High-Intensity Focused Ultrasound for Pain Management in Patients with Cancer
High-Intensity Focused Ultrasound for Pain Management in Patients with Cancer
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DOI：
10.1148/rg.2018170129
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发表时间：
2018-03-01
期刊：
影响因子：
5.5
通讯作者：
Napoli, Alessandro
中科院分区：
文献类型：
--
作者：
Dababou, Susan;Marrocchio, Cristina;Napoli, Alessandro
癌症相关疼痛影响高达80%的恶性肿瘤患者。疼痛是一种重要的痛苦症状，它降低了患者的生活质量，并对患者的生存产生了负面影响。阿片类止痛剂通常是癌症相关疼痛的主要治疗方法，手术、放射治疗、化疗和其他干预措施用于治疗难治性疼痛。这些治疗方法可能会产生严重的副作用和全身毒性，可能不会有效。高强度聚焦超声是一种完全非侵入性的技术，被批准用于治疗子宫肌瘤、骨转移瘤和特发性震颤。在磁共振成像或超声引导下，高强度超声波聚焦在一个很小的、划分得很好的区域，从而实现精确的局部消融。这种治疗方法可能代表了一种治疗恶性疾病患者的多模式方法--促进疼痛缓解，增强局部药物输送和放射治疗效果，刺激抗癌特异性免疫反应，并潜在地促进局部肿瘤控制。聚焦超声可以通过产生几种效应来实现疼痛缓解，包括组织去神经、肿瘤质量减少和神经调节，这些效应可以影响疼痛起源的不同路径。与其他止痛疗法相比，这项技术具有几个关键优势：它是完全非侵入性的，可以用来实现快速疼痛控制，可以安全地重复使用，可以与化疗和放射治疗联合使用，以增强其效果。(C)RSNA，2018年
Cancer-related pain affects up to 80% of patients with malignancies. Pain is an important distressing symptom that diminishes the quality of life and negatively affects the survival of patients. Opioid analgesics are generally the primary therapy for cancer-related pain, with surgery, radiation therapy, chemotherapy, and other interventions used in cases of treatment-resistant pain. These treatments, which can be associated with substantial side effects and systemic toxicity, may not be effective. High-intensity focused ultrasound is an entirely noninvasive technique that is approved for treatment of uterine fibroids, bone metastases, and essential tremors. With magnetic resonance imaging or ultrasonographic guidance, high-intensity ultrasound waves are focused on a small well-demarcated region to result in precise localized ablation. This treatment may represent a multimodality approach to treating patients with malignant diseases-facilitating pain palliation, enhanced local drug delivery and radiation therapy effects, and stimulation of anticancer specific immune responses, and potentially facilitating local tumor control. Focused ultrasound can be used to achieve pain palliation by producing several effects, including tissue denervation, tumor mass reduction, and neuromodulation, that can influence different pathways at the origin of the pain. This technology has several key advantages compared with other analgesic therapies: It is completely noninvasive, might be used to achieve rapid pain control, can be safely repeated, and can be used in combination with chemotherapy and radiation therapy to enhance their effects. (C) RSNA, 2018