Background

Clinical Trials Square

Bone cancer is made up of abnormal masses of cancerous tissue that occupy space within or on top of bones. Most commonly, these cancers are metastatic, and spread from other locations, such as the breast, prostate or lung. There are also primary bone cancers, but they are much less common than metastatic cancers.

The most common symptom of bone cancer is persistent pain or swelling at or near a bone or joint. Diagnosis is typically accomplished by a physical exam, and xray or other imaging studies.

Special bones can have further delineations. Spinal tumors can be classified anatomically into two groups:

(1) intramedullary: those that originate within the spinal cord, either as a primary growth or from metastatic spread
(2) extramedullary: those arising outside of the spinal cord, either from within the dura mater lining (intradural) or outside the dura mater lining (extradural).

Current Treatment

The goal of treatment for cancer depends on the size, type and location of the cancer as well as the patient’s age and general health. Surgery is the most common treatment, and the goal is to remove the tumor completely. Other treatments can include chemotherapy, radiation therapy, cryotherapy or other types of removal options.

For tumors of the spine, treatment may also involve decompression of the nerves that exit the spinal column, and there also may be considerations of stabilizing the spine from impending fractures.

Focused Ultrasound Research

Focused ultrasound is not approved to treat cancer of the bones.

However, focused ultrasound has been shown to be a promising tool for pain palliation of bone metastases through local bone denervation. The physician is able to heat the targeted bone and bone-tissue interface where the nerves reside, to destroy nerve fibers and prevent them from transmitting pain signals. .

This method can also damage cancer tissue in the targeted region, so focused ultrasound treatment aimed at pain palliation can also result in cancer shrinkage. In most spinal cancer cases, the ultrasound beam is unable to penetrate through bone to target tumors within the spinal canal, so surgical removal of the posterior spinal elements would be necessary before focused ultrasound could be used.

Focused ultrasound has been used to treat Sacral Chordoma, which is a rare cancer of the bones of the spine. 

Notable Papers

Menikou G, Yiallouras C, Yiannakou M, Damianou C. MRI-guided focused ultrasound robotic system for the treatment of bone cancer. Int J Med Robot. 2016 Jul 15. doi: 10.1002/rcs.1753.

Vinay R, KusumDevi V. Potential of targeted drug delivery system for the treatment of bone metastasis. Drug Deliv. 2016;23(1):21-9. doi: 10.3109/10717544.2014.913325.

Ringe KI, Panzica M, von Falck C. Thermoablation of Bone Tumors. Rofo. 2016 Jun;188(6):539-50. doi: 10.1055/s-0042-100477.

Hurwitz M, Ghanouni P, Kanaev S, Iozeffi D, Gianfelice D, Fennessy F M, Kuten A, Meyer J E, LeBlang S D, Roberts A, Choi J, Larner J M, Napoli A, Turkevich V, Inbar Y, Tempany C M, Pfeffer. Magnetic Resonance-Guided Focused Ultrasound for Patients With Painful Bone Metastases: Phase III Trial Results. JNCI N Natl Cancer Inst 2014 Apr; 10.1093.

 

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