Abstract

Objective

To document longitudinal symptom, quality-of-life and imaging response in patients with recurrent gynecological tumors treated with magnetic resonance guided high intensity focused ultrasound (MRgHIFU), and compare changes in patients with intra- versus extra-pelvic lesions.

Methods

Eleven symptomatic patients with painful recurrent gynecological tumors were treated with MRgHIFU (Profound Sonalleve) in a prospective single center study (NCT02714621). Pain scores, analgesic intake and quality-of-life metrics, whole tumor volume, and perfused tumor volume from Gadolinium-enhanced T1W imaging documented before and up to 90 days after treatment were compared between patients with intra- and extra-pelvic tumors.

Results

Two of five patients with intra-pelvic and three of six patients with extra-pelvic tumors were classified as responders (>2 point reduction in NRS pain score without analgesia increase or a > 25% reduction in analgesic use). Cohort reductions in worst pain scores were not significant for either group. Emotional functioning for the whole cohort improved, although physical functioning did not. Ablative thermal temperatures were achieved in three patients with extra-pelvic tumors, but in none whose tumors were intra-pelvic. Pain response did not correlate with thermal dose. Tumor volume increased by 18% immediately post-treatment in the extra-pelvic but not in the intra-pelvic group. Ratio of perfused to whole lesion volume decreased by >20% by day 30 in extra-pelvic, but not intra-pelvic tumors although at day 30 both extra-pelvic and intra-pelvic tumors increased in volume.

Conclusion

MRgHIFU treatments can be delivered safely to patients with recurrent gynecological tumors. Extra-pelvic tumors responded better than intra-pelvic tumors and showed immediate swelling and reduction in perfused volume by day 30.

中文翻译：

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MRGHIFU 缓解复发性妇科肿瘤的可行性：盆腔内和盆腔外疾病的症状、生活质量和影像学反应的比较

 抽象的

 客观的

记录接受磁共振引导高强度聚焦超声 (MRgHIFU) 治疗的复发性妇科肿瘤患者的纵向症状、生活质量和影像学反应，并比较盆腔内与盆腔外病变患者的变化。

 方法

在一项前瞻性单中心研究 (NCT02714621) 中，11 名有症状的疼痛性复发性妇科肿瘤患者接受了 MRgHIFU（Profound Sonalleve）治疗。对盆腔内和盆腔外肿瘤患者在治疗前和治疗后 90 天记录的疼痛评分、镇痛摄入量和生活质量指标、整个肿瘤体积和来自钆增强 T1W 成像的灌注肿瘤体积进行比较。

 结果

五名盆腔内肿瘤患者中的两名和六名盆腔外肿瘤患者中的三名被列为有反应者（NRS 疼痛评分降低 >2 分，但镇痛药使用量减少> 25%）。两组中最严重疼痛评分的降低均不显着。整个队列的情绪功能得到改善，但身体功能却没有改善。三名患有盆腔外肿瘤的患者达到了消融热温度，但没有一个肿瘤位于盆腔内。疼痛反应与热剂量无关。盆腔外组的肿瘤体积在治疗后立即增加了 18%，但盆腔内组的肿瘤体积没有增加。到第30天时，盆腔外肿瘤的灌注与整个病灶体积的比率下降了>20%，但盆腔内肿瘤的体积没有下降，尽管在第30天盆腔外和盆腔内肿瘤的体积都增加了。

 结论

MRgHIFU 治疗可以安全地应用于复发性妇科肿瘤患者。盆腔外肿瘤的反应优于盆腔内肿瘤，并在第 30 天时立即出现肿胀和灌注量减少。