Bone metastases are a common problem, caused by advanced cancer, resulting in pain. Pain caused by metastatic bone pain is difficult to relieve, and has adverse effects on the quality of life of patients, their partners and caregivers. Radiation therapy (RT), the standard treatment for palliation of metastatic bone pain, is only effective in 60-70% of patient cases. Alternative treatment options are urgently needed.

Pain management can be significantly improved by MRI-guided high-intensity focused ultrasound (MR-HIFU). The HIFU technique heats and destroys cancer cells in an MRI scanner via  targeted sound waves. The aim of the treatment is to shrink the tumour and reduce the symptoms. At present, MR-HIFU is not yet part of routine care.

The FURTHER project aims to demonstrate the (cost) effectiveness of MR-HIFU as an alternative or complementary treatment option for the relief of pain caused by bone metastases. For this purpose, a three-armed, internationally randomized controlled trial (RCT) with 216 patients will be performed. This study compares early and late pain responses in patients treated only with RT; patients treated only with MR-HIFU; and patients treated with both RT and MR-HIFU.

A prediction model will be developed to identify patients who will benefit from MR-HIFU. A pilot RCT will be conducted to investigate the effectiveness of MR-HIFU as part of a comprehensive pain management strategy. Finally, socio-economic barriers to the integration of MR-HIFU in routine care in the broader European context will be identified and analysed. FURTHER will make recommendations on equal access to this promising palliative treatment.


UMC Utrecht is the coordinator of this project

Grant scheme

  • H2020 – SC1-BHC-23-2018: novel patient-centred approaches for surviviorship, palliation and/or end-of-life care
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