Efficacy and safety of magnetic resonance-guided focused ultrasound for the treatment of painful bone metastases: a systematic review and meta-analysis

Abstract

Objective To report the safety and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) in the treatment of painful bone metastases through a systematic review and meta-analysis of pain scores before and after MRgFUS treatment and post-treatment adverse events. Materials and methods A comprehensive literature search of PubMed and Embase databases was performed for studies evaluating the efficacy and/or safety of MRgFUS. The mean difference of pain scores (10-point visual analogue scale or numerical rating scale) between baseline and 1-month/3-month pain scores was collected and analyzed in a pooled meta-analysis. Post-treatment adverse events based on the Common Terminology Criteria for Adverse Events (CTCAE) grading were recorded and the pooled prevalence was calculated. Results A total of 33 studies published between 2007 and 2019 were collected, resulting in a total sample size of 1082 patients. The majority of the studies were prospective with a reported follow-up period of 3 months. The pooled proportion of patients that achieved pain relief from MRgFUS (complete response or partial response [≥ 2-point improvement of pain score]) was 79% (95% CI 73–83%). The pooled 1-month and 3-month mean difference in pain score were − 3.8 (95% CI − 4.3; − 3.3) and − 4.4 (95% CI − 5.0; − 3.7), respectively. The overall rate of high-grade (CTCAE grade 3 or higher) and low-grade (CTCAE grade 2 or lower) MRgFUS-related adverse events were 0.9% and 5.9%, respectively. Conclusion MRgFUS is an effective procedure that is able to provide significant pain palliation for patients with symptomatic bone metastases with a favorable safety profile.

State-of-the-art of minimally invasive treatments of bone metastases

“…In detail, severe adverse events comprised four fractures, one DVT, and two cases of grade III skin burn. Conversely, 47 (5.9%) mild toxicity cases (CTCAE grade less than 3) were recorded, encompassing post-treatment pain (24 cases), low-grade skin burns (5 cases), focal edema (7 cases), focal numbness (8 cases), and post-treatment fever (3 cases) [116] .Specifically, post-radiotherapy acute pain fare had an incidence ranging from 40% to 68% compared with only 3% observed with MRgFUS in these studies [116] , [117] .…”

Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review

“…In addition, pain palliation has proved to be quickly achieved a few days after the procedure, lasting more than 3 months [ 63 ]. In particular, a systematic review and meta-analysis from Baal et al [ 131 ] investigated the safety and efficacy of MRgFUS for painful bone metastases in 33 studies published between 2007 and 2019, for a total of 1082 patients. Complete response or partial response was 79% (95% CI 73–83%).…”

“…MRgFUS treatment has a favorable safety profile, and the most common complications are skin burns, pain, vomiting, and delayed fractures [ 133 , 134 , 135 ]. High-grade and low-grade MRgFUS-related adverse events rates have been reported of 0.9% and 5.9%, respectively [ 131 ]. Moreover, MRgFUS has proved to be a cost-effective technique compared with medication-only approaches for the palliation of painful bone metastases in patients with medically refractory metastatic bone pain [ 136 ].…”

Early economic modeling of magnetic resonance image-guided high intensity focused ultrasound compared to radiotherapy for pain palliation of bone metastases

“…The increases in utility due to complete/partial pain relief were 35% and 15% from the base state, respectively. Increases in utilities due to complete or partial pain relief were assumed to occur within seven days after MR-HIFU, and within four weeks after EBRT (30).…”