High-intensity focused ultrasound ablation in hepatic and pancreatic cancer: complications

Jung, Seung Eun; Cho, Se Hyun; Jang, Jin Hee; Han, Ji-Hye

doi:10.1007/s00261-010-9628-2

Cited by 117 publications

(99 citation statements)

References 19 publications

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“…[6][7][8][9] Histotripsy uses cavitation, which is a threshold phenomenon. When acoustic pressure perturbations within the focal volume of the transducer are large enough (ie, negative pressure swings sufficiently low), cavitation will occur.…”

Section: Discussionmentioning

confidence: 99%

Histotripsy Homogenization of the Prostate: Thresholds for Cavitation Damage of Periprostatic Structures

Styn

Hall

Fowlkes

et al. 2011

Journal of Endourology

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Background and Purpose: Histotripsy is a noninvasive, pulsed ultrasound technology that produces mechanically homogenized tissue within targeted volumes. Previous work has demonstrated prostatic tissue debulking in a canine model. The aim was to establish safety thresholds by evaluating histologic changes of urinary sphincter, neurovascular bundle (NVB), and rectum after targeted histotripsy treatment of these critical structures. Materials and Methods: Rectum, urinary sphincter, and NVB in five anesthetized canines were targeted for histotripsy treatment (50 total points). Locations received 1k, 10k, or 100k acoustic pulses (4 microsecond, 1 MHz) at a repetition frequency of 500 Hz. Canine subjects were euthanized immediately (2), survived 3 days (1), or 2 weeks (3) after treatment. Prostates, periprostatic tissue, and rectum were harvested and processed for histology. Results: The sphincter was structurally intact with minimal muscle fiber disruption even after 100k pulses (n = 10). Undamaged nerves, arteries, and veins of the NVB were seen despite mechanical homogenization of surrounding loose connective tissue (n = 19). The rectum, however, exhibited dose-dependent damage (n = 20). 1k pulses yielded mild submucosal hemorrhage. 10k pulses resulted in moderate collagen disruption and focal mucosal homogenization. 100k pulses produced damage to the mucosa and muscularis propria with extensive hemorrhage and collagen disruption. One canine treated with 100k pulses needed early euthanasia (day 3) because of complications from a urine leak. Conclusions: Histotripsy histologic tissue effect varied based on targeted structure with substantial structural preservation of NVB and sphincter. Rectal subclinical damage was apparent after 1k pulses and increased in extent and severity with escalating doses. Future work will include assessment of functional outcomes and refinement of these initial safety thresholds.

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Section: Discussionmentioning

confidence: 99%

Histotripsy Homogenization of the Prostate: Thresholds for Cavitation Damage of Periprostatic Structures

Styn

Hall

Fowlkes

et al. 2011

Journal of Endourology

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“…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).…”

Section: Records Included For Qualitative Synthesis N=67mentioning

confidence: 99%

“…Forty-four studies reported on the clinical use of HIFU (7,(10)(11)(12)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) to treat liver lesions , while 19 series were found on HIFU treatment for pancreatic cancers (6,(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73) and 4 studies included patients suffering from both liver and pancreatic cancers (74)(75)(76)(77), reporting on a total of 1,682 and 823 cases for the liver and pancreas, respectively. However, the real number of patients who benefited from HIFU treatment is much larger, since a recent review article from Zhou reported on over 3,000 cases of advanced pancreatic cancer treated with HIFU alone or in combination with chemotherapy (CHT) or radiotherapy (RT) (78).…”

Section: Study Selection and Level Of Evidencementioning

confidence: 99%

“…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).…”

Section: Complicationsmentioning

confidence: 99%

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

Diana¹,

Schiraldi²,

Liu³

et al. 2016

Hepatobiliary Surg. Nutr.

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Background: High intensity focused ultrasound (HIFU) is emerging as a valid minimally-invasive imageguided treatment of malignancies. We aimed to review to current state of the art of HIFU therapy applied to the digestive system and discuss some promising avenues of the technology.Methods: Pertinent studies were identified through PubMed and Embase search engines using the following keywords, combined in different ways: HIFU, esophagus, stomach, liver, pancreas, gallbladder, colon, rectum, and cancer. Experimental proof of the concept of endoluminal HIFU mucosa/submucosa ablation using a custom-made transducer has been obtained in vivo in the porcine model. Results:Forty-four studies reported on the clinical use of HIFU to treat liver lesions, while 19 series were found on HIFU treatment of pancreatic cancers and four studies included patients suffering from both liver and pancreatic cancers, reporting on a total of 1,682 and 823 cases for liver and pancreas, respectively. Only very limited comparative prospective studies have been reported. Conclusions:Digestive system clinical applications of HIFU are limited to pancreatic and liver cancer. It is safe and well tolerated. The exact place in the hepatocellular carcinoma (HCC) management algorithm remains to be defined. HIFU seems to add clear survival advantages over trans arterial chemo embolization (TACE) alone and similar results when compared to radio frequency (RF). For pancreatic cancer, HIFU achieves consistent cancer-related pain relief. Further research is warranted to improve targeting accuracy and efficacy monitoring. Furthermore, additional work is required to transfer this technology on appealing treatments such as endoscopic HIFU-based therapies.Keywords: High intensity focused ultrasound (HIFU); liver cancer; pancreatic cancer; miniature HIFU delivery system; endoluminal applications of HIFU; mucosa and submucosal ablations using HIFU

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“…However, as reported in previous studies, HIFU induced skin burns and pain in the treatment region, neurapraxia of stomach and intestines, rarely developed superior mesenteric infarction and perforation in terminal ileum [4]. Jung et al [5] showed that the ultrasound heat could cause third-degree burn, necrosis of the ribs along the main ultrasound beam path, rib fractures and other complications such as biliary obstruction, pneumothorax and fistula formation.…”

Section: Introductionmentioning

confidence: 79%

Characteristic Uptake Pattern of Bone Scintigraphy in Patients with Hepatocellular Carcinoma Following Treatment with High-Intensity Focused Ultrasound

Lai

et al. 2013

Nucl Med Mol Imaging

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Purpose This study retrospectively reviews the characteristic bone scintigraphic findings in 18 patients with hepatocellular carcinoma (HCC) following treatment with high-intensity focused ultrasound (HIFU). A potential complication of HIFU is damage to the tissues along the path of the ultrasound beam and structures superficial to the lesion of interest. Methods Patients with hepatocellular carcinoma who underwent a bone scan between 1st December 2005 and 31st December 2011 were considered for this study. Among these patients, only those who had bone scans after the HIFU treatment were included. The time between HIFU treatment and bone scans, HIFU energy, HCC sites, tumour sizes and related radiological findings were evaluated. Results In total, 20 bone scans of 18 patients were reviewed. Of these scans, two patients were normal; three patients showed decreased uptake, four patients showed increased uptake and nine patients showed mixed uptakes of the bony tracer in their rib cages. The defects were located in the anterior, lateral, anterolateral or posterolateral aspects of the rib cage. The majority of those cold defects were in the right anterior rib cages. SPECT/CT was used to localise the decreased uptake in ribs. The magnetic resonance imaging in individual patients invariably showed ill-defined rim enhancement along the right chest wall, signifying chest wall injury. Conclusions The results showed that tissue ablation using HIFU caused tissue injury along the pathway of highintensity ultrasound beams. The harm to tissues is presented as photopenic area on the rib cages due to necrosis or hot spots due to rib fractures in the bone scan. Since these cold defects are subtle, they are easily overlooked or mistaken as aggressive bony metastasis.

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High-intensity focused ultrasound ablation in hepatic and pancreatic cancer: complications

Abstract: The complications of HIFU develop mainly around the targeted lesions or along the ultrasound beam pathway. It is essential to have awareness of the possible complications related to HIFU and its imaging features for to avoiding serious complications.

Cited by 117 publications

References 19 publications

Histotripsy Homogenization of the Prostate: Thresholds for Cavitation Damage of Periprostatic Structures

Histotripsy Homogenization of the Prostate: Thresholds for Cavitation Damage of Periprostatic Structures

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

Characteristic Uptake Pattern of Bone Scintigraphy in Patients with Hepatocellular Carcinoma Following Treatment with High-Intensity Focused Ultrasound

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