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      Clinical Application of High-intensity Focused Ultrasound in Cancer Therapy

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          Abstract

          The treatment of cancer is an important issue in both developing and developed countries. Clinical use of ultrasound in cancer is not only for the diagnosis but also for the treatment. Focused ultrasound surgery (FUS) is a noninvasive technique. By using the combination of high-intensity focused ultrasound (HIFU) and imaging method, FUS has the potential to ablate tumor lesions precisely. The main mechanisms of HIFU ablation involve mechanical and thermal effects. Recent advances in HIFU have increased its popularity. Some promising results were achieved in managing various malignancies, including pancreas, prostate, liver, kidney, breast and bone. Other applications include brain tumor ablation and disruption of the blood-brain barrier. We aim at briefly outlining the clinical utility of FUS as a noninvasive technique for a variety of types of cancer treatment.

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          Overview of therapeutic ultrasound applications and safety considerations.

          Douglas Miller, Nadine Smith, Michael Bailey … (2012)
          Applications of ultrasound in medicine for therapeutic purposes have been accepted and beneficial uses of ultrasonic biological effects for many years. Low-power ultrasound of about 1 MHz has been widely applied since the 1950s for physical therapy in conditions such as tendinitis and bursitis. In the 1980s, high-pressure-amplitude shock waves came into use for mechanically resolving kidney stones, and "lithotripsy" rapidly replaced surgery as the most frequent treatment choice. The use of ultrasonic energy for therapy continues to expand, and approved applications now include uterine fibroid ablation, cataract removal (phacoemulsification), surgical tissue cutting and hemostasis, transdermal drug delivery, and bone fracture healing, among others. Undesirable bioeffects can occur, including burns from thermal-based therapies and severe hemorrhage from mechanical-based therapies (eg, lithotripsy). In all of these therapeutic applications of ultrasound bioeffects, standardization, ultrasound dosimetry, benefits assurance, and side-effect risk minimization must be carefully considered to ensure an optimal benefit to risk ratio for the patient. Therapeutic ultrasound typically has well-defined benefits and risks and therefore presents a manageable safety problem to the clinician. However, safety information can be scattered, confusing, or subject to commercial conflicts of interest. Of paramount importance for managing this problem is the communication of practical safety information by authoritative groups, such as the American Institute of Ultrasound in Medicine, to the medical ultrasound community. In this overview, the Bioeffects Committee of the American Institute of Ultrasound in Medicine outlines the wide range of therapeutic ultrasound methods, which are in clinical use or under study, and provides general guidance for ensuring therapeutic ultrasound safety.
          Article 0 comments Cited 156 times – based on 0 reviews     Review now
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            Renal cell cancer stage migration: analysis of the National Cancer Data Base.

            Christopher Kane, Katherine Mallin, Jamie Ritchey … (2008)
            Evidence exists to suggest a pattern of increasing early diagnosis of renal cell carcinoma (RCC). The aim of the study was to analyze patterns of disease presentation and outcome of RCC by AJCC stage using data from the National Cancer Data Base (NCDB) over a 12-year period. The NCDB was queried for adults diagnosed between 1993 and 2004 presenting with ICD-O-2 of 3 renal cell tumors arising in the kidney. Cases were classified by demographics, 2002 AJCC stage (6th edition), and histology. The Cochran-Armitage Test for Trend was used to determine statistical significance of trends over time. Cox regression multivariate analysis was used to evaluate the impact of stage and histology on relative survival. SPSS 14.0 was used for analyses. Between 1993 and 2004 a total of 205,963 patients from the NCDB fit our case definition of RCC. Comparisons between 1993 and 2004 data show an increase in stage I disease and decrease in stage II, III, and IV disease (P < or = .001). The size of stage I tumors also decreased from a mean of 4.1 cm in 1993 to 3.6 cm in 2003. In multivariate analysis, stage, but not histology, predicted relative survival. A 3.3% increase in survival was found for patients diagnosed in 1998 compared with patients diagnosed in 1993. A greater proportion of newly diagnosed patients with RCC currently present with stage I disease compared with earlier years. Stage predicts relative survival for patients with kidney cancer. More recently diagnosed patients have improved relative survival. (Copyright) 2008 American Cancer Society.
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              Transcranial magnetic resonance imaging- guided focused ultrasound surgery of brain tumors: initial findings in 3 patients.

              Nathan McDannold, Greg T Clement, Peter Black … (2010)
              This work evaluated the clinical feasibility of transcranial magnetic resonance imaging-guided focused ultrasound surgery. Transcranial magnetic resonance imaging-guided focused ultrasound surgery offers a potential noninvasive alternative to surgical resection. The method combines a hemispherical phased-array transducer and patient-specific treatment planning based on acoustic models with feedback control based on magnetic resonance temperature imaging to overcome the effects of the cranium and allow for controlled and precise thermal ablation in the brain. In initial trials in 3 glioblastoma patients, multiple focused ultrasound exposures were applied up to the maximum acoustic power available. Offline analysis of the magnetic resonance temperature images evaluated the temperature changes at the focus and brain surface. We found that it was possible to focus an ultrasound beam transcranially into the brain and to visualize the heating with magnetic resonance temperature imaging. Although we were limited by the device power available at the time and thus seemed to not achieve thermal coagulation, extrapolation of the temperature measurements at the focus and on the brain surface suggests that thermal ablation will be possible with this device without overheating the brain surface, with some possible limitation on the treatment envelope. Although significant hurdles remain, these findings are a major step forward in producing a completely noninvasive alternative to surgical resection for brain disorders.
              Article 0 comments Cited 113 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cancer
                Journal ID (iso-abbrev): J Cancer
                Journal ID (publisher-id): jca
                Title: Journal of Cancer
                Publisher: Ivyspring International Publisher (Sydney )
                ISSN (Electronic): 1837-9664
                Publication date Collection: 2016
                Publication date (Electronic): 3 January 2016
                Volume: 7
                Issue: 3
                Pages: 225-231
                Affiliations
                1. School of Medicine, Chung Shan Medical University, Taichung, Taiwan
                2. Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
                3. Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
                Author notes
                ✉ Corresponding authors: Yi-Hsuan Hsiao, M.D., PhD. School of Medicine, Chung Shan Medical University, Department of Obstetrics and Gynecology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500 Taiwan. Phone: +886-4-7238595 Fax: +886-4-7228289 E-mail: 54315@ 123456cch.org.tw . Or Guang-Perng Yeh, M.D. School of Medicine, Chung Shan Medical University, Department of Obstetrics and Gynecology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500 Taiwan. Phone: +886-4-7238595 Fax: +886-4-7228289 E-mail: 4011@ 123456cch.org.tw

                Competing Interests: The authors have declared that no competing interest exists.

                Article
                Publisher ID: jcav07p0225
                DOI: 10.7150/jca.13906
                PMC ID: 4747875
                PubMed ID: 26918034
                SO-VID: 2df5d00c-eca7-47d9-af71-ec1ace588644
                Copyright © © Ivyspring International Publisher. Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited. See http://ivyspring.com/terms for terms and conditions.
                History
                Date received : 18 September 2015
                Date accepted : 3 December 2015
                Categories
                Subject: Review

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: focused ultrasound surgery,cancer therapy,high-intensity focused ultrasound,ablation
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: focused ultrasound surgery, cancer therapy, high-intensity focused ultrasound, ablation

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