Authors' recommendations: Description of Technology: This report focuses on the use of magnetic resonance–guided focused ultrasound therapy (MRgFUS) (ExAblate; InSightec Ltd.) as a pain relief strategy for bone metastases. The ExAblate system uses a focused ultrasound transducer via a robotic system within a patient table, all of which is fully integrated within an magnetic resonance imaging (MRI) scanner. A physician controls and monitors the treatment while using the MRI to identify, target, and deliver high-intensity focused ultrasound to the bone metastases. For MRgFUS therapy, pretreatment scans are used to localize the target bone lesion and construct 3-dimensional treatment plans. The patient is positioned such that the target lesion is in direct contact with the MRI patient table. The focused ultrasound transducer is housed in a water bath in the MRI table. Therapeutic ultrasound waves are delivered at 65°C to the targeted bone. MRI scans are performed during the procedure to monitor the effects of ultrasound on bone and tissue and to adjust beam delivery. The MRgFUS procedure is performed by a radiologist on an outpatient basis using conscious sedation and generally takes 1 to 2 hours depending on the number of areas treated. Patients are monitored for 1 to 2 hours following treatment for adverse events. Patients requiring general anesthesia may be hospitalized overnight. The exact mechanism for pain palliation from MRgFUS is not fully understood but is thought to involve the indirect ablation of periosteum and tumor tissue in the ultrasound beam path. Nerve fibers in the bone periosteum are considered to be a major source of pain from bone metastases, and ablation of these nerves may result in pain palliation after MRgFUS. Clinical alternatives for the palliation of metastatic bone pain include external beam radiation therapy; chemotherapy; bisphosphonates; radiopharmaceuticals; laser ablation; radiofrequency ablation; hormonal therapy; surgery; cryotherapy; and analgesics, such as narcotics and nonsteroidal anti-inflammatory drugs. Patient Population: MRgFUS treatment with the ExAblate system (models 2000/2100/2100 VI) is indicated for pain palliation of metastatic bone cancer in patients 18 years of age or older who are not candidates for, have not responded to, or have refused standard radiation

Project Status: Completed

Year Published: 2016

URL for published report: The report may be purchased from: http://www.hayesinc.com/hayes/crd/?crd=15732

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: HAYES, Inc.

Contact Address: 157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215 855 0615; Fax: 215 855 5218

Contact Name: saleinfo@hayesinc.com

Contact Email: saleinfo@hayesinc.com

Copyright: 2014 Winifred S. Hayes, Inc