Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer

Abstract

Purpose: Evaluation of ultrasound-guided high-intensity focused ultrasound (HIFU) used for the first time in Germany in patients with inoperable pancreatic cancer for reduction of tumor volume and relief of tumor-associated pain. Materials and Methods: 15 patients with locally advanced inoperable pancreatic cancer and tumor-related pain symptoms were treated by HIFU (n?=?6 UICC stage III, n?=?9 UICC stage IV). 13 patients underwent simultaneous standard chemotherapy. Ablation was performed using the JC HIFU system (Chongqing, China HAIFU Company) with an ultrasonic device for real-time imaging. Imaging follow-up (US, CT, MRI) and clinical assessment using validated questionnaires (NRS, BPI) was performed before and up to 15 months after HIFU. Results: Despite biliary or duodenal stents (4/15) and encasement of visceral vessels (15/15), HIFU treatment was performed successfully in all patients. Treatment time and sonication time were 111?min and 1103?s, respectively. The applied total energy was 386?768?J. After HIFU ablation, contrast-enhanced imaging showed devascularization of treated tumor regions with a significant average volume reduction of 63.8?% after 3 months. Considerable pain relief was achieved in 12 patients after HIFU (complete or partial pain reduction in 6 patients). Conclusion: US-guided HIFU with a suitable acoustic pathway can be used for local tumor control and relief of tumor-associated pain in patients with locally advanced pancreatic cancer. Key points: ??US-guided HIFU allows an additive treatment of unresectable pancreatic cancer. ??HIFU can be used for tumor volume reduction. ??Using HIFU, a significant reduction of cancer-related pain was achieved. ??HIFU provides clinical benefit in patients with pancreatic cancer. Citation Format: ??Strunk HM, Henseler J, Rauch M et?al. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. Fortschr R?ntgenstr 2016; 188: 662???670

Effects of high‑intensity focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer

“…It was first reported in 2000 that HIFU successfully ablates and treats pancreatic cancer (29). Several studies have confirmed the safety and efficacy of HIFU in the treatment of pancreatic cancer (10,(14)(15)(16)(19)(20)(21)(22)(23)(24)(25)(29)(30)(31)(32)(33)(34). The most common complications observed following HIFU treatment of pancreatic cancer include skin burns (10,15,17,(21)(22)(23)(30)(31)(32), pancreatitis (10,18,23,31,32), duodenal fistula (23,31) and obstructive jaundice (19,34).…”

“…widely used in the treatment of uterine fibroids and hepatocellular carcinoma, with good therapeutic results (12). Previous studies have confirmed that HIFU therapy effectively alleviates cancer-associated abdominal pain, reduces tumor volume and may confer an additional survival benefit (11,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). However, vascular complications caused by this treatment have been reported, including secondary occlusion of the superior mesenteric artery (24) and portal vein thrombosis (25).…”

“…In related studies, patients with pancreatic cancer received RFA and IRE and the primary complications included acute pancreatitis (8,9,(42)(43)(44)(45)(46)48), abdominal pain (46,48), pancreatic fistula (8,9,42,43,45,49), duodenal ulcer or perforation (9,(42)(43)(44)49), gastrointestinal bleeding (42,(44)(45)(46)(47) and biliary fistula (46). In HIFU, the main complications included acute pancreatitis, skin burn, abdominal pain (22,33,34) and elevated amylase expression levels (14,21,33,34), whereas vascular adverse events are rarely recorded and patients can recover and be discharged within a short time (24,25). In addition, HIFU treatment utilizes ultrasound without involving the use of needles, electrodes, probes or similar items, therefore HIFU is safer and less invasive compared with other local ablation methods and can be performed in patients with tumors near vessels, the intestine or the bile duct stent (7).…”

High‐Intensity Focused Ultrasonography and Radiofrequency Ablation of Renal Cell Carcinoma Arisen in Transplanted Kidneys: Single‐Center Experience With Long‐Term Follow‐Up and Review of Literature

“…In addition to the curative aspect of the procedure, HIFU has also been shown to have palliative importance by reducing tumor‐related pain and thus improving quality of life for patients with advanced disease. A large series with more than 200 patients with pancreatic cancer treated in China with HIFU suggested a reduction of the tumor size, reduction of visceral pain, and increased survival . There was a small percentage of in‐hospital complications, and no deaths were observed.…”

Fortgeschrittenes Pankreaskarzinom: Hoch-intensiver fokussierter Ultraschall (HIFU) und andere lokal ablative Verfahren

“…Interventionalisten abhängig sind. Der Ultraschall (US) ge steuerte HIFU bietet dabei eine minimalinvasive und wirksame Be handlungsoption, die in Kombination mit einer palliativen Stan dardchemotherapie zur Schmerzlinderung und lokalen Tumorkon trolle erfolgreich eingesetzt werden kann [7,8] und im Gegensatz zu den anderen lokal ablativen Verfahren ohne das Einbringen von Nadeln, Sonden oder Elektroden funktioniert. Vor diesem Hinter grund werden im Folgenden unsere Erfahrungen zur symptomati schen Therapie mit USgesteuertem HIFU beim fortgeschrittenen Pankreaskarzinom anderen lokal ablativen Verfahren gegenüber gestellt.…”