Feasibility of ExAblate MRI Guided High Intensity Focused Ultrasound Tx of Soft Tissue Tumors

N/ATerminatedNCT01965002

Pejman Ghanouni5 enrolled

Overview

The goal of this project is to evaluate the safety and preliminary efficacy of ExAblate magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) surgery in the treatment of soft tissue tumors of the extremities.

Given that the incidence of cancer increases with age, the number of elderly patients diagnosed and treated for soft tissue sarcomas (STS) will increase. The dilemma is that surgeons and medical oncologists may be hesitant to treat elderly patients in a comparably intensive manner as is used in the treatment of younger patients; factors such as decreased performance status, significant comorbidities, and disease natural history may erode enthusiasm for aggressive STS resection. To this end, a less invasive way of treating soft tissue tumors would be helpful in younger patients to minimize morbidity and in the elderly to provide less aggressive treatment options. The InSightec ExAblate 2000 magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) system is a non-invasive thermal ablation device fully integrated with an MR imaging system and used for the ablation of soft tissue (5-10). The ExAblate combines a focused ultrasound surgery (FUS) delivery system and a conventional diagnostic 1.5 T or 3 T MRI scanner. It provides a real-time therapy planning algorithm, thermal dosimetry, and closed-loop therapy control.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Soft Tissue Neoplasms

Interventions

MRgHIFUDEVICE

The InSightec ExAblate 2000 magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) system is a non-invasive thermal ablation device fully integrated with an MR imaging system and used for the ablation of soft tissue

AspirinDRUG

325 mg PO for deep venous thrombosis (DVT) prophylaxis initiated 2 hours prior to magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatment

EnoxaparinDRUG

40 mg by subcutaneous (SC) administration, for deep venous thrombosis (DVT) prophylaxis initiated 2 hours prior to magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) treatment

Eligibility

Sex: ALLMin age: 10 Years

Medical Language ↔ Plain English

INCLUSION CRITERIA * ≥ 10 years of age. * Benign or malignant soft tissue tumors of the extremities, flanks, pelvis, or shoulders requiring surgical intervention. * Tumor must not have been treated previously with radiation. * Targeted tumor(s) are accessible to the ExAblate device * Targeted volume within the tumor is located deeper than 1 cm from the skin * Targeted tumor is clearly visible by non-contrast magnetic resonance imaging (MRI) * Karnofsky Performance Status \> 60 * Normal platelet count and coagulation profile * Glomerular filtration rate \> 60 mL/min * Able to safely undergo MRI exam and receive mild sedation for the treatment. * Able to tolerate being in the MRI scanner for the duration of the study. * Able and willing to give consent (or consent + assent where applicable), and able to attend all study visits. EXCLUSION CRITERIA * Previous radiation treatment to the tumor. * Currently receiving dialysis. * Acute medical condition (eg, pneumonia, sepsis) expected to hinder completion of the study * Unstable cardiac status including: * Unstable angina pectoris on medication * Patients with documented myocardial infarction within six months of protocol entry * Congestive heart failure requiring medication (other than diuretic) * Patients on anti-arrhythmic drugs * Severe hypertension (diastolic BP \> 100 on medication) * Contraindication for MR imaging such as implanted metallic devices that are not MRI-safe, size limitations, etc * Severe hematologic, neurologic, or other uncontrolled disease * Known intolerance or allergy to medications used for sedation (midazolam), analgesia (fentanyl), and local and regional anesthesia (lidocaine, bupivacaine, and ropivacaine) * Known intolerance or allergy to MR contrast agent (gadolinium chelates) including advanced kidney disease * Pregnant and nursing * Karnofsky Performance Score \< 60 * Severe cerebrovascular disease \[cardiovascular accident (CVA) within 6 months\] * Not able or not willing to tolerate the required prolonged stationary position during treatment (up to 5 hrs of total table time) * Target volume in tumor is less than 1 cm from neurovascular bundles, major blood vessels, bowel, or bladder. * Targeted tumors: * NOT visible by non-contrast MRI, OR * NOT accessible to ExAblate device * Not a candidate for either regional anesthesia or mild sedation * Not be participating in another trial testing other investigational agents or devices

Locations (1)

Stanford University School of Medicine

Stanford, California, United States

Outcomes

Primary Outcomes

Overall Safety - Incidence of Any Device-related Adverse Events

Safety determined by evaluating for the incidence of any device-related adverse events. Patients will be assessed for pain and limb function, and by clinical examination before and after treatment to collect adverse events related to the treatment. Safety is reported as the total incidence of device-related adverse events.

Time frame: 1 week

Secondary Outcomes

Adverse Event Severity

Safety is further assessed by an evaluation of severity for the treatment-related adverse events, reported as the number of adverse events for each of the Common Terminology Criteria for Adverse Events (CTCAE) v4.0 grades. CTCAE Severity: 1. mild 2. moderate 3. severe 4. life-threatening 5. fatal

Time frame: 6 months

Percent Successful Tumor Ablation

In the resected tumor specimen, the volume of the ablated area will be determined by obtaining a digital photograph of each pathology slice. The region of interest corresponding to the ablated area will be traced, and the ablated area will be calculated for each slice and summed. Accuracy is assessed as the percent ablated volume relative to pre-treatment tumor volume.

Time frame: Up to 1 week

Data from ClinicalTrials.gov

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