Abstract
IntroductionHigh-intensity focused ultrasound (HIFU) is an ablative treatment undergoing assessment for the treatment of benign and malignant disease. We describe the first reported intracavitary HIFU ablation for recurrent, unresectable and symptomatic cervical cancer.Case descriptionA 38 year old woman receiving palliative chemotherapy for metastatic cervical adenocarcinoma was offered ablative treatment from an intracavitary trans-rectal HIFU device (Sonablate® 500). Pre-treatment symptoms included vaginal bleeding and discharge that were sufficient to impede her quality of life. No peri-procedural adverse events occurred. Symptoms resolved completely immediately post-procedure, reappeared at 7 days, increasing to pre-procedural levels by day 30.Discussion and evaluationThis first time experience of intracavitary cervical HIFU suggests that it is feasible for palliation of advanced cervical cancer, with no early evidence of unexpected toxicity. Ethical approval had also been granted for the use of per-vaginal access if appropriate. This route, alone or in combination with the rectal route, may provide increased accessibility in future patients with a redesigned device more suited to trans-vaginal ablations.ConclusionIntracavitary HIFU is a potentially safe procedure for the treatment of cervical cancer and able to provide symptomatic improvement in the palliative setting.
Highlights
High-intensity focused ultrasound (HIFU) is an ablative treatment undergoing assessment for the treatment of benign and malignant disease
This first time experience of intracavitary cervical HIFU suggests that it is feasible for palliation of advanced cervical cancer, with no early evidence of unexpected toxicity
We describe the first reported intracavitary HIFU ablation for cervical cancer and determine that HIFU was feasible with demonstrable benefits
Summary
This first time experience of intracavitary cervical HIFU suggests that it is feasible for palliation of advanced cervical cancer, with no early evidence of unexpected toxicity. Figure depicting intraoperative tissue changes identified using the integrated ultrasound imaging transducer of the Sonablate® 500 HIFU device. The device was not initially intended for gynaecological use, and it proved impossible to obtain satisfactory alignment to the target site as energy delivery is perpendicular to the transducer. This demonstrates the need to have HIFU transducers tailored to individual indications. Trans-vaginal ablations would reduce the risk of post-procedural fistulae when compared to the trans-rectal approach, remove the possibility of skin burns seen with trans-abdominal treatments and lower the potential for damage to the healthy intervening tissue, by shortening the distance to the tumour
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