A New Treatment for Painful Bone Mets from Liver Cancer

Liver cancer is a disease that may have no symptoms in its early stages. It is often diagnosed at a stage when it’s beyond cure. It occurs most often in people with certain risk factors, including Hepatitis B or C, alcohol abuse/cirrhosis of the liver, diabetes, and obesity. In the U.S., there are about 30,000 new cases each year. Men are more likely to develop liver cancer than women.

Can liver cancer spread to other organs?

Today, there are many effective treatments that help control the growth of liver cancer, so people are living longer with this disease. Ironically, though, this increases the chances of “breakaway” tumor cells escaping into the bloodstream, where they can eventually reach other organs and start growing there. This is called metastatic liver cancer to distinguish it from a primary cancer. For example, lung cancer means a primary cancer that has originated in the lung, whereas a liver cancer tumor that implants itself in the lung is called metastatic liver cancer to the lung (also called liver cancer lung mets).

Liver cancer most often spreads to the lung. Unlike prostate cancer, which commonly spreads to bone, liver cancer mets to bone are less frequent. According to some estimates, 3-20% of liver cancer patients will have liver cancer bone mets.¹ About 50-75% of liver cancer bone mets occur in the spine.²

Liver cancer bone mets

Though liver cancer isn’t highly drawn to bone, if it is able to implant there it “hijacks” the growth factors and rich blood supply that sustain healthy bones. This damages the bone, leading to symptoms that characterize bone mets from any cancer:

• Pain in the bone
• Weakened bone that breaks easily (spontaneously or the result of an accidental fall or blow)
• Compression of the spinal cord if the bone mets are growing in the spine. This means pressure on the nerves of the spinal cord that can cause weakness, urinary problems, numbness or radiant pain, movement difficulties and even paralysis
• As bone mets destroy bone, calcium is released into the bloodstream causing elevated blood levels. High calcium levels can lead to loss of appetite, extreme thirst, nausea, etc.

While any of the above symptoms can be very discouraging, even depressing, bone pain that becomes excruciating literally robs a person of quality of life. Extreme pain is crippling, and difficult to control using medication. Therefore, procedures such as surgery or radiation treatments may be done as palliative measures. Palliation is not curative, but is done as a way to alleviate pain and discomfort. This is important, since ongoing liver cancer treatments can prolong life – but longer life while having severe pain is not a prospect many patients embrace. On the other hand, if the source of pain is removed, liver cancer patients welcome medical protocols that extend life.

Until recently, conventional palliative interventions were either surgery or radiation. However, pain management was not always adequate or lasting. In addition, there are drawbacks to either approach. Surgery comes with a hospital stay, risk of infection, and post-surgery pain while waiting to see if it was successful in reducing or eliminating the source of bone pain. With radiation, its effectiveness is not known for up to several weeks because radiation takes time to destroy the nerve cells – and many patients either don’t like the idea of radiation exposure, or they have already been treated with radiation for other problems and therefore can’t have any more.

A revolutionary ultrasound treatment for painful liver cancer bone mets

A new type method of treating painful bone mets avoids the drawbacks of surgery and radiation while offering efficient pain control. It is called MRI-guided Focused Ultrasound (MRgFUS). Unlike surgery, MRgFUS is noninvasive and does not create additional short-term pain. Unlike radiation, it brings pain relief in 3-7 days.

MRgFUS is a treatment that focuses ultrasound “beams” or sound waves onto a target where they are able to create destructive heat. This targeted heat deadens the nerves that receive and transmit pain messages. In certain cases, the treatment can be tailored to destroy all or part the bone lesion as well, but the primary purpose is to greatly reduce the pain. MRgFUS succeeds without invasively entering the body, as in surgery, and there is no radiation involved.

A recent study compared MRgFUS vs. radiation therapy (RT) for relieving painful bone mets. As the authors wrote, “MRgFUS was more efficient than RT in terms of the time course of pain palliation as it yielded a significantly higher response rate at 1 week after treatment.”³ Specifically, 71% of MRgFUS patients had pain relief at one week, compared with only 26% of RT patients.

For patients with liver cancer bone mets who are having intense pain, the Sperling Medical Group is proud to offer the ExAblate® MRgFUS system. For more information, contact our Center, or visit our website.

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¹ Kim S, Chun M, Wang H, et al. Bone Metastasis from Primary Hepatocellular Carcinoma: Characteristics of Soft Tissue Formation. Cancer Research and Treatment: Official Journal of Korean Cancer Association. 2007;39(3):104-108. doi:10.4143/crt.2007.39.3.104.
²Rim CH, Choi C, Choi J, Seong J. Establishment of a Disease-Specific Graded Prognostic Assessment for Hepatocellular Carcinoma Patients with Spinal Metastasis. Gut and Liver. 2017;11(4):535-542. doi:10.5009/gnl16486.
³ Lee HL, Kuo CC, Tsai JT, Chen CY et al. Magnetic resonance-guided focused ultrasound versus conventional radiation therapy for painful bone metastasis: a matched-pair study. J Bone Joint Surg Am. 2017 Sep 20;99(18):1572-1578.