Safety Evaluation of High-Intensity Focused Ultrasound in Patients with Pancreatic Cancer

Abstract

Introduction: This study was performed to analyze the safety of high-intensity focused ultrasound (HIFU) for treating pancreatic cancer. Methods: 224 cases with advanced pancreatic cancer were enrolled into this study. Real-time sonographic images were taken, and vital signs, liver and kidney function, skin burns, local reactions, and systemic effects were monitored and recorded before, during, and after HIFU. Computed tomography or magnetic resonance imaging (MRI) was also performed before and after HIFU. Results: Serum amylase level increased in 16 cases (7.1%) 1 day after HIFU treatment, and 9 of these cases also had abnormal urinary amylase levels. Gastrointestinal (GI) dysfunction such as abdominal distension and anorexia with slight nausea was observed in 10 cases (4.5%) after HIFU treatment. 1 case with pancreatic head cancer developed obstructive jaundice 2 weeks after HIFU treatment. Vertebral injury, identified by MRI, occurred in 2 cases, although no symptoms were seen. No severe complications such as skin burns, lesion bleeding, GI tract bleeding or GI perforation were observed in any of the cases. Conclusion: For specific patients, HIFU treatment is a safe, non-invasive treatment for pancreatic cancer but requires careful preoperative preparation and exact operative performance.

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

“…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).…”

“…The largest published series on HIFU treatment for liver cancer included 151 unresectable cases which were prospectively compared to 30 comparable patients receiving only supportive palliative care (21). The largest series of HIFU treatment for pancreatic tumors reported on 224 cases (6).…”

“…Pancreatitis (biological or clinical symptoms) (n=34) (6,56,62,(70)(71)(72)75) Post-HIFU reactive pleural effusion in absence of artificial pleural infusion (n=15) (21,24,45) Cholecystitis (n=4) (24,75) Biliary tract obstructions (n=2) (26,75) Renal impairement and hematuria (n=9) (24,38) Supraventricular tachycardia (n=5), hypertension (n=8) (24) Liver abscess (n=2) (34,38) HIFU, high intensity focused ultrasound.…”

Clinical applications of high-intensity focused ultrasound

“…Local ablative therapy with HIFU has been used in patients with unresectable pancreatic cancer and proven to be safe in both clinical trials and retrospective studies, 31,[58][59][60] with no damage to the exocrine or endocrine function. [61][62][63] It has been used as a form of palliative treatment in some pilot studies with a median survival ranging from 10 to 12.6 months, either alone or combined with chemotherapy.…”

“…[62][63][64][65] Pain relief was also found to be effective. 31,58,59,63,65,66 Unfortunately, treatment after HIFU usually lacked histomorphological examination. The survival benefit needs to be tested in further studies, and preferably confirmed by randomised controlled trials.…”