Effectiveness and Safety of High-intensity Focused Ultrasound for Bone Tumors: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGYing-qiang ^1,2 , LIXiang-lian ¹ ,  LIYou-ping ¹ , LUOQian-qian ³

1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Department of Medical Administration, 363 Hospital, Chengdu 610041, China;
3. National Chengdu Center for Safety Evaluation of Drugs, Chengdu 610041, China;

Corresponding author：

LIYou-ping, Email: yzmylab@hotmail.com

Keywords：

High-intensity focused ultrasound; Bone tumor; Osteosarcoma; Systematic review

DOI：

10.7507/1672-2531.20150055

Video：

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Objective To explore the effectiveness and safety of high-intensity focused ultrasound (HIFU) for bone tumors, so as to provide a reference for clinical decision. Methods PubMed, EMbase, The Cochrane Library, CNKI and VIP databases were systematically searched for clinical effectiveness and safety studies of HIFU for bone tumors up to August 2014. Study selection, data extraction and quality assessment were applied independently by two reviewers, and then RevMan 5.1 software was used for conducting meta-analysis. If the data cannot be synthesized, the research outcome was described with a qualitative analysis. Results A total of 10 case series including 257 patients (157 males, 100 females) were included. The current evidence indicated that overall survival rates for all primary bone malignancy at 1-, 2-, 3- and 5-year were 89.8%, 72.3%, 60.5% and 50.5%, respectively. For the patients with clinical stage Ⅱb, the rates were 93.3%, 82.4%, 75% and 63.7%, respectively. For those with clinical stage Ⅲ, the rates were 79.2%, 42.2%, 21.1% and 15.8%, respectively. The local recurrence rate of HIFU for bone tumors was 7% to 9%, and recurrences at 1-, 2-, 3- and 5-year were 0%, 6.2%, 11.8% and 11.8%, respectively. The amputation rate was 2% to 7%. The adverse reaction rate was 27.2% (70/257), and among them the main was mild skin burn (21/257, 8.2%), followed by I degree burns (16/257, 6.2%), nerve damage (10/257, 3.9%) and fracture (6/257, 2.3%). Conclusion HIFU provide an alternative choice for patients with bone malignancy, with a certain effectiveness and safety. However, high-quality, large-scale randomized controlled trials or cohort studies which may focus on vary kinds of tumors, clinical stage and site of lesions are urgently needed, so that clinicians can use sufficient evidence for their clinical decision-making.

Citation： WANGYing-qiang, LIXiang-lian, LIYou-ping, LUOQian-qian. Effectiveness and Safety of High-intensity Focused Ultrasound for Bone Tumors: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2015, 15(3): 327-334. doi: 10.7507/1672-2531.20150055 Copy

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2.	陈志峰, 陈万青, 陈建国, 等. 中国肿瘤登记地区人群骨肿瘤发病分析. 中国肿瘤临床, 2012, 39(20):1509-1513.
3.	Anract P.[Surgical management of primary bone cancer]. Bull Acad Natl Med, 2009, 193(1):107-126.
4.	Mavrogenis AF, Abati CN, Romagnoli C, et al. Similar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma. Clin Orthop Relat Res, 2012, 470(6):1735-1748.
5.	Hofer SO, Molema G, Hermens RA, et al. The effect of surgical wounding on tumour development. Eur J Surg Oncol, 1999, 25(3):231-243.
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11.	Chen W, Zhu H, Zhang L, et al. Primary bone malignancy:effective treatment with high-intensity focused ultrasound ablation. Radiology, 2010, 255(3):967-978.
12.	陈文直, 王智彪, 伍烽, 等. 高强度聚焦超声治疗原发恶性骨肿瘤的初步临床研究. 中华肿瘤杂志. 2002, 24(06):612-615.
13.	陈文直, 伍烽, 朱辉, 等. 高强度聚焦超声治疗骨肉瘤初步临床观察. 中国肿瘤临床, 2001, 28(7):489-491.
14.	曾燕, 罗小平, 喻明宪, 等. 动脉灌注化疗与高强度聚焦超声联合治疗恶性骨肿瘤的血管造影变化. 重庆医科大学学报, 2000, 25(04):411-413.
15.	曾燕, 罗小平, 淦伟, 等. 恶性骨肿瘤超声聚焦刀与介入联合治疗后影像学检查的初步研究. 临床放射学杂志. 2000, 19(07):444-447.
16.	李仲全. 高强度聚焦超声治疗骨肉瘤的临床应用研究. 中外医疗, 2013, (29):56-57.
17.	Wang Y, Wang W, Tang J. Primary malignant tumours of the bony pelvis:US-guided high intensity focused ultrasound ablation. Int J hyperthermia, 2013, 29(7):683-687.
18.	徐梅华, 蔡克银. 高强度聚焦超声治疗老年骨转移癌的近期疗效. 中国老年学杂志, 2012, 32(20):4542-4543.
19.	胡文莉, 焦玉冰, 张浩, 等. 高强度聚焦超声治疗骶骨肿瘤19例分析. 人民军医, 2012, 55(2):161-162.
20.	庄开颜, 进克效, 焦玉冰, 等. 高强度聚焦超声治疗骶髂部骨肿瘤的初步临床观察. 解放军医学杂志. 2010, 35(04):474-474.
21.	李静, 盖绿华, 杨武威, 等. 低功率聚焦超声对骨/软组织肿瘤化疗增敏作用的临床观察. 山东医药. 2008, 48(37):53-54.
22.	寇海燕, 孙鲲, 张宏, 等. 高强度聚焦超声治疗骨肿瘤15例. 武警医学, 2006, 17(9):686-688.
23.	李伟兵, 章明, 白向君, 等. 恶性骨肿瘤的高强度聚焦超声无创治疗. 中国骨肿瘤骨病, 2003, 2(05):301-304, 317.
24.	Wiromrat P, Jetsrisuparb A, Komvilaisak P, et al. Incidence and survival rates among pediatric osteogenic sarcoma cases in Khon Kaen, Thailand, 1985-2010. Asian Pac Cancer Prev, 2012, 13(9):4281-4284.
25.	Xu M, Xu SF, Yu XC. Clinical analysis of osteosarcoma patients treated with high-dose methotrexate-free neoadjuvant chemotherapy. Curr Oncol, 2014, 21(5):e678-684.
26.	Liu Y, Xu Y, Lin N, et al. High-dose methotrexate (HD-MTX) used as an adjunct with other chemotherapeutics for the treatment of osteosarcoma. Cell Biochem Biophys, 2014.[Epub ahead of print].
27.	Tan PX,Yong BC,Wang J, et al. Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee. Eur J Surg Oncol, 2012,38(12):1171-1177.
28.	Sherman CE, O'Connor MI, Sim FH. Survival, local recurrence, and function after pelvic limb salvage at 23 to 38 years of follow-up. Clin Orthop Relat Res, 2012, 470(3):712-727.

1. Hameed M, Dorfman H. Primary malignant bone tumors--recent developments. Semin Diagn Pathol, 2011, 28(1):86-101.
2. 陈志峰, 陈万青, 陈建国, 等. 中国肿瘤登记地区人群骨肿瘤发病分析. 中国肿瘤临床, 2012, 39(20):1509-1513.
3. Anract P.[Surgical management of primary bone cancer]. Bull Acad Natl Med, 2009, 193(1):107-126.
4. Mavrogenis AF, Abati CN, Romagnoli C, et al. Similar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma. Clin Orthop Relat Res, 2012, 470(6):1735-1748.
5. Hofer SO, Molema G, Hermens RA, et al. The effect of surgical wounding on tumour development. Eur J Surg Oncol, 1999, 25(3):231-243.
6. Bogden AE, Moreau JP, Eden PA. Proliferative response of human and animal tumours to surgical wounding of normal tissues:onset, duration and inhibition. Br J Cancer, 1997, 75(7):1021-1027.
7. 刘正, 侯树勋. 恶性骨肿瘤的高强度聚焦超声治疗研究进展. 中国骨肿瘤骨病, 2010, 9(3):259-262.
8. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement. PLoS Med, 2009, 6(7):e1000097.
9. Higgins JPT,Green S (editors).Cochrane handbook for systematic reviews of interventions version 5.1.0[updated March 2011]. The Cochrane Collaboration,2011.Available at:www.cochrane-handbook.org.
10. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四:观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4):297-299.
11. Chen W, Zhu H, Zhang L, et al. Primary bone malignancy:effective treatment with high-intensity focused ultrasound ablation. Radiology, 2010, 255(3):967-978.
12. 陈文直, 王智彪, 伍烽, 等. 高强度聚焦超声治疗原发恶性骨肿瘤的初步临床研究. 中华肿瘤杂志. 2002, 24(06):612-615.
13. 陈文直, 伍烽, 朱辉, 等. 高强度聚焦超声治疗骨肉瘤初步临床观察. 中国肿瘤临床, 2001, 28(7):489-491.
14. 曾燕, 罗小平, 喻明宪, 等. 动脉灌注化疗与高强度聚焦超声联合治疗恶性骨肿瘤的血管造影变化. 重庆医科大学学报, 2000, 25(04):411-413.
15. 曾燕, 罗小平, 淦伟, 等. 恶性骨肿瘤超声聚焦刀与介入联合治疗后影像学检查的初步研究. 临床放射学杂志. 2000, 19(07):444-447.
16. 李仲全. 高强度聚焦超声治疗骨肉瘤的临床应用研究. 中外医疗, 2013, (29):56-57.
17. Wang Y, Wang W, Tang J. Primary malignant tumours of the bony pelvis:US-guided high intensity focused ultrasound ablation. Int J hyperthermia, 2013, 29(7):683-687.
18. 徐梅华, 蔡克银. 高强度聚焦超声治疗老年骨转移癌的近期疗效. 中国老年学杂志, 2012, 32(20):4542-4543.
19. 胡文莉, 焦玉冰, 张浩, 等. 高强度聚焦超声治疗骶骨肿瘤19例分析. 人民军医, 2012, 55(2):161-162.
20. 庄开颜, 进克效, 焦玉冰, 等. 高强度聚焦超声治疗骶髂部骨肿瘤的初步临床观察. 解放军医学杂志. 2010, 35(04):474-474.
21. 李静, 盖绿华, 杨武威, 等. 低功率聚焦超声对骨/软组织肿瘤化疗增敏作用的临床观察. 山东医药. 2008, 48(37):53-54.
22. 寇海燕, 孙鲲, 张宏, 等. 高强度聚焦超声治疗骨肿瘤15例. 武警医学, 2006, 17(9):686-688.
23. 李伟兵, 章明, 白向君, 等. 恶性骨肿瘤的高强度聚焦超声无创治疗. 中国骨肿瘤骨病, 2003, 2(05):301-304, 317.
24. Wiromrat P, Jetsrisuparb A, Komvilaisak P, et al. Incidence and survival rates among pediatric osteogenic sarcoma cases in Khon Kaen, Thailand, 1985-2010. Asian Pac Cancer Prev, 2012, 13(9):4281-4284.
25. Xu M, Xu SF, Yu XC. Clinical analysis of osteosarcoma patients treated with high-dose methotrexate-free neoadjuvant chemotherapy. Curr Oncol, 2014, 21(5):e678-684.
26. Liu Y, Xu Y, Lin N, et al. High-dose methotrexate (HD-MTX) used as an adjunct with other chemotherapeutics for the treatment of osteosarcoma. Cell Biochem Biophys, 2014.[Epub ahead of print].
27. Tan PX,Yong BC,Wang J, et al. Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee. Eur J Surg Oncol, 2012,38(12):1171-1177.
28. Sherman CE, O'Connor MI, Sim FH. Survival, local recurrence, and function after pelvic limb salvage at 23 to 38 years of follow-up. Clin Orthop Relat Res, 2012, 470(3):712-727.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of High-intensity Focused Ultrasound for Bone Tumors: A Systematic Review

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