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Magnetic resonance-guided focused ultrasound versus percutaneous thermal ablation in local control of bone oligometastases: a systematic review and meta-analysis

  • Musculoskeletal Radiology
  • Published:
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Abstract

Background

The percutaneous thermal ablation techniques (pTA) are radiofrequency ablation, cryoablation, and microwave ablation, suitable for the treatment of bone oligometastases. Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive ablation technique.

Objectives

To compare the effectiveness and safety of MRgFUS and pTA for treating bone oligometastases and their complications.

Methods

Studies were selected with a PICO/PRISMA protocol: pTA or MRgFUS in patients with bone oligometastases; non-exclusive curative treatment. Exclusion criteria were: primary bone tumor; concurrent radiation therapy; palliative therapy; and absence of imaging at follow-up. PubMed, BioMed Central, and Scopus were searched. The modified Newcastle–Ottawa Scale assessed articles quality. For each treatment (pTA and MRgFUS), we conducted two separate random-effects meta-analyses to estimate the pooled effectiveness and safety. The effectiveness was assessed by combining the proportions of treated lesions achieving local tumor control (LTC); the safety by combining the complications rates of treated patients. Meta-regression analyses were performed to identify any outcome predictor.

Results

A total of 24 articles were included. Pooled LTC rate for MRgFUS was 84% (N = 7, 95% CI 66–97%, I2 = 74.7%) compared to 65% of pTA (N = 17, 95% CI 51–78%, I2 = 89.3%). Pooled complications rate was similar, respectively, 13% (95% CI 1–32%, I2 = 81.0%) for MRgFUS and 12% (95% CI 8–18%, I2 = 39.9%) for pTA, but major complications were recorded with pTA only.

The meta-regression analyses, including technique type, study design, tumor, and follow-up, found no significant predictors.

Discussion

The effectiveness and safety of the two techniques were found comparable, even though MRgFUS is a noninvasive treatment that did not cause any major complication. Limited data availability on MRgFUS and the lack of direct comparisons with pTA may affect these findings.

Conclusions

MRgFUS can be a valid, safe, and noninvasive treatment for bone oligometastases. Direct comparison studies are needed to confirm its promising benefits.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Theragnostics, “Mariano Santo” Cosenza Hospital, Cosenza, Italy

    Mario Leporace & Ferdinando Calabria

  2. UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Valentina Lancellotta & Luca Tagliaferri

  3. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

    Valentina Baccolini

  4. UOS Medical Physics, Cosenza Hospital, Cosenza, Italy

    Francesca Castrovillari

  5. Second Department of Radiology, University General Hospital “ATTIKON” - Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios K. Filippiadis

  6. Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy

    Roberto Iezzi

  7. Institute of Radiology - Università Cattolica del Sacro Cuore, Rome, Italy

    Roberto Iezzi

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Contributions

All authors contributed to the study. ML was responsible for the study's conception, design, and research. VB was responsible for the statistical analysis. FC collaborated on the statistical methodology. ML, FC, and VL wrote the manuscript. FC, VL, and DKF revised and corrected the manuscript. LT and RI coordinated and supervised the work. All authors read and approved the manuscript for submission.

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Correspondence to Mario Leporace.

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Leporace, M., Lancellotta, V., Baccolini, V. et al. Magnetic resonance-guided focused ultrasound versus percutaneous thermal ablation in local control of bone oligometastases: a systematic review and meta-analysis. Radiol med 129, 291–306 (2024). https://doi.org/10.1007/s11547-024-01780-4

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