Bone metastases are a common manifestation of advanced cancer, with pain as a devastating consequence. Metastatic bone pain is difficult to manage and has a detrimental impact on quality of life of patients, their partners and care-givers. The current standard of care for patients with painful bone metastasis includes palliative external beam radiotherapy (EBRT) and pain medication. While EBRT is a well-established treatment option that is easy to administer and well tolerated, EBRT is only effective in 60-70% of patients and usually takes up to four weeks before inducing pain response. Inadequate pain relief is therefore common and alternative treatment options are urgently needed.
Pain palliation may be substantially improved by including magnetic resonance image guided high intensity focused ultrasound (MR-HIFU) as alternative or in addition to EBRT. Preliminary studies suggest that MR-HIFU induces rapid pain relief (within days), and may palliate pain in patients in whom EBRT is not effective. Currently, strong evidence and context is lacking for wide-spread implementation of MR-HIFU into routine care.
The goals of the FURTHER project
The FURTHER project aims to demonstrate the (cost)effectiveness of MR-HIFU as an alternative or additional treatment option to relief metastatic bone pain. For this purpose, a three arm international randomized controlled trial including 216 patients will be conducted comparing early and late pain response in patients treated with EBRT only, MR-HIFU only, and EBRT combined with MR-HIFU. A pilot pathway RCT will be conducted to explore the effectiveness of MR-HIFU as a part of a comprehensive pain management strategy. Finally, FURTHER will map and analyse socio-economic barriers for integration of MR-HIFU in routine care in the wider European context and make recommendations on how to provide equal access to this promising new treatment.