Abstract
Purpose
The purpose of this study was to evaluate the safety and efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for ablation of solid tumours without damaging the surrounding structures.
Materials and methods
A specific written informed consent was obtained from every patient before treatment. From September 2008 to April 2009, 22 patients with 29 lesions were treated: nine patients with liver and/or soft-tissue metastases from colorectal carcinoma (CRC), six with pancreatic solid lesions, three with liver and/or bone metastases from breast cancer, one with osteosarcoma, one with muscle metastasis from lung cancer, one with iliac metastasis from multiple myeloma and one with abdominal liposarcoma. The mean diameter of tumours was 4.2 cm. All patients were evaluated 1 day, 1 month and 3 months after HIFU treatment by multidetector computed tomography (MDCT), positron-emission tomography (PET)-CT and clinical evaluation. The treatment time and adverse events were recorded.
Results
All patients had one treatment. Average treatment and sonication times were, respectively, 162.7 and 37.4 min. PET-CT or/and MDCT showed complete response in 11/13 liver metastases; all bone, soft-tissue and pancreatic lesions were palliated in symptoms, with complete response to PET-CT, MDCT or magnetic resonance imaging (MRI); the liposarcoma was almost completely ablated at MRI. Local oedema was observed in three patients. No other side effects were observed. All patients were discharged 1–3 days after treatment.
Conclusions
According to our preliminary experience in a small number of patients, we conclude that HIFU ablation is a safe and feasible technique for locoregional treatment and is effective in pain control.
Riassunto
Obiettivo
L’obiettivo di questo studio è stato quello di valutare la sicurezza e l’efficacia dell’applicazione degli ultrasuoni focalizzati ad elevata intensità (USgHIFU) nell’ablazione terapeutica di tumori solidi senza danneggiare le strutture circostanti.
Materiali e metodi
Uno specifico consenso informato scritto è stato ottenuto da tutti i pazienti prima del trattamento. Da settembre 2008 ad aprile 2009 sono stati trattati 22 pazienti con 29 lesioni: 9 pazienti con metastasi epatiche e/o dei tessuti molli da carcinoma del colon retto (CRC), sei pazienti con lesioni solide del pancreas, tre con metastasi epatiche e/o ossee da tumore mammario, uno con osteosarcoma, uno con metastasi muscolare da tumore del polmone, uno con lesione iliaca da mieloma multiplo ed uno con liposarcoma addominale. Il diametro medio era di 4,2 cm. Tutti i pazienti sono stati valutati ad 1 giorno, 1 mese e a 3 mesi di distanza dal trattamento HIFU con tomografia computerizzata multidetettore (MDCT), tomografia computerizzata con tomografia ad emissione di positroni (PET-CT) e valutazione clinica. La durata del trattamento e gli eventi avversi sono stati registrati.
Risultati
Tutti i pazienti sono stati trattati in una unica sessione. Il tempo medio di trattamento e di sonazione sono stati di 162,7 e 37,4 minuti, rispettivamente. PET-CT e/o MDCT hanno mostrato risposta completa in 11/13 metastasi epatiche; tutte le lesioni ossee, dei tessuti molli e le lesioni pancreatiche sono state palliate nei sintomi, con risposta completa all’esame PET-CT, MDCT o risonanza magnetica (RM); il liposarcoma ha mostrato una ablazione quasi completa all’esame RM. Edema locale è stato osservato in tre pazienti senza ulteriori eventi avversi. Tutti i pazienti sono stati dimessi da 1 a 3 giorni dopo il trattamento.
Conclusioni
Secondo la nostra esperienza preliminare da un limitato numero di pazienti, l’ablazione USgHIFU può essere considerata una metodica sicura e fattibile in assenza di alternative terapeutiche locoregionali e valida per il controllo del dolore.
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References/Bibliografia
Lynn JG, Zwemer RL, Chick AJ (1942) A new method for the generation and use of focused ultrasound in experiment biology. J Gen Physiol 26:179–193
Kennedy J (2005) High intensity focused ultrasound in the treatment of solid tumours. Nat Rev Cancer 5:321–327
Tempany CM, Stewart EA, McDannold N et al (2003) MR imaging-guided focused ultrasound surgery of uterine leiomyomas: a feasibility study. Radiology 226:897–905
Wu F, Wang ZB, Zhu H et al (2005) Feasibility of US-guided high-intensity focused ultrasound treatment in patients with advanced pancreatic cancer: initial experience. Radiology 236:1034–1040
Illing RO, Kennedy JE, Wu F et al (2005) The safety and feasibility of extracorporeal high-intensity focused ultrasound (HIFU) for the treatment of liver and kidney tumours in a Western population. Br J Cancer 93:890–895
Morita Y, Ito N, Hikida H et al (2008) Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids — early experience. Eur J Obstet Gynecol Reprod Biol 139:199–203
Wu F, Wang ZB, Chen WZ et al (2004) Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview. Ultrason Sonochem 11:149–154
Wu F, Wang ZB, Cao YD et al (2007) “Wide local ablation” of localized breast cancer using high intensity focused ultrasound. J Surg Oncol 96:130–136
Li YY, Sha WH, Zhou YJ, Nie YQ (2007) Short and long term efficacy of high intensity focused ultrasound therapy for advanced hepatocellular carcinoma. J Gastroenterol Hepatol 22:2148–2154
Stewart EA, Gedroyc WM, Tempany CM (2003) Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. Am J Obstet Gynecol 189:48–54
Stewart EA, Gostout B, Rabinovici J et al (2007) Sustained relief of leiomyoma symptoms by using focused ultrasound surgery. Obstet Gynecol 110:279–287
Livraghi T, Makuuchi M, Buscarini L (1997) Diagnosis and treatment of hepatocellular carcinoma. Greenwich Medical Media, London
Llovet JM, Real MI, Montana X (2002). Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739
Veltri A, Moretto P, Doriguzzi A et al. (2006) Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable nonearly hepatocellular carcinoma (HCC). Eur Radiol 16:661–669
Bruix J, Sala M, Llovet JM (2004) Chemoembolization for hepatocellular carcinoma. Gastroenterology 127(5 Suppl 1):S179–S188
Wu F, Wang ZB, Chen WZ et al (2004) Extracorporeal high intensity focused ultrasound ablation in the treatment of patients with large hepatocellular carcinoma. Ann Surg Oncol 11:1061–1069
Zhang L, Zhu H, Jin CB et al (2009) High intensity focused ultrasound (HIFU): Effective and safe therapy for hepatocellular carcinoma adjacent to major hepatic veins. Eur Radiol 19:437–445
DeVita VT, Hellman S, Rosenberg SA (2001) Cancer: principles and practice of oncology. Lippincott Williams & Wilkins, Philadelphia
Kennedy JE, Wu F, ter Haar GR et al (2004) High-intensity focused ultrasound for the treatment of liver tumours. Ultrasonics 42:931–935
Zhu H, Zhou K, Zhang L et al (2009) High intensity focused ultrasound (HIFU) therapy for local treatment of hepatocellular carcinoma: Role of partial rib resection. Eur J Radiol 72:160–166
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Orgera, G., Monfardini, L., Della Vigna, P. et al. High-intensity focused ultrasound (HIFU) in patients with solid malignancies: evaluation of feasibility, local tumour response and clinical results. Radiol med 116, 734–748 (2011). https://doi.org/10.1007/s11547-011-0634-4
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DOI: https://doi.org/10.1007/s11547-011-0634-4