) that induces reactive oxygen species. Another approach may be based on improving the penetration of anti-cancer agents into UM cells. The most promising technologies from this group are based on enhancing drug delivery by applying electric current. One such approach is called transcorneal iontophoresis and has already been shown to increase the local concentration of several different therapeutics. Another technique, electrically enhanced chemotherapy, may promote drug delivery from the intercellular space to cells. Finally, new advanced nanoparticles are developed to combine diagnostic imaging and therapy (i.e., theranostics). However, these methods are mostly at an early stage of development. More advanced and targeted preclinical studies and clinical trials would be needed to introduce some of these techniques to routine clinical practice.

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Bone metastasis treatment using magnetic resonance-guided high intensity focused ultrasound

Bone ◽

10.1016/j.bone.2015.08.025 ◽

2015 ◽

Vol 81 ◽

pp. 513-523 ◽

Cited By ~ 7

Author(s):

Sin Yuin Yeo ◽

Aaldert Elevelt ◽

Katia Donato ◽

Bert van Rietbergen ◽

Natalie D. ter Hoeve ◽

...

Keyword(s):

Magnetic Resonance ◽

Bone Metastasis ◽

High Intensity ◽

Focused Ultrasound ◽

High Intensity Focused Ultrasound

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New Modalities of Cycloablation and High-Intensity-Focused Ultrasound

Minimally Invasive Glaucoma Surgery ◽

10.1007/978-981-15-5632-6_9 ◽

2020 ◽

pp. 121-131

Author(s):

Natasha Nayak Kolomeyer ◽

Marlene R. Moster

Keyword(s):

Intraocular Pressure ◽

High Intensity ◽

Ciliary Body ◽

Focused Ultrasound ◽

Treatment Options ◽

Laser System ◽

High Intensity Focused Ultrasound ◽

Refractory Glaucoma ◽

Visual Potential ◽

History Of

Abstract Cycloablative or cyclodestructive procedures aim to lower intraocular pressure (IOP) by decreasing the function of the ciliary body and thereby decreasing the rate of aqueous production. Cycloablative procedures were typically used in refractory glaucoma in eyes with poor visual potential; however, more focused energy and targeted destruction of the ciliary body have led to an increase in cyclodestructive treatment options that are now an important adjunct to our surgical armamentarium. This chapter highlights the history of these procedures while focusing on current modalities including transscleral diode cyclophotocoagulation (TSCPC), micropulse transscleral diode cyclophotocoagulation (MP-TSCPC, MicroPulse P3, IRIDEX IQ810 Laser System, Mountain View, CA, USA), and High-Intensity Focused Ultrasound (HIFU). Specifically, this chapter discusses the protocols, indications, results, and complications of each featured procedure.

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MR guided high intensity focused ultrasound (MRgFUS) for the treatment of oligometastatic prostate cancer bone metastasis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e17600 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e17600-e17600

Author(s):

Alessandro Napoli ◽

Luca Marchetti ◽

Enrico Cortesi ◽

Paolo Marchetti

Keyword(s):

Prostate Cancer ◽

Bone Metastasis ◽

Focused Ultrasound ◽

Treatment Time ◽

Invasive Procedure ◽

High Intensity Focused Ultrasound ◽

Bone Lesions ◽

Non Invasive ◽

Oligometastatic Prostate Cancer

e17600 Background: With improvements in diagnostic modalities such as functional imaging, oligometastatic prostate cancer is being diagnosed with greater frequency than ever before. Our aim was to determine MRgFUS ability to downstage patients with oligometastatic bone disease with single session of non-invasive metastasis-directed therapy. Methods: The study was designed with intention-to-treat metastatic bone lesions. Patients were enrolled if they had accessible bone metastasis and could safely undergo MRgFUS (InSightec, Israel). Baseline measurable characteristics included dynamic contrast enhanced MRI study (DCE; Gd-BOPTA, Bracco; GE 750 3T magnet) with semiquantitative perfusion analysis, PSA level (ng/ml) and choline PET (SUV). Measurable variables were obtained at treatment time, 3 months, 12 months and 24 months follow-up. Results: 18 patients fulfilled the inclusion criteria and safely underwent MRgFUS procedure of metastatic bone ablations. Lesions were located in the pelvis (11), scapula (3) and long bones (4). At baseline all lesions showed a significant DCE perfusion (highly vascular) with mean perfusion reduction of 88% at 3 months follow-up (CI: 100-50; p < 0.001) stable at subsequent follow-up scans. Similarly PSA levels decreased from a mean baseline of 19 (ng/ml) to 7.1, 2.9 and 2.1, at 3-12 and 24 moths respectively. SUV values showed similar trend with reduction from baseline (mean 8.9 to 3.0, 2.3 and 1.7: p < 0.001). In all patients single MRgFUS session was appropriate without any major or minor adverse events reported. Conclusions: MRgFUS is a totally non-invasive procedure that can obtain complete bone ablation in patients with oligometastatic prostate disease. The technique features a radiation-free approach that can be of incremental value in long-survivor subset on oncological patients, significantly reducing risk of toxic effects. Concurrent chemo regimen is not a contraindication.

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