Transrectal high-intensity focused ultrasonography is feasible as a new therapeutic option for advanced recurrent rectal cancer: report on the first case worldwide

Abstract

High-intensity focused ultrasonography is the only completely non-invasive thermal therapy. To date its applications have been limited but clinical indications are expanding with enhanced technological advances that have increased the accuracy of targeting and decreased the duration of treatment times. We report its first use for rectal cancer.Ann R Coll Surg Engl 2011; 93: e119-e121 doi 10.1308/147870811X592458Locally recurrent rectal cancer can give rise to unpleasant symptoms such as tenesmus, mucus discharge and bleeding. Symptom progression usually results in deterioration of quality of life, especially following failure of conventional treatment options such as radiotherapy and cytotoxic chemotherapy. There is a clear and unmet need for new therapeutic options in this situation.High-intensity focused ultrasonography (HIFU) is a novel non-invasive ablative technology. By delivering high-power ultrasound waves to a small focal area, temperatures above 60C (usually 80-90C) can be reached. This results in coagulative necrosis and cavitation.

High-intensity focused ultrasound: advances in technology and experimental trials support enhanced utility of focused ultrasound surgery in oncology

“…Symptoms improved within 24 h, there were no complications and repeat MRI at Day 7 showed tumour necrosis of the targeted area. Furthermore, the patient's overall physical condition improved to the extent that palliative radiotherapy became possible [44]. A UK Phase I/II trial has since been initiated to further investigate the feasibility and efficacy of transrectal HIFU in patients with locally advanced rectal cancer (09/H0808/43).…”

In vivo Efficacy of HIFU (High Intensity Focused Ultrasound) on Mice with Ehrlich Ascites Carcinoma

“…The increase in temperature as well as large stress pressures with explosion and rupture are observed (2). It is sufficient to raise the live tissue temperature above 56°C in 1 s for rapid cell death depending on coagulation necrosis, and the increases in temperature up to 80°C-90°C in the tissues are observed with HIFU (1,4). These pathological events are lethal for cells, and therefore they are used for the destruction of cancerous tissues.…”

“…In recent years, HIFU has been used in the treatment of many benign and malignant diseases. The use of HIFU has become increasingly common because of the improvements in focusing and treatment time in the development process of the technique (1). It was transrectally used at a frequency of 3 MHz in the treatment of patients with locally advanced prostate cancer, and successful results were reported (5).…”

“…Post-procedural pathological examinations also revealed that coagulation necrosis developed in patients with breast cancer who were treated with HIFU (7,8). Studies have demonstrated that HIFU is effective on hepatocellular carcinoma, renal cell carcinoma, benign thyroid nodules, uterine myomas, and locally advanced rectum and pancreatic cancers (1,(9)(10)(11)(12)(13).…”

Ultrasound-guided trans-rectal high-intensity focused ultrasound (HIFU) for advanced cervical cancer ablation is feasible: a case report

“…UK National Ethics Committee approval (09/H0808/43) was granted for a pilot study to assess the feasibility, safety and efficacy of ultrasound-guided intracavitary HIFU in pelvic malignancy. Intracavitary HIFU treatment of a man with recurrent anastomotic colorectal cancer by our group resulted in symptomatic improvement within 24 h and radiological evidence of tumour necrosis at the target ablation site [ 5 ]. We wanted to expand the potential of intracavitary HIFU therapy by, for the first time, determining feasibility for its use and ability to palliate, relieve pain and improve quality of life in advanced cervical cancer.…”