Efficacy Of High-intensity Focused Ultrasound Treatment Research Articles

肝細胞癌に対する超音波ガイド下high-intensity focused ultrasound治療

High-intensity focused ultrasound (HIFU) is a noninvasive method that can cause complete coagulation necrosis without requiring the insertion of any instruments. The purpose of this study was to evaluate the safety and efficacy of HIFU treatment for small liver cancers without performing transcatheter arterial chemoembolization (TACE) or rib resection. HIFU ablation was performed without rib resection or the aid of TACE or percutaneous ethanol injection (PEI) in 25 patients with hepatocellular carcinoma. The HIFU system (Chongqing Haifu Tech, Chongqing, China) was used under ultrasound guidance. All 25 patients completed the treatment without experiencing any adverse events. Complete coagulation was achieved by applying the sonications from the intercostal space when the tumor was located in the right lobe. After treatment, serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) levels were significantly higher than the baseline values; these levels recovered within 1 week. An epidural anesthetic provided sufficient pain suppression during the procedure. None of the patients developed acute hepatic failure, liver abscess or renal dysfunction. In conclusion, HIFU is effective for the treatment of patients with small liver cancer.

Evaluation on the immune effects and imaging of high intensity focused ultrasound in the treatment ofpancreatic carcinoma

Objective To explore the immune effects of high intensity focused ultrasound （HIFU） in the treatment of pancreatic carcinoma and to investigate the imaging methods to evaluate HIFU＇s efficacy~ Methods A total of 32 patients with pancreatic carcinoma treated by HIFU were enrolled. The freeze-thaw antigen was prepared by freezing and thawing the cancer cells. HIFU antigen was prepared by cancer cells sonicated by HIFU. The killing effects of no antigen activated dendritic cells （DC） induced T lymphocyte （DC-T）, freeze-thaw antigen activated DC induced T lymphocyte （freeze-thaw antigen-DC-T） and HIFU activated DC induced T lymphocyte （HIFUantigen-DC-T） in autologous pancreatic cancer cells were detected by lactic dehydrogenase kit. The changes of immune indexes [-heat shock protein 70 （HSP70）, T helper lymphocyte Thl/Th2 and transforming growth factor-β （TGF-β] before and after HIFU treatment were determined by enzyme linked immunosorbnent assay （ELISA） method. The changes of clinical efficacy indexes [visual analogue scale （VAS）, performance status （PS） and carbohydrate antigen （CA） 19-9] before and after HIFU treatment were compared. The instant and recent （two months） efficacy of HIFU treatment were evaluated by contrast-enhanced ultrasonograph（CEUS） and computed tomography （CT）. The line q test was performed for comparision between groups, t-test was applied for comparision before and after treatment. Results Compared with freeze-thaw antigen, the killing effect of HIFU antigen-DC-T in autologous pancreatic cancer cells was higher （ 40. 24% ±45 10. 56% vs 46.93%±13.26%, q=3.44,P〈0.05）. HSP70 [（17.31±4, 75） ng/mlvs （22.84±5.56） ng/ml], Thl/Th2 （1.24±0.36 vs 1.47±0.31）, TGF-13 [（1.39±0.41） ng/ml vs （1.04±0. 38） ng/ml], VAS （3.97±1.32 vs 3.26±1.18）, PS （2.76±1.02 vs 2.21±0.86） and CA19-9 level[（135.39± 37.45） U/ml vs （114.82±30.51） U/ml] improved after HIFU treatment compared with those before treatment （t=4.278; 2. 739, 3. 542, 2. 268, 2. 332 and 2.409,allP〈0.05）. CEUSandCT showed that blood supply and the volume of the tumors reduced after HIFU treatment. Conclusions HIFU is effective in treating pancreatic carcinoma, improving immune status of patients and enhancing anti- tumor response. CEUS can real-time evaluate the efficacy of HIFU treatment. Key words: Pancreatic neoplasms; Ultrasonic therapy; Ultrasonography; Dendritic cells

Multidisciplinary treatment with chemotherapy, targeted drug, and high-intensity focused ultrasound in advanced pancreatic carcinoma

This study reports a case of an advanced pancreatic cancer patient with liver metastasis who was treated with a combination of chemotherapy, targeted drugs, and high-intensity focused ultrasound (HIFU). The abdominal pain was successfully relieved after the HIFU therapy. The patient had an 18-month survival with satisfactory quality of life. Large-scale randomized clinical trials are necessary to evaluate the long-term efficacy of HIFU treatment with or without chemotherapy and/or targeted drug therapy for pancreatic carcinoma.

Extracorporeal high intensity focused ultrasound in the treatment of patients with solid malignancy

The ideal treatment of localized cancer should cause the complete death of tumor cells without damage to surrounding normal tissue. High intensity focused ultrasound (HIFU) is such a potential treatment, which can induce complete coagulation necrosis of a targeted tumor, at depth, through the intact skin. The concept of using HIFU as a non‐invasive therapy has attracted attention in medicine for 60 years. Recently, it has received increasing interest as a promising modality for the treatment of localized solid malignancies. The goal of this article is to introduce recent clinical developments in the use of extracorporeal HIFU ablation for solid tumors, including those of liver, breast, bone, kidney, pancreas, soft tissue, and uterus. It describes the physical principles and ablative mechanisms, three‐dimensional therapeutic regimes, and medical imaging used in HIFU. Currently, large numbers of patients with solid malignancy are already treated using HIFU, and short‐term clinical results are very encouraging. However, large‐scale randomized clinical trials are necessary to evaluate long‐term efficacy of HIFU treatment for solid malignancies. It is concluded that this non‐invasive ablation can be considered as a conventional therapy for widespread clinical use only when the results from prospective, randomized clinical trials worldwide are available.