骨轉移疼痛新治療：磁振導航聚焦超音波熱治療

Bone metastases are commonly associated with debilitating pain in patients with advanced cancer, often influencing their quality of life. Current treatment options for pain control of bone metastases consist of systemic therapies (such as chemotherapy, analgesics, biphosphonates and hormonal therapy) and local treatments (e.g., surgery, palliative radiotherapy and so on). Unfortunately, many patients with bone metastases still suffered severe pain due to most medical therapies do not achieve a long-term-efficacy, cause side effects or who do not respond to radiation therapy. Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive thermal ablation that enables the physician to perform localized treatment of bone metastases. The possible mechanism of MRgFUS for pain palliation may be thermal periosteal denervation in bone surface surrounding the tumor. In October 2012, the U.S. Food and Drug Administration (FDA) has approved the MRgFUS (ExAblate® MRgFUS system, InSightec, Inc., Haifa, Israel) for pain palliation associated with bone metastases. In 2014, ExAblate® MRgFUS system had also been approved by Ministry of Health and Welfare in Taiwan. The Taipei Medical University Hospital (TMUH) has installed MRgFUS system in 2014, and 56 cancer patients who diagnosed with bone metastases had received this system for palliation of their pain till the end of 2015. Earlier evidence showed that patients who treated with MRgFUS for treating their pain of bone metastases reported significant decrease in pain severity and pain interference, improving their quality of life, a reduction in their use of analgesics, and increase of bone density at the site of treated osteolytic metastases at 3 months post treatment follow-up. Therefore, MRgFUS was demonstrated to be effective palliative treatment for the painful bone metastases and assessed the potential of the technique for localized tumor control.