High‐Intensity Focused Ultrasound Ablation for Treatment of Hepatocellular Carcinoma and Hypersplenism

Abstract

The purpose of this work was to preliminarily investigate the efficacy and safety of high-intensity focused ultrasound treatment of hepatocellular carcinoma and hypersplenism. Nine patients with hepatocellular carcinoma complicated by hypersplenism (5 male and 4 female; median age, 56 years; range, 51-66 years) were treated with ultrasound-guided high-intensity focused ultrasound. Complications were recorded. Laboratory examination and magnetic resonance imaging were used to evaluate the efficacy. After high-intensity focused ultrasound treatment, mean spleen ablation ± SD of 28.76% ± 6.1% was discovered; meanwhile, the white blood cell count, platelet count, and liver function of the patients were substantially improved during the follow-up period. In addition, symptoms such as epistaxis and gingival bleeding were ameliorated or even eliminated, and the quality of life was improved. Follow-up imaging showed a nonperfused volume in the spleen and an absence of a tumor blood supply at the treated lesions in the liver. For the first time to our knowledge, high-intensity focused ultrasound ablation was used to treat hepatocellular carcinoma complicated by hypersplenism. High-intensity focused ultrasound may be an effective and safe alternative for treatment of hepatocellular carcinoma complicated by hypersplenism, but further studies are necessary to clarify the mechanisms.

High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system—current state of the art and future perspectives

“…Planned iatrogenic right hydrothorax with intra-pleural infusion of warm saline solution was reported in 272 cases, to enhance HIFU coupling in cases of liver dome tumor (26,35,36,38,41,45,52,55,75). Other studies reported on the use of artificial pleural infusion or artificial ascites in selected cases, without detailing the number of patients (42)(43)(44)49,51). Intragastric water filling and colon irrigation have also been described to optimize acoustic coupling and consequently reduce the risks of burn injuries to air-filled viscera that might interpose between the HIFU transducer and the target (41).…”

“…The most frequent complications were skin burns at the application sites and osteonecrosis of ribs or vertebra along the US pathway ( Tables 5,6). Post-HIFU pain was not assessed systematically and was reported in 17 studies (384 patients undergoing liver HIFU procedures) (7,12,(19)(20)(21)(22)24,26,28,29,32,39,41,45,49,54,75) and 6 studies (62 patients receiving HIFU for pancreatic malignancies) (56,59,62,70,71,75). In only a few of those trials, a semi-quantitative evaluation tool was used to report pain level, based on the analgesic requirements (mild = no analgesic; moderate = non-steroidal anti-inflammatory drugs; severe = required morphine) (7,19,20,24,39).…”

High-intensity focused ultrasound ablation: an effective and safe treatment for secondary hypersplenism

“…7,21,22 Another study has shown that HIFU is feasible and effective in the treatment of experimental splenomegaly and hypersplenism. 5 We reported that HIFU may be an effective and safe alternative for treatment of HCC that is complicated by hypersplenism, 23 However, no clinical results of HIFU for secondary hypersplenism have been reported. Because of the particularities of secondary hypersplenism, such as abundant blood sinus and vessels in spleen tissues, hyperkinesis of portal vein, fragile spleen tissues and poor liver function, leucopenia and/or thrombocytopaenia and depressed immune function, it is important to investigate the safety and efficiency of HIFU treatment for patients with secondary hypersplenism.…”

Comparison of Percutaneous Ablation Technologies in the Treatment of Malignant Liver Tumors

“…Since its first introduction in 1942, the technology of HIFU has continuously evolved, and recent developments have allowed its application to treat tumors of various solid organs, including the pancreas, liver, prostate, breast, uterus, bone, and soft tissue. [35][36][37][38] Recently, the addition of magnetic resonance (MR) guidance for HIFU has generated a renewed interest in this technology for tumor ablation. MR imaging-guided HIFU or focused ultrasound is mainly used in the treatment of uterine fibroids for which it has been approved for use by the U.S. Food and Drug Administration (FDA).…”