Focused ultrasound reduces cancer pain
When cancer progresses and spreads to the bone, patients often suffer debilitating pain. Now, a new phase III clinical trial shows that non-invasive magnetic resonance guided focused ultrasound treatment that heats the cancer within the bone, relieves pain and improves function for most patients when other treatment options are limited. The results were published in the Journal of the National Cancer Institute (JNCI).
Magnetic resonance guided focused ultrasound surgery (MRgFUS) is a technique that’s been safely used to treat thousands of women with uterine fibroids. However, “this is the first phase III study to use this technology in the treatment of cancer, ” says the study’s principal investigator and lead author Mark Hurwitz, M.D., Vice Chairman of Quality, Safety and Performance Excellence and Director of Thermal Oncology in the department of Radiation Oncology at Thomas Jefferson University.
Although radiation therapy is commonly used to treat bone-related pain and effective for most patients, not all patients experience pain relief and over time those who do may have recurrence of pain. In addition, it’s possible for a patient to receive the maximum radiation dose that can be safely delivered without fully controlling the pain. In situations where radiation therapy is not an option, alternative treatments are required.
A total of 147 patients from 17 centers in the U.S., Canada, Israel, Italy, and Russia were enrolled in the study and randomized to undergo MRgFUS or a sham treatment.
Patients in the treatment group received focused ultrasound precisely targeted to their bone tumors to heat the tumor tissue to between 65 and 85 degrees Celsius, resulting in its destruction. During each treatment, the patients were monitored real-time via magnetic resonance imaging (MRI) to ensure the right tissue was targeted and the right temperatures were reached while ensuring heat in surrounding normal tissues and organs remained at safe levels. The control group underwent the same procedure but without the ultrasound device turned on. Finally, patients who did not respond to the placebo treatment within two weeks were allowed to be unblinded and offered MRgFUS.
Patients responded well to treatment, with 64 percent experiencing either no pain or a significant reduction in their pain at three months as measured by a 2 point or greater decrease in the numeric rating score(NRS) for pain, a clinically validated measurement tool. Many patients were able to reduce or stop use of opiod medications. Notably, most patients experienced pain relief and improved functioning within several days of treatment.
“It’s clear that for many of these patients, pain has a major impact on their everyday lives,” says Dr. Hurwitz. “This approach offers a new way to help alleviate that pain via an out-patient non-invasive procedure.”
The next steps in this line of research, says Hurwitz, is to refine the treatment technique to get an even greater response rate, and to apply radiation and thermal therapy together in treatment of bone metastases noting the established clinical benefits for other malignant conditions with this combination. To that end, Jefferson has opened a new program for thermal oncology within its Department of Radiation Oncology in order to provide patients with access to thermal therapies that have been shown to augment radiation treatment.
Causes of cancer pain
Most cancer pain is caused by the tumour pressing on bones, nerves or other organs in your body. Sometimes pain is related to your cancer treatment. For example, some chemotherapy drugs can cause numbness and tingling in your hands and feet or a burning sensation at the place where they are injected. Radiotherapy can cause skin redness and irritation.
Remember that some pain may have nothing to do with your cancer. You may have the general aches and pains that everyone gets from time to time.
Acute and chronic pain
Cancer pain can be acute or chronic. Acute pain is due to damage caused by an injury and tends to only last a short time. For example, having an operation can cause acute pain. The pain goes when the wound heals. In the meantime, painkillers will usually keep it under control.
Chronic pain is pain caused by changes to nerves. Nerve changes may occur due to cancer pressing on nerves or due to chemicals produced by a tumour. It can also be caused by nerve changes due to cancer treatment. The pain continues long after the injury or treatment is over and can range from mild to severe. It can be there all the time and is also called persistent pain. Chronic pain can be difficult to treat, but painkillers or other pain control methods can successfully control it in about 95 out of every 100 people (95%).
Pain that is not well controlled can develop into chronic pain. So it is important to take painkillers that you are prescribed. Trying to put up with the pain can make it harder to control in the future.
If you have chronic cancer pain, you may have times when the pain is not controlled by the medicines you are taking. This is called breakthrough pain. If you are taking regular painkillers but still get pain at times, let your doctor or nurse know. They can prescribe extra top up doses of painkillers for you to take when you need them.
“The work provides cancer patients with more options for treatment of cancer pain and the opportunity for patients to reduce opioid use, which has significant side effects,” says Adam Dicker, M.D., Ph.D., Chair of Jefferson’s department of radiation oncology, and not involved in the paper.
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This study was supported by InSightec Ltd, Tirat Carmel, Israel. Dr. Hurwitz has provided expert testimony on behalf of Insightec for the purpose of regulatory approval.
For more information please contact Edyta Zielinska, .(JavaScript must be enabled to view this email address), 215-955-5291
Article reference: M.D. Hurwitz et al., “Magnetic Resonance–Guided Focused Ultrasound for Patients With Painful Bone Metastases: Phase III Trial Results,” J Natl Cancer Inst, doi: 10.1093/jnci/dju082, 2014.
About Jefferson
Thomas Jefferson University (TJU), the largest freestanding academic medical center in Philadelphia, is nationally renowned for medical and health sciences education and innovative research. Founded in 1824, TJU includes Jefferson Medical College (JMC), one of the largest private medical schools in the country and ranked among the nation’s best medical schools by U.S. News & World Report, and the Jefferson Schools of Nursing, Pharmacy, Health Professions, Population Health and the Graduate School of Biomedical Sciences. Jefferson University Physicians is TJU’s multi-specialty physician practice consisting of the full-time faculty of JMC. Thomas Jefferson University partners with its clinical affiliate, Thomas Jefferson University Hospitals.
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Edyta Zielinska
.(JavaScript must be enabled to view this email address)
215-955-5291
Thomas Jefferson University