Ultrasound-based combination therapy: potential in urologic cancer

Finley, David S.; Pouliot, Frédéric; Shuch, Brian; Chin, Arnold I.; Pantuck, A.J.; deKernion, Jean B.; Belldegrun, Arie S.

doi:10.1586/era.10.174

Cited by 17 publications

(9 citation statements)

References 55 publications

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“…Conclusions from this finding should not be made, although if this decline in serum PSA were to be reproduced, one possible reason for it might be the presentation of antigens to the immune response leading to a secondary immune response against the remaining prostate tissue. 23 …”

Section: Discussionmentioning

confidence: 99%

Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study

Ahmed

Hindley

Dickinson

et al. 2012

The Lancet Oncology

353

230

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SummaryBackgroundRadical whole-gland therapy can lead to significant genitourinary and rectal side-effects for men with localised prostate cancer. We report on whether selective focal ablation of unifocal and multifocal cancer lesions can reduce this treatment burden.MethodsMen aged 45–80 years were eligible for this prospective development study if they had low-risk to high-risk localised prostate cancer (prostate specific antigen [PSA] ≤15 ng/mL, Gleason score ≤4 + 3, stage ≤T2), with no previous androgen deprivation or treatment for prostate cancer, and who could safely undergo multiparametric MRI and have a general anaesthetic. Patients received focal therapy using high-intensity focused ultrasound, delivered to all known cancer lesions, with a margin of normal tissue, identified on multiparametric MRI, template prostate-mapping biopsies, or both. Primary endpoints were adverse events (serious and otherwise) and urinary symptoms and erectile function assessed using patient questionnaires. Analyses were done on a per-protocol basis. This study is registered with ClinicalTrials.gov, number NCT00561314.Findings42 men were recruited between June 27, 2007, and June 30, 2010; one man died from an unrelated cause (pneumonia) 3 months after treatment and was excluded from analyses. After treatment, one man was admitted to hospital for acute urinary retention, and another had stricture interventions requiring hospital admission. Nine men (22%, 95% CI 11–38) had self-resolving, mild to moderate, intermittent dysuria (median duration 5·0 days [IQR 2·5–18·5]). Urinary debris occurred in 14 men (34%, 95% CI 20–51), with a median duration of 14·5 days (IQR 6·0–16·5). Urinary tract infection was noted in seven men (17%, 95% CI 7–32). Median overall International Index of Erectile Function-15 (IIEF-15) scores were similar at baseline and at 12 months (p=0·060), as were median IIEF-15 scores for intercourse satisfaction (p=0·454), sexual desire (p=0·644), and overall satisfaction (p=0·257). Significant deteriorations between baseline and 12 months were noted for IIEF-15 erectile (p=0·042) and orgasmic function (p=0·003). Of 35 men with good baseline function, 31 (89%, 95% CI 73–97) had erections sufficient for penetration 12 months after focal therapy. Median UCLA Expanded Prostate Cancer Index Composite (EPIC) urinary incontinence scores were similar at baseline as and 12 months (p=0·045). There was an improvement in lower urinary tract symptoms, assessed by International Prostate Symptom Score (IPSS), between baseline and 12 months (p=0·026), but the IPSS-quality of life score showed no difference between baseline and 12 months (p=0·655). All 38 men with no baseline urinary incontinence were leak-free and pad-free by 9 months. All 40 men pad-free at baseline were pad-free by 3 months and maintained pad-free continence at 12 months. No significant difference was reported in median Trial Outcomes Index scores between baseline and 12 months (p=0·113) but significant improvement was shown in median Functional Assessment of Canc...

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Section: Discussionmentioning

confidence: 99%

Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study

Ahmed

Hindley

Dickinson

et al. 2012

The Lancet Oncology

353

230

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“…Hyperthermia induces relevant changes in tumor milieu that could enhance tumor responsiveness to radiation treatment: hyperthermia produces an increased blood flow and consequently delivery of oxygen and trophic molecules thus enhancing tumor metabolic activities. This feature lastly leads to an increase of tumor responsiveness to radiation therapy [80]. It is possible to say that FUS induces a sensitization to radiotherapy (Fig.…”

Section: Hyperthermia and Radiation Treatmentmentioning

confidence: 95%

“…It is possible to say that FUS induces a sensitization to radiotherapy (Fig. 7) [80]. Sensitized tumors could require a lower dose of radiation to be effective, thus potentially reducing radiation-induced side effects [81].…”

Section: Hyperthermia and Radiation Treatmentmentioning

confidence: 99%

Applications of Focused Ultrasound in Cerebrovascular Diseases and Brain Tumors

et al. 2019

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Oncology and cerebrovascular disease constitute two of the most common diseases afflicting the central nervous system. Standard of treatment of these pathologies is based on multidisciplinary approaches encompassing combination of interventional procedures such as open and endovascular surgeries, drugs (chemotherapies, anti-coagulants, anti-platelet therapies, thrombolytics), and radiation therapies. In this context, therapeutic ultrasound could represent a novel diagnostic/therapeutic in the armamentarium of the surgeon to treat these diseases. Ultrasound relies on mechanical energy to induce numerous physical and biological effects. The application of this technology in neurology has been limited due to the challenges with penetrating the skull, thus limiting a prompt translation as has been seen in treating pathologies in other organs, such as breast and abdomen. Thanks to pivotal adjuncts such as multiconvergent transducers, magnetic resonance imaging (MRI) guidance, MRI thermometry, implantable transducers, and acoustic windows, focused ultrasound (FUS) is ready for prime-time applications in oncology and cerebrovascular neurology. In this review, we analyze the evolution of FUS from the beginning in 1950s to current state-of-the-art. We provide an overall picture of actual and future applications of FUS in oncology and cerebrovascular neurology reporting for each application the principal existing evidences.

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“…However, the drawbacks of long treatment time and the need for regional anaesthesia require more research. Current interest is largely placed on ultrasound-based combination therapy [77].…”

Section: Bladder Cancermentioning

confidence: 99%

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

Malietzis¹,

Monzon²,

Hand³

et al. 2013

BJR

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High-intensity focused ultrasound (HIFU) is a rapidly maturing technology with diverse clinical applications. In the field of oncology, the use of HIFU to non-invasively cause tissue necrosis in a defined target, a technique known as focused ultrasound surgery (FUS), has considerable potential for tumour ablation. In this article, we outline the development and underlying principles of HIFU, overview the limitations and commercially available equipment for FUS, then summarise some of the recent technological advances and experimental clinical trials that we predict will have a positive impact on extending the role of FUS in cancer therapy.

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Ultrasound-based combination therapy: potential in urologic cancer

Cited by 17 publications

References 55 publications

Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study

Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study

Applications of Focused Ultrasound in Cerebrovascular Diseases and Brain Tumors

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

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