The safety and feasibility of extracorporeal high-intensity focused ultrasound (HIFU) for the treatment of liver and kidney tumours in a Western population

Illing, Rowland; Kennedy, James E.; Wu, Feng; Haar, Gail ter; Protheroe, Andrew; Friend, P; Gleeson, Fergus; Cranston, David; Phillips, Rachel R.; Middleton, Mark R.

doi:10.1038/sj.bjc.6602803

Cited by 522 publications

(339 citation statements)

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“…HIFU has been proposed for the treatment of various medical conditions, such as uterine fibroids and prostate, breast, pancreatic, and liver tumors [89][90][91][92][93]. Good results have also been obtained in patients with primary or secondary hyperparathyroidism [94].…”

Section: Clinical Resultsmentioning

confidence: 99%

Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84 % at 3-6 months, and from 62 to 93 % at 1 year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81 % at 3-6 months, and from 13 to 82 % at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed.Keywords Laser Á Radiofrequency Á Microwave Á Highintensity focused ultrasound Á Thyroid nodule SOMMARIO I noduli benigni della tiroide sono una evenienza comune nella popolazione generale. Più spesso vengono scoperti occasionalmente durante un esame ecografico fatto per altri motivi, sono asintomatici e non richiedono alcun trattamento. Qualora i noduli diventino sintomatici, l'escissione chirurgica è ancora considerato il trattamento standard. Tuttavia, negli ultimi anni, è cresciuta l'esperienza circa il trattamento di tali noduli tramite ablazione percutanea sotto guida ecografica tanto che, attualmente, questo viene spesso proposto come trattamento di scelta. Lo scopo del nostro lavoro è fare una revisione della letteratura riguardante l'argomento, con un particolare focus sulle differenti tecniche attualmente a disposizione, in particolare radiofrequenza (RFA), laser (LA), microonde (MWA) e high-intensity-focus ultrasound (HIFU). Al momento ci sono ancora poche evidenze sull'efficacia di MWA e HIFU. Secondo quanto riportato in letteratura, buoni risultati sono stati ottenuti con RFA e LA. Riguardo la radiofrequenza, la riduzione volumetrica dopo la procedura ablativa va da 47 a 84 % a 3-6 mesi e da 62 a 93 % a 1 anno; anche il laser sembra essere efficace nel causare la riduzione del nodulo, con percentuali che vanno da 37 a 81 % a 3-6-mesi a da 13 a 82 % a 1 anno di follow-up Abbiamo poi discusso brevemente le

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Section: Clinical Resultsmentioning

confidence: 99%

Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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“…Today, US ablative therapy is being investigated or clinically used in numerous applications in the prostate (16)(17)(18)(19), uterine fibroids (20,21), liver (22,23), kidney (24,25), breast (26), or brain (27). Depending on the anatomic location, optimal transmission of the US energy is achieved either by extracorporeal access (abdomen, uterus, brain, bone, kidney, or breast), transrectal/transurethral access (prostate), or endoluminal access (biliary duct, esophagus, rectum).…”

mentioning

confidence: 99%

Automatic temperature control for MR-guided interstitial ultrasound ablation in liver using a percutaneous applicator: Ex vivo and in vivo initial studies

Delabrousse¹,

Salomir²,

Birer³

et al. 2010

Magn. Reson. Med.

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Image-guided thermal ablation offers minimally invasive options for treating hepatocellular carcinoma and colorectal metastases in liver. Here, the feasibility and the potential benefit of active temperature control for MR-guided percutaneous ultrasound ablation was investigated in pig liver. An MR-compatible interstitial ultrasound applicator (flat transducer), a positioning system with rotation-translation guiding frame, and an orbital ring holder were developed.Step-by-step rotated elementary lesions were produced, each being formed by directive heating of a flame-shaped volume of tissue. In vivo feasibility of automatic temperature control was investigated on two pigs. Proton Resonance Frequency Shift (PRFS)-based MR thermometry was performed on a 1.5-T clinical scanner, using SENSE acceleration and respiratory gating. MR follow-up of animals and macroscopic analysis were performed at 3 and, respectively, 4 days postprocedure. No sonication-related radiofrequency artifacts were detected on MR images. The temperature controller converged to the target elevation within 62°C unless the requested power level exceeded the authorized limit. Large variability of the controller's applied powers from one sonication to another was found both ex vivo and in vivo, indicating highly anisotropic acoustic coupling and/or tissue response to identical beam pattern along different radial directions. The automatic control of the temperature enabled reproducible shape of lesions (15 6 2 mm radial depth). Magn Reson Med 63:667-679, 2010.V C 2010 Wiley-Liss, Inc.

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“…Patients were assessed regularly for evidence of any complications and serum creatinine levels were monitored daily for at least 3 days. Patients were followed for a mean (range) of 15 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months. Routine postoperative cross-sectional imaging was undertaken at 3 months to assess for evidence of disease recurrence or metastasis and then 6-monthly or annually thereafter.…”

Section: Specimen Analysismentioning

confidence: 99%

“…Extracorporeal HIFU for kidney tumours has been assessed in phase I/II trials with some success. However, early promise with extracorporeal devices was dampened by suboptimal dose delivery because of attenuation of the abdominal wall and rib cage, coupled with the inherent difficulties of patient movement during tumour targeting [17].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study

et al. 2010

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Study Type – Therapy (case series) Level of Evidence What’s known on the subject? and What does the study add? Renal cancer is increasingly diagnosed when tumours are small and asymptomatic, during routine abdominal imaging. Whilst surgery is an effective and potentially curative option, it carries a significant risk of complications. Recent work suggests that thermally ablative therapies (RFA, cryotherapy, HIFU) may be suitable minimally invasive treatment options in selected patients. The success of extracorporeal HIFU has been limited by the abdominal wall and rib‐cage limiting energy delivery. For this study, a purpose‐built laparoscopic HIFU probe was designed to allow direct application of the transducer to the tumour surface, thus facilitating tumour destruction. Successful and accurate tumour destruction was demonstrated, paving the way for further clinical trials, subject to device modifications. OBJECTIVE To test and establish clinical proof of concept for a laparoscopic high‐intensity focused ultrasound (HIFU) device that facilitates delivery of ultrasound by direct application of a probe to the tumour surface. PATIENTS AND METHODS Twelve patients with renal tumours were treated with laparoscopic HIFU using a newly designed probe inserted via an 18‐mm laparoscopic port. HIFU treatment was targeted at a pre‐defined proportion of the tumour and immediate laparoscopic partial or radical nephrectomy was then performed. RESULTS No tumour ablation was seen in the first five patients which made modifications in the treatment protocol necessary. After this, definite histological evidence of ablation was seen in the remaining seven patients. The ablated zones were within the targeted area in all patients and no intra‐lesional skipping was seen. Subcapsular skipping was seen at the probe–tumour interface in two patients with viable tumour cells seen at microscopy. One patient did not undergo surgical extirpation; subsequent biopsy revealed no viable tumour cells. There were no intraoperative or postoperative complications directly related to HIFU therapy and patients have reached a mean (range) follow‐up of 15 (8–24) months with no evidence of metastatic disease or late complications. CONCLUSIONS Tumour ablation with laparoscopic HIFU is feasible. Homogenous ablation can be achieved with no vital tissue within the targeted zone. The technique is associated with low morbidity and may have a role in the definitive management of small tumours.

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The safety and feasibility of extracorporeal high-intensity focused ultrasound (HIFU) for the treatment of liver and kidney tumours in a Western population

Cited by 522 publications

References 20 publications

Image-guided thermal ablation of benign thyroid nodules

Image-guided thermal ablation of benign thyroid nodules

Automatic temperature control for MR-guided interstitial ultrasound ablation in liver using a percutaneous applicator: Ex vivo and in vivo initial studies

Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study

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