Focused Ultrasound Therapy
Focused ultrasound is an early-stage, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with pain from many types of cancer. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the body without damaging surrounding normal tissue. Where the beams converge, the ultrasound produces precise ablation (thermal destruction of tissue) enabling significant and sustained pain reduction without surgery.
Focused ultrasound technology is approved to relieve several types of pain. One device is approved by the FDA for treatment of pain due to bone metastases. Devices to treat arthritis pain and back pain (originating from facet arthritis) are approved in Europe, but not yet in the United States. Focused ultrasound lessens the pain through targeted and precise ablation of nerves that serve the affected area.
Currently, the improvement of a patient’s cancer pain after focused ultrasound treatment may be observed while looking for other improvements. In a study of ten pancreatic cancer patients who received focused ultrasound, the patients’ narcotic use was cut in half following focused ultrasound treatment, and in two patients it was completely eliminated. This reduction was sustained in the three month follow up, and prompted the author to suggest that a larger study on the analgesic effect should be considered. (Strunk, et. al.)
The primary options for treatment of cancer pain include medications and sometimes invasive procedures.
For certain patients, focused ultrasound could provide a noninvasive and perhaps more effective alternative to existing pain management strategies, with less risk of complications and lower cost.
- Focused ultrasound pain relief can be more effective than repeated medication dosing strategies.
- Focused ultrasound pain relief does not have the added risks of nausea, respiratory depression, addiction, or other side effects associated with narcotic pain medicines.
- Focused ultrasound is noninvasive, so it does not carry added concerns like surgical wound healing or infection.
- It can be repeated, if necessary.
A clinical trial in Meldola, Italy, is looking at treating the pain from bone metastasis of solid tumors with focused ultrasound.
A clinical trial in Surry, UK, is looking at treating pain from bone metastasis with focused ultrasound.
Regulatory Approval and Reimbursement
Focused ultrasound treatment for pain associated with cancer is not yet approved by regulatory bodies or covered by medical insurance companies.
Marinova M, Huxold HC, Henseler J, Mücke M, Conrad R, Rolke R, Ahmadzadehfar H, Rauch M, Fimmers R, Luechters G, Cuhls H, Radbruch L, Schild HH, Strunk H. Clinical Effectiveness and Potential Survival Benefit of US-Guided High-Intensity Focused Ultrasound Therapy in Patients with Advanced-Stage Pancreatic Cancer. Ultraschall Med. 2018 Apr 17. doi: 10.1055/a-0591-3386.
Dababou S, Marrocchio C, Rosenberg J, Bitton R, Pauly KB, Napoli A, Hwang JH, Ghanouni P. A meta-analysis of palliative treatment of pancreatic cancer with high intensity focused ultrasound. J Ther Ultrasound. 2017 Apr 1;5:9. doi: 10.1186/s40349-017-0080-4. eCollection 2017.
Shi Y, Ying X, Hu X, Shen H. Pain management of pancreatic cancer patients with high-intensity focused ultrasound therapy. Pak J Pharm Sci. 2017 Jan;30(1 Suppl):303-307.
Marinova M, Strunk HM, Rauch M, Henseler J, Clarens T, Brüx L, Dolscheid-Pommerich R, Conrad R, Cuhls H, Radbruch L, Schild HH, Mücke M. [High-intensity focused ultrasound (HIFU) for tumor pain relief in inoperable pancreatic cancer : Evaluation with the pain sensation scale (SES)]. Schmerz. 2016 Jul 11. [Epub ahead of print] German.
Strunk HM, Henseler J, Rauch M, Mücke M, Kukuk G, Cuhls H, Radbruch L, Zhang L, Schild HH, Marinova M. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. Rofo. 2016 Jul;188(7):662-70. doi: 10.1055/s-0042-105517.