First Clinical Experience of Intra-Operative High Intensity Focused Ultrasound in Patients with Colorectal Liver Metastases: A Phase I-IIa Study (original) (raw)
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2011 IEEE International Ultrasonics Symposium, 2011
Surgical resection is the only treatment of colorectal liver metastases that can ensure long-term survival and cure in some patients. However, only 20% of patients are suitable for surgery. As a result, many nonresectional modalities of treatment have been assessed to provide an alternative to liver resection. Several limitations have been observed when using these techniques and available evidence is limited. Here, we report that a new design of high intensity focused ultrasound transducer can significantly enlarge the coagulated volume over short periods of time and that treatment in the liver can be guided in real-time using an integrated ultrasound imaging probe. Our long-term objective is to develop a device that can be used during surgery for eventual clinical use in conjunction with resection. Eight ultrasound emitters, divided into 256 elements, were created by sectioning a single toroid piezocomposite transducer. The focal zone was conical in shape and located 70 mm from the transducer; enabling the treatment of deep-seated tumors. A single thermal lesion was created when the eight emitters performed alternative and consecutive 5-s ultrasound exposures. This article presents in vivo evidence that the coagulated volume obtained from a 40 s total exposure in the liver was 7.0 ؎ 2.5 cm 3 (minimum 1.5 -maximum 20.0 cm 3 ) with an average diameter of 17.5 ؎ 3.8 mm (minimum 10.0 -maximum 29.0 mm). All lesions were visible with high contrast on sonograms. The correlation between the diameter of lesions observed on sonograms and during gross examination was 92%. This method also allowed the user to easily enlarge the coagulated volume by juxtaposing single lesions. This approach may have a role in treating unresectable colorectal liver metastases and may also be used in conjunction with resection to extend its limits. (E-mail: David.Melodelima@inserm.fr)
High-intensity focused ultrasound ablation in hepatic and pancreatic cancer: complications
Abdominal Imaging, 2011
Purpose: To evaluate the complications of high-intensity focused ultrasound (HIFU) in patients with hepatic and pancreatic cancer. Materials and Methods: From January 2006 to December 2008, 133 sessions of HIFU treatment were performed in 114 consecutive patients with primary hepatic tumor (n = 57), hepatic metastasis (n = 22), and pancreatic cancer (n = 35) under general anesthesia. The extracorporeal, ultrasound-guided Model-JC system (HAIFU, Chongqing, China)
The Journal of the Acoustical Society of America, 2013
Surgical resection is the only treatment of colorectal liver metastases that can ensure long-term survival and cure in some patients. However, only 20% of patients are suitable for surgery. As a result, many nonresectional modalities of treatment have been assessed to provide an alternative to liver resection. Several limitations have been observed when using these techniques and available evidence is limited. Here, we report that a new design of high intensity focused ultrasound transducer can significantly enlarge the coagulated volume over short periods of time and that treatment in the liver can be guided in real-time using an integrated ultrasound imaging probe. Our long-term objective is to develop a device that can be used during surgery for eventual clinical use in conjunction with resection. Eight ultrasound emitters, divided into 256 elements, were created by sectioning a single toroid piezocomposite transducer. The focal zone was conical in shape and located 70 mm from the transducer; enabling the treatment of deep-seated tumors. A single thermal lesion was created when the eight emitters performed alternative and consecutive 5-s ultrasound exposures. This article presents in vivo evidence that the coagulated volume obtained from a 40 s total exposure in the liver was 7.0 ؎ 2.5 cm 3 (minimum 1.5 -maximum 20.0 cm 3 ) with an average diameter of 17.5 ؎ 3.8 mm (minimum 10.0 -maximum 29.0 mm). All lesions were visible with high contrast on sonograms. The correlation between the diameter of lesions observed on sonograms and during gross examination was 92%. This method also allowed the user to easily enlarge the coagulated volume by juxtaposing single lesions. This approach may have a role in treating unresectable colorectal liver metastases and may also be used in conjunction with resection to extend its limits. (E-mail: David.Melodelima@inserm.fr)
Scandinavian Journal of Surgery, 2014
Introduction: To assess the results and outcome of radiofrequency ablation in the treatment of recurrent colorectal liver metastases. Patients and Methods: Between January 2005 and September 2012, we treated 59 patients with recurrent colorectal metastases not amenable to surgery with 77 radiofrequency ablation procedures. Radiofrequency was indicated if oncologic resection was technically not possible or the patient was not fit for major surgery. A total of 91 lesions were treated. The mean number of liver tumors per patient was 1.5, and the mean tumor diameter was 2.3 cm. In 37.5% of the cases, lesions had a subcapsular location, and 34% were close to a vascular structure. Results: The morbidity rate was 18.7%, and there were no post-procedural deaths. Distant extrahepatic recurrence appeared in 50% of the patients. Local recurrence at the site of ablation appeared in 18% of the lesions. Local recurrence rate was 6% in lesions less than 3 cm and 52% in lesions larger than 3 cm. Th...
British journal of cancer, 2005
High-intensity focused ultrasound (HIFU) provides a potential noninvasive alternative to conventional therapies. We report our preliminary experience from clinical trials designed to evaluate the safety and feasibility of a novel, extracorporeal HIFU device for the treatment of liver and kidney tumours in a Western population. The extracorporeal, ultrasound-guided Model-JC Tumor Therapy System (HAIFU Technology Company, China) has been used to treat 30 patients according to four trial protocols. Patients with hepatic or renal tumours underwent a single therapeutic HIFU session under general anaesthesia. Magnetic resonance imaging 12 days after treatment provided assessment of response. The patients were subdivided into those followed up with further imaging alone or those undergoing surgical resection of their tumours, which enabled both radiological and histological assessment. HIFU exposure resulted in discrete zones of ablation in 25 of 27 evaluable patients (93%). Ablation of li...
Annals of Surgical Oncology, 2004
Background: High intensity focused ultrasound (HIFU) is a noninvasive treatment modality that induces complete coagulative necrosis of a deep tumor through the intact skin. The current study was conducted to determine the safety, efficacy, and feasibility of extracorporeal HIFU in the treatment of patients with hepatocellular carcinoma (HCC). Methods: A total of 55 patients with HCC with cirrhosis were enrolled in this prospective, nonrandomized clinical trial. Among them, 51 patients had unresectable HCC. Tumor size ranged from 4 to 14 cm in diameter with mean diameter of 8.14 cm. According to tumor, node, metastasis (TNM) classification, 15 patients corresponded to stage II, 16 to stage IIIA, and 24 to IIIC. All patients had HIFU, and the median number of HIFU session was 1.69. Safety and efficacy of HIFU were assessed in this trial. Results: No severe side effect was observed in the patients treated with HIFU. Follow-up imaging showed an absence of tumor vascular supply and the shrinkage of treated lesions. Serum α-fetoprotein returned to normal level in 34% of patients. The overall survival rates at 6, 12, and 18 months were 86.1%, 61.5%, and 35.3%, respectively. The survival rates were significantly higher in patients in stage II than those in stage IIIA (P = .0132) and in stage IIIC (P = .0265). Conclusion: As a noninvasive therapy, HIFU appears to be effective, safe, and feasible in the treatment of patients with HCC. It may play an important role in the ablation of large tumors.
Hpb, 2013
Background: High-intensity focused ultrasound (HIFU) ablation is a non-invasive treatment for hepatocellular carcinoma (HCC). At present, data on the treatment's long-term outcome are limited. This study analysed the survival outcome of HIFU ablation for HCCs smaller than 3 cm. Patients and methods: Forty-seven patients with HCCs smaller than 3 cm received HIFU treatment between October 2006 and September 2010. Fifty-nine patients who received percutaneous radiofrequency ablation (RFA) were selected for comparison. The two groups of patients were compared in terms of pre-operative variables and survival. Results: More patients in the HIFU group patients had Child-Pugh B cirrhosis (34% versus 8.5%; P = 0.001). The 1-and 3-year overall survival rates of patients whose tumours were completely ablated in the HIFU group compared with the RFA group were 97.4% versus 94.6% and 81.2% versus 79.8%, respectively (P = 0.530). The corresponding 1-and 3-year disease-free survival rates were 63.6% versus 62.4% and 25.9% versus 34.1% (P = 0.683). Conclusions: HIFU ablation is a safe and effective method for small HCCs. It can achieve survival outcomes comparable to those of percutaneous RFA and thus serves as a good alternative ablation treatment for patients with cirrhosis.
High-intensity focused ultrasound ablation of liver tumors in difficult locations
International Journal of Hyperthermia, 2021
Purpose of review To introduce recent developments in a noninvasive treatment of using high-intensity focused ultrasound (HIFU) for ablating uterine localized adenomyosis, and to discuss their potential in this application. Recent findings This literature roughly reviewed conservative therapy for uterine localized adenomyosis and emphasized using HIFU for ablating it. The main histological change of HIFU treatment was the coagulative necrosis of adenomyosis cells, with damage on small blood vessels of adenomyoma. MR-guided focused ultrasound surgery (MRgFUS) and ultrasound-guided HIFU ablation of focal adenomyosis were with satisfactory results. MRgFUS was less invasive and safely ablated adenomyosis tissue close to the endometrium or to serosal surface. HIFU might be safe and effective for treating patients with adenomyosis, and the acoustic intensity was a key factor for therapeutic efficacy as the severity of symptoms might correlate with lesion extent in some patients. At a given therapeutic dose, the influence of acoustic intensity on focal temperature rise was greater than that of exposure time. Some other experiments showed that the size of adenomyoma was increased 3-4 months after HIFU treatment. The reasons were related to the size of tumor, treatment parameters, operation procedure, and the blood supply of the targeted tissue. Although recent results have been very encouraging, further trials are essential to evaluate the long-term efficacy, and cost-effectiveness of HIFU ablation in localized adenomyosis. Summary Compared with current conservative treatments, HIFU may be a noninvasive approach and may offer complete ablation of adenomyoma, with less trauma, less complication, and low cost and short hospital stay for treating patients with uterine localized adenomyosis.