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Zhao J, Wang Q, Li X, Hu X, Shen H. Effective high intensity focused ultrasound treatment in recurrent aggressive breast fibromatosis: a case report. Onco Targets Ther 2019; 12:5251-5256. [PMID: 31308695 PMCID: PMC6612964 DOI: 10.2147/ott.s202933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022] Open
Abstract
Aggressive breast fibromatosis (referred to as a desmoid tumor) is a rare, locally invasive, non-metastasizing tumor with high recurrence rate. The therapeutic modalities range from surgery and radiotherapy to medical treatments. However, the optimal treatment is controversial, especially in a situation of repeated recurrence. Here, we present a case of a patient with aggressive breast fibromatosis with multiple recurrence after surgeries, who underwent high intensity focused ultrasound (HIFU) treatment effectively without side effects. To our knowledge, this is the first reported case of HIFU treatment in aggressive breast fibromatosis, which indicates that HIFU might be a novel, promising modality for this rare disease.
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Affiliation(s)
- Jing Zhao
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Qiyuan Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiuzhen Li
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiaoye Hu
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hong Shen
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China
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Najafi A, Fuchs B, Binkert CA. Mid-term results of MR-guided high-intensity focused ultrasound treatment for relapsing superficial desmoids. Int J Hyperthermia 2019. [PMID: 31068030 DOI: 10.1080/02656736.2019.1608376] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Desmoids are locally infiltrative, nonmalignant soft tissue tumors. Surgery, radiation therapy, and chemotherapy have been the mainstay of treatment, but relapse is common and side effects can result in significant morbidity. MR-HIFU is increasingly recognized as an alternative treatment modality. We assessed the success rate of MR-HIFU for the treatment of extra-abdominal desmoids at our institute. MATERIALS AND METHODS Five patients with relapsing desmoid tumors (three males, two females; age range 40-79 years) were treated using the Sonalleve system in an outpatient setting without general anesthesia. Changes in total tumor volumes were measured with a tumor tracking software. Adverse events were documented. RESULTS MR-HIFU was successful in all patients without severe side effects. Follow up ranged from 13 to 60 months. Three patients required more than one treatment session. In 3 patients with small lesions (mean = 9.7 mL), complete ablation was achieved with no evidence of viable tumor on follow up MRI at an average of 35.7 months, while in two patients with larger lesions (mean = 46 mL) the targeted tumor volumes decreased by 73% at 14 months. Skin injuries comprised first- and second-degree burns and were observed with short distance to skin (mean = 0.9 cm) and proximity to bone (i.e. ribs). Skin burns healed within weeks with topical treatment. CONCLUSION MR-HIFU shows good mid-term result for extra-abdominal desmoids with complete response for small lesions and stabilization of larger lesions. MR-HIFU for desmoids can be performed under regional anesthesia/sedation as outpatients.
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Affiliation(s)
- Arash Najafi
- a Department of Radiology and Nuclear Medicine , Canton Hospital Winterthur , Winterthur , Switzerland
| | - Bruno Fuchs
- b Department of Orthopedics and Trauma Surgery , Canton Hospital Winterthur , Winterthur , Switzerland
| | - Christoph A Binkert
- a Department of Radiology and Nuclear Medicine , Canton Hospital Winterthur , Winterthur , Switzerland
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Bitton RR, Webb TD, Pauly KB, Ghanouni P. Prolonged heating in nontargeted tissue during MR‐guided focused ultrasound of bone tumors. J Magn Reson Imaging 2019; 50:1526-1533. [DOI: 10.1002/jmri.26726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- Rachel R. Bitton
- School of Medicine, Department of RadiologyStanford University Stanford California USA
| | - Taylor D. Webb
- Department of Electrical EngineeringStanford University Stanford California USA
| | - Kim Butts Pauly
- School of Medicine, Department of RadiologyStanford University Stanford California USA
| | - Pejman Ghanouni
- School of Medicine, Department of RadiologyStanford University Stanford California USA
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Bucknor MD, Beroukhim G, Rieke V, Ozhinsky E, Lobach I. The impact of technical parameters on ablation volume during MR-guided focused ultrasound of desmoid tumors. Int J Hyperthermia 2019; 36:473-476. [PMID: 30922118 DOI: 10.1080/02656736.2019.1590654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Desmoid tumors are benign, locally aggressive soft tissue tumors derived from fibroblasts. Magnetic resonance-guided focused ultrasound (MRgFUS) is a safe and effective treatment for desmoid tumors. The purpose of this study was to retrospectively review the MRgFUS treatments of desmoid tumors at our institution to determine which technical treatment parameters contributed most significantly to the accumulation of thermal dose. MATERIALS AND METHODS The study protocol was approved by the local IRB. We retrospectively reviewed data from MRgFUS treatments performed in histologically-confirmed desmoid tumors, over a period of 18 months. Sonication parameter means were compared with ANOVA. Mixed effects and linear regression models were used to evaluate the relative contribution of different parameters to thermal dose volume. RESULTS Nine-hundred thirty-six sonications were reviewed in 13 treatments. Accumulated dose per sonication was greatest for elongated sonications (0.96 cc ± 0.90) compared to short (0.88 ± 0.93 cc) and nominal (0.55 ± 0.70 cc) sonications, p < .001. 65.2% of short sonications resulted in high percentage ablations, compared to 46.0% of nominal and 35.1% of elongated sonications. Standardized beta coefficients (anticipated increased volume in cc per unit) for power, duration, energy and average temperature were 0.006, 0.057, 0.00035 and 0.03, p < .001. Regarding dose efficacy, dose area contributed the greatest to this variability - 50.7% (45.5-54.8%), followed by distance - 16.6% (12.9-20.0%). CONCLUSIONS A variety of sonication parameters significantly contributed to thermal ablation volume following MRgFUS of desmoid tumors, in reproducible patterns. This work can serve as the basis for future models working toward improved planning for MRgFUS treatments.
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Affiliation(s)
- Matthew D Bucknor
- a Department of Radiology and Biomedical Imaging , University of California, San Francisco , San Francisco , CA , USA
| | - Gabriela Beroukhim
- a Department of Radiology and Biomedical Imaging , University of California, San Francisco , San Francisco , CA , USA
| | - Viola Rieke
- a Department of Radiology and Biomedical Imaging , University of California, San Francisco , San Francisco , CA , USA
| | - Eugene Ozhinsky
- a Department of Radiology and Biomedical Imaging , University of California, San Francisco , San Francisco , CA , USA
| | - Iryna Lobach
- b Department of Epidemiology and Biostatistics , University of California, San Francisco , San Francisco , CA , USA
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MR Imaging of Pediatric Musculoskeletal Tumors:: Recent Advances and Clinical Applications. Magn Reson Imaging Clin N Am 2019; 27:341-371. [PMID: 30910102 DOI: 10.1016/j.mric.2019.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pediatric musculoskeletal tumors comprise approximately 10% of childhood neoplasms, and MR imaging has been used as the imaging evaluation standard for these tumors. The role of MR imaging in these cases includes identification of tumor origin, tissue characterization, and definition of tumor extent and relationship to adjacent structures as well as therapeutic response in posttreatment surveillance. Technical advances have enabled quantitative evaluation of biochemical changes in tumors. This article reviews recent updates to MR imaging of pediatric musculoskeletal tumors, focusing on advanced MR imaging techniques and providing information on the relevant physics of these techniques, clinical applications, and pitfalls.
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Matoori S, Roveri M, Tiefenboeck P, Romagna A, Wuerthinger O, Kolokythas O, Froehlich JM. An MRI-guided HIFU-triggered wax-coated capsule for supertargeted drug release: a proof-of-concept study. Eur Radiol Exp 2019; 3:11. [PMID: 30838465 PMCID: PMC6401064 DOI: 10.1186/s41747-019-0090-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/05/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Externally controlling and monitoring drug release at a desired time and location is currently lacking in the gastrointestinal tract. The aim of the study was to develop a thermoresponsive wax-coated capsule and to trigger its release upon applying a magnetic resonance imaging (MRI)-guided high-intensity focused ultrasound (HIFU) pulse. METHODS Capsules containing a lyophilised gadolinium-based contrast agent (GBCA) were coated with a 1:1 (mass/mass) mixture of lanolin and cetyl alcohol (melting point ≈43 °C) and exposed to simulated gastric and intestinal fluids (United States Pharmacopoeia) at 37 °C for 2 and 24 h, respectively. In a HIFU gel phantom, wax-coated capsules (n = 3) were tracked based on their T1- and T2-hypointensity by 1.5-T T1- and T2-weighted MRI pre- and post-exposure to an MRI-guided HIFU pulse. RESULTS Lanolin/cetyl alcohol-coated capsules showed high resistance to simulated gastrointestinal fluids. In a gel phantom, an MRI-guided HIFU pulse punctured the wax coating, resulting in the hydration and release of the encapsulated lyophilised GBCA and yielding a T1-hyperintense signal close to the wax-coated capsule. CONCLUSION We provide the proof-of-concept of applying a non-invasive MRI-guided HIFU pulse to actively induce the disintegration of the wax-coated capsule, and a method to monitor the release of the cargo via T1-weighted MRI based on the hydration of an encapsulated lyophilised GBCA. The wax-coated capsule platform enables temporally and spatially supertargeted drug release via the oral route and promises to address a currently unmet clinical need for personalised local therapy in gastrointestinal diseases such as inflammatory bowel diseases and cancer.
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Affiliation(s)
- Simon Matoori
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093, Zurich, Switzerland.
| | - Maurizio Roveri
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093, Zurich, Switzerland
| | - Peter Tiefenboeck
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093, Zurich, Switzerland
| | - Annatina Romagna
- Clinical Research Group, Klus Apotheke Zurich, Zurich, Switzerland
| | - Olha Wuerthinger
- Clinical Research Group, Klus Apotheke Zurich, Zurich, Switzerland
| | - Orpheus Kolokythas
- Department of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Johannes M Froehlich
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 1-5/10, 8093, Zurich, Switzerland
- Clinical Research Group, Klus Apotheke Zurich, Zurich, Switzerland
- Department of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland
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Ballatori SE, Hecht JL, Lozano-Calderón SA. A Desmoid Tumor Involving the Subscapularis Muscle: A Case Report. JBJS Case Connect 2019; 9:e3. [PMID: 30628921 DOI: 10.2106/jbjs.cc.18.00184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 31-year-old woman developed worsening pain and paresthesia in the neck, shoulder, and arm over a period of 6 years. Magnetic resonance imaging revealed a soft-tissue mass in the subscapular region, with likely involvement of the scapula and the subscapularis muscle. The mass was resected, and the final histologic diagnosis was desmoid-type fibromatosis. CONCLUSION Desmoid tumors with subscapularis muscle involvement are exceedingly rare. Although limited range of motion is the more common presentation for these tumors, this case demonstrates that desmoid tumors may present with primarily neurologic symptoms.
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Affiliation(s)
| | | | - Santiago A Lozano-Calderón
- Massachusetts General Hospital, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Gondim Teixeira P, Chanson A, Verhaeghe JL, Lecocq S, Louis M, Hossu G, Blum A. Correlation between tumor growth and hormonal therapy with MR signal characteristics of desmoid-type fibromatosis: A preliminary study. Diagn Interv Imaging 2019; 100:47-55. [DOI: 10.1016/j.diii.2018.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/09/2018] [Accepted: 06/27/2018] [Indexed: 12/28/2022]
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Timbergen MJM, van de Poll-Franse LV, Grünhagen DJ, van der Graaf WT, Sleijfer S, Verhoef C, Husson O. Identification and assessment of health-related quality of life issues in patients with sporadic desmoid-type fibromatosis: a literature review and focus group study. Qual Life Res 2018; 27:3097-3111. [PMID: 30014458 PMCID: PMC6244798 DOI: 10.1007/s11136-018-1931-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE Sporadic desmoid-type fibromatosis (DTF) is a rare, chronic, non-metastasising, disease of the soft tissues. It is characterised by local invasive and unpredictable growth behaviour and a high propensity of local recurrence after surgery thereby often having a great impact on health-related quality of life (HRQL). This study aims to review currently used HRQL measures and to asses HRQL issues among DTF patients. METHODS A mixed methods methodology was used consisting of (1) a systematic literature review, according to the PRISMA guidelines (2009), using search terms related to sporadic DTF and HRQL in commonly used databases (e.g. Embase, Medline Ovid, Web of science, Cochrane Central, Psyc Info, and Google scholar), to provide an overview of measures previously used to evaluate HRQL among DTF patients; (2) focus groups to gain insight into HRQL issues experienced by DTF patients. RESULTS The search strategy identified thirteen articles reporting HRQL measures using a wide variety of cancer-specific HRQL tools, functional scores, symptom scales (e.g. NRS), and single-item outcomes (e.g. pain and functional impairment). No DTF-specific HRQL tool was found. Qualitative analysis of three focus groups (6 males, 9 females) showed that participants emphasised the negative impact of DTF and/or its treatment on several HRQL domains. Six themes were identified: (1) diagnosis, (2) treatment, (3) follow-up and recurrence, (4) physical domain, (5) psychological and emotional domain, and (6) social domain. CONCLUSION A DTF-specific HRQL tool and consensus regarding the preferred measurement tool among DTF patients is lacking. Our study indicates that HRQL of DTF patients was negatively affected in several domains. A DTF-specific HRQL measure could improve our understanding of short- and long-term effects and, ideally, can be used in both clinic and for research purposes.
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Affiliation(s)
- Milea J M Timbergen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands.
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Winette T van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
- Division of Clinical Studies, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, 's-Gravendijkwal 230, Room BE-428, 3015 CE, Rotterdam, The Netherlands
| | - Olga Husson
- Division of Clinical Studies, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
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Scipione R, Anzidei M, Bazzocchi A, Gagliardo C, Catalano C, Napoli A. HIFU for Bone Metastases and other Musculoskeletal Applications. Semin Intervent Radiol 2018; 35:261-267. [PMID: 30402009 DOI: 10.1055/s-0038-1673363] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
High-intensity focused ultrasound (HIFU) is a totally noninvasive procedure that has shown promising results in the management of numerous malignant and nonmalignant conditions. Under magnetic resonance or ultrasound guidance, high-intensity ultrasound waves are focused on a small, well-defined target region, inducing biologic tissue heating and coagulative necrosis, thus resulting in a precise and localized ablation. This treatment has shown both great safety and efficacy profiles, and may offer a multimodal approach to different diseases, providing pain palliation, potential local tumor control, and, in some cases, remineralization of trabecular bone. In musculoskeletal field, HIFU received FDA approval for treating bone metastasis, but its application has also been extended to other conditions, such as osteoid osteoma, desmoid tumor, low-flow vascular malformation, and facet joint osteoarthritis. This article illustrates the basic principles of HIFU and its main effects on biologic tissues with particular attention on bone, provides a step-by-step description of the HIFU procedure, and discusses the commonly treated conditions, in particular bone metastases.
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Affiliation(s)
- Roberto Scipione
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Michele Anzidei
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alberto Bazzocchi
- Department of Radiology, Rizzoli Orthopedic Institute, University of Bologna, Bologna, Italy
| | - Cesare Gagliardo
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Magnetic Resonance Imaging-guided High-intensity Focused Ultrasound Applications in Pediatrics: Early Experience at Children's National Medical Center. Top Magn Reson Imaging 2018; 27:45-51. [PMID: 29406415 DOI: 10.1097/rmr.0000000000000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) is a novel technology that integrates magnetic resonance imaging with therapeutic ultrasound. This unique approach provides a completely noninvasive method for precise thermal ablation of targeted tissues with real-time imaging feedback. Over the past 2 decades, MR-HIFU has shown clinical success in several adult applications ranging from treatment of painful bone metastases to uterine fibroids to prostate cancer and essential tremor. Although clinical experience in pediatrics is relatively small, the advantages of a completely noninvasive and radiation-free therapy are especially attractive to growing children. Unlike elderly patients, young children must deal with an entire lifetime of negative effects related to collateral tissue damage associated with invasive surgery, side effects of chemotherapy, and risk of secondary malignancy due to radiation exposure. These reasons provide a clear rationale and strong motivation to further advance clinical utility of MR-HIFU in pediatrics. We begin with an introduction to MR-HIFU technology and the clinical experience in adults. We then describe our early institutional experience in using MR-HIFU ablation to treat symptomatic benign, locally aggressive, and metastatic tumors in children and young adults. We also review some limitations and challenges encountered in treating pediatric patients and highlight additional pediatric applications which may be feasible in the near future.
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Elhelf IS, Albahar H, Shah U, Oto A, Cressman E, Almekkawy M. High intensity focused ultrasound: The fundamentals, clinical applications and research trends. Diagn Interv Imaging 2018; 99:349-359. [DOI: 10.1016/j.diii.2018.03.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
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Ghanouni P, Kishore S, Lungren MP, Bitton R, Chan L, Avedian R, Bazzocchi A, Butts Pauly K, Napoli A, Hovsepian DM. Treatment of Low-Flow Vascular Malformations of the Extremities Using MR-Guided High Intensity Focused Ultrasound: Preliminary Experience. J Vasc Interv Radiol 2018; 28:1739-1744. [PMID: 29157478 DOI: 10.1016/j.jvir.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/29/2017] [Accepted: 06/02/2017] [Indexed: 10/18/2022] Open
Abstract
Five patients with painful vascular malformations of the extremities that were refractory to standard treatment and were confirmed as low-flow malformations on dynamic contrast-enhanced magnetic resonance (MR) imaging were treated with MR imaging-guided high intensity focused ultrasound. Daily maximum numeric rating scale scores for pain improved from 8.4 ± 1.5 to 1.6 ± 2.2 (P = .004) at a median follow-up of 9 months (range, 4-36 mo). The size of the vascular malformations decreased on follow-up MR imaging (median enhancing volume, 8.2 mL [0.7-10.1 mL] before treatment; 0 mL [0-2.3 mL] after treatment; P = .018) at a median follow-up of 5 months (range, 3-36 mo). No complications occurred.
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Affiliation(s)
- Pejman Ghanouni
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488.
| | - Sirish Kishore
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Matthew P Lungren
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Rachelle Bitton
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Lauren Chan
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Raffi Avedian
- Department of Orthopedic Surgery, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | - Alberto Bazzocchi
- Department of Diagnostic and Interventional Radiology, Rizzoli Institute, Bologna, Italy
| | - Kim Butts Pauly
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
| | | | - David M Hovsepian
- Department of Radiology, Stanford University, Richard M. Lucas Center for Imaging, 1201 Welch Rd., Stanford, CA 94305-5488
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D’Souza AL, Chevillet JR, Ghanouni P, Yan X, Tewari M, Gambhir SS. Tumor characterization by ultrasound-release of multiple protein and microRNA biomarkers, preclinical and clinical evidence. PLoS One 2018; 13:e0194268. [PMID: 29547636 PMCID: PMC5856340 DOI: 10.1371/journal.pone.0194268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/28/2018] [Indexed: 12/28/2022] Open
Abstract
We have previously shown that low frequency ultrasound can release biomarkers from cells into the murine circulation enabling an amplification and localization of the released biomarker that could be used as a blood-based method to detect cancer earlier and monitor therapy. In this study, we further demonstrate that this technique could be used for characterization of tumors and/or identification of cellular masses of unknown origin due to the release of multiple protein and nucleic acid biomarkers in cells in culture, mice and patients. We sonicated colon (LS174T) and prostate (LNCaP) cancer cell lines in culture at a low frequency of 1 MHz and show that there were several-fold changes in multiple protein and microRNA (miRNA) abundance with treatment at various intensities and time. This release was dependent on the duration and intensity of the sonication for both cell lines. Significant increased release in biomarkers was also observed following tumor sonication in living mice bearing subcutaneous LS174T cell line xenografts (for proteins and nucleic acids) and in an experimental LS174T liver tumor model (for proteins only). Finally, we demonstrated this methodology of multiple biomarker release in patients undergoing ablation of uterine fibroids using MR guided high intensity focused ultrasound. Two protein biomarkers significantly increased in the plasma after the ultrasound treatment in 21 samples tested. This proof that ultrasound-amplification method works in soft tissue tumor models together with biomarker multiplexing, could allow for an effective non-invasive method for identification, characterization and localization of incidental lesions, cancer and other disease. Pre-treatment quantification of the biomarkers, allows for individualization of quantitative comparisons. This individualization of normal marker levels in this method allows for specificity of the biomarker-increase to each patient, tumor or organ being studied.
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Affiliation(s)
- Aloma L. D’Souza
- Departments of Radiology, Stanford University, Stanford, California, United States of America
- Molecular Imaging Program, Stanford University, Stanford, California, United States of America
| | - John R. Chevillet
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Pejman Ghanouni
- Departments of Radiology, Stanford University, Stanford, California, United States of America
| | - Xinrui Yan
- Departments of Radiology, Stanford University, Stanford, California, United States of America
- Molecular Imaging Program, Stanford University, Stanford, California, United States of America
| | - Muneesh Tewari
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Sanjiv S. Gambhir
- Departments of Radiology, Stanford University, Stanford, California, United States of America
- Molecular Imaging Program, Stanford University, Stanford, California, United States of America
- Bioengineering, Stanford University, Stanford, California, United States of America
- * E-mail:
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Corea J, Ye P, Seo D, Butts-Pauly K, Arias AC, Lustig M. Printed Receive Coils with High Acoustic Transparency for Magnetic Resonance Guided Focused Ultrasound. Sci Rep 2018; 8:3392. [PMID: 29467432 PMCID: PMC5821831 DOI: 10.1038/s41598-018-21687-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/01/2018] [Indexed: 01/20/2023] Open
Abstract
In magnetic resonance guided focused ultrasound (MRgFUS) therapy sound waves are focused through the body to selectively ablate difficult to access lesions and tissues. A magnetic resonance imaging (MRI) scanner non-invasively tracks the temperature increase throughout the tissue to guide the therapy. In clinical MRI, tightly fitted hardware comprised of multichannel coil arrays are required to capture high quality images at high spatiotemporal resolution. Ablating tissue requires a clear path for acoustic energy to travel but current array materials scatter and attenuate acoustic energy. As a result coil arrays are placed outside of the transducer, clear of the beam path, compromising imaging speed, resolution, and temperature accuracy of the scan. Here we show that when coil arrays are fabricated by additive manufacturing (i.e., printing), they exhibit acoustic transparency as high as 89.5%. This allows the coils to be placed in the beam path increasing the image signal to noise ratio (SNR) five-fold in phantoms and volunteers. We also characterize printed coil materials properties over time when submerged in the water required for acoustic coupling. These arrays offer high SNR and acceleration capabilities, which can address current challenges in treating head and abdominal tumors allowing MRgFUS to give patients better outcomes.
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Affiliation(s)
- Joseph Corea
- Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, 94720, USA
| | - Patrick Ye
- Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Dongjin Seo
- Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, 94720, USA
| | | | - Ana Claudia Arias
- Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, 94720, USA
| | - Michael Lustig
- Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, 94720, USA.
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Munakomi S. Aggressive fibromatosis in the infratemporal fossa presenting as trismus: a case report. J Med Case Rep 2018; 12:41. [PMID: 29455674 PMCID: PMC5817795 DOI: 10.1186/s13256-018-1577-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 01/21/2018] [Indexed: 11/12/2022] Open
Abstract
Background Here we report a very rare entity of an infratemporal region aggressive fibromatosis in a 23-year-old Tharu man who had presented with the symptoms of painless but progressive trismus. Case presentation We describe a case of aggressive fibromatosis in a 23-year-old Tharu man. Radiological imaging as well as an immunohistochemistry panel from a biopsy indicated a diagnosis of an aggressive fibromatosis. Since there was no aggravation in his trismus following surgery and because of his poor socioeconomic status, he was advised to attend regular follow-up visits without any adjuvant therapy. Conclusions This case report adds to the notion of keeping the differential diagnosis of an aggressive fibromatosis in all patients presenting with progressive but painless trismus. The characteristic imaging findings as well an immunohistochemistry panel will help us clinch the correct diagnosis.
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Dillon CR, Farrer A, McLean H, Almquist S, Christensen D, Payne A. Experimental assessment of phase aberration correction for breast MRgFUS therapy. Int J Hyperthermia 2017; 34:731-743. [PMID: 29278946 DOI: 10.1080/02656736.2017.1422029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE This study validates that phase aberrations in breast magnetic resonance-guided focussed ultrasound (MRgFUS) therapies can be corrected in a clinically relevant time frame to generate more intense, smaller and more spatially accurate foci. MATERIALS AND METHODS Hybrid angular spectrum (HAS) ultrasound calculations in an magnetic resonance imaging (MRI)-based tissue model, were used to compute phase aberration corrections for improved experimental MRgFUS heating in four heterogeneous breast-mimicking phantoms (n = 18 total locations). Magnetic resonance(MR) temperature imaging was used to evaluate the maximum temperature rise, focus volume and focus accuracy for uncorrected and phase aberration-corrected sonications. Thermal simulations assessed the effectiveness of the phase aberration correction implementation. RESULTS In 13 of 18 locations, the maximum temperature rise increased by an average of 30%, focus volume was reduced by 40% and focus accuracy improved from 4.6 to 3.6 mm. Mixed results were observed in five of the 18 locations, with focus accuracy improving from 6.1 to 2.5 mm and the maximum temperature rise decreasing by 8% and focus volume increasing by 10%. Overall, the study demonstrated significant improvements (p < 0.005) in maximum temperature rise, focus volume and focus accuracy. Simulations predicted greater improvements than observed experimentally, suggesting potential for improvement in implementing the technique. The complete phase aberration correction procedure, including model generation, segmentation and phase aberration computations, required less than 45 min per sonication location. CONCLUSION The significant improvements demonstrated in this study i.e., focus intensity, size and accuracy from phase aberration correction have the potential to improve the efficacy, time-efficiency and safety of breast MRgFUS therapies.
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Affiliation(s)
- Christopher R Dillon
- a Department of Radiology and Imaging Sciences , University of Utah , Salt Lake City , UT , USA
| | - Alexis Farrer
- b Department of Bioengineering , University of Utah , Salt Lake City , UT , USA
| | - Hailey McLean
- a Department of Radiology and Imaging Sciences , University of Utah , Salt Lake City , UT , USA
| | - Scott Almquist
- c School of Computing , University of Utah , Salt Lake City , UT , USA
| | - Douglas Christensen
- b Department of Bioengineering , University of Utah , Salt Lake City , UT , USA.,d Department of Electrical and Computer Engineering , University of Utah , Salt Lake City , UT , USA
| | - Allison Payne
- a Department of Radiology and Imaging Sciences , University of Utah , Salt Lake City , UT , USA
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Concurrent Imatinib and Radiation Therapy for Unresectable and Symptomatic Desmoid Tumors. Sarcoma 2017; 2017:2316839. [PMID: 28761389 PMCID: PMC5516706 DOI: 10.1155/2017/2316839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/23/2017] [Accepted: 06/04/2017] [Indexed: 11/25/2022] Open
Abstract
Desmoid tumors are locally aggressive fibroproliferative neoplasms that can lead to pain and dysfunction due to compression of nerves and surrounding structures. Desmoid tumors often progress through medical therapy, and there is frequently a delay of multiple months before radiation can provide symptomatic relief. To achieve more rapid symptomatic relief and tumor regression for unresectable desmoid tumors causing significant morbidity such as brachial plexus impingement with loss of extremity function, we have selectively utilized a combination of imatinib and radiation therapy. Here, we retrospectively review four patients treated with concurrent imatinib and radiation therapy. The treatment was typically tolerated with minimal toxicity though one patient developed avascular necrosis of the irradiated humeral head possibly related to the combined treatment. All the patients treated have had a partial response or stable disease on imaging. Improvement of symptoms was observed in all the treated patients with a median time to relief of 2.5 months after starting radiation therapy. Concurrent radiation and imatinib may represent a viable treatment option for unresectable and symptomatic desmoid tumors where rapid relief is needed to prevent permanent loss of function.
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Dillon CR, Rieke V, Ghanouni P, Payne A. Thermal diffusivity and perfusion constants from in vivo MR-guided focussed ultrasound treatments: a feasibility study. Int J Hyperthermia 2017; 34:352-362. [DOI: 10.1080/02656736.2017.1340677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Christopher R. Dillon
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Viola Rieke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Pejman Ghanouni
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Allison Payne
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
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Jeys L, Morris G, Evans S, Stevenson J, Parry M, Gregory J. Surgical Innovation in Sarcoma Surgery. Clin Oncol (R Coll Radiol) 2017; 29:489-499. [PMID: 28502707 DOI: 10.1016/j.clon.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022]
Abstract
The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed.
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Affiliation(s)
- L Jeys
- Royal Orthopaedic Hospital, Birmingham, UK; School of Health and Life Sciences, Aston University, Birmingham, UK.
| | - G Morris
- Royal Orthopaedic Hospital, Birmingham, UK
| | - S Evans
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
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Tsagozis P, Stevenson JD, Grimer R, Carter S. Outcome of surgery for primary and recurrent desmoid-type fibromatosis. A retrospective case series of 174 patients. Ann Med Surg (Lond) 2017; 17:14-19. [PMID: 28386395 PMCID: PMC5374757 DOI: 10.1016/j.amsu.2017.03.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The best management of relapsing desmoid-type fibromatosis, a benign but locally infiltrative soft-tissue tumour, is largely undecided. Our aim was to investigate the incidence and the factors influencing local relapse after surgery for primary and recurrent disease of the trunk and extremities. PATIENTS AND METHODS Retrospective analysis of 174 patients who had surgical treatment for desmoid-type fibromatosis. The quality of the surgical margins and use of adjuvant radiotherapy or chemotherapy were analysed regarding local recurrences in primary and recurrent disease. RESULTS Clear margins were achieved in 41% of cases. 10-year local control rate was 58% for clear primary resections as compared to 37% with intralesional primary resections (p = 0.030). Extremity tumours had a higher risk of local recurrence compared to trunk and pelvic ones (p < 0.001). Attempted resection of recurrent disease was associated with an approximately 90% incidence of relapse after each procedure, despite the quality of the surgical margins being equivalent to primary resections. Quality of surgical margins was not important for local control of recurrent lesions. Adjuvant treatments (radiotherapy and chemotherapy) had a no significant effect on the local control rate of recurrent disease (odds ratio 0.693 and 0.969 respectively). CONCLUSIONS A complete primary excision is the best window of opportunity to achieve local control of desmoid-type fibromatosis. Once the disease relapses, surgical intervention is accompanied with a high risk of failure, irrespective of the quality of the margins and adjuvant treatment given.
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Affiliation(s)
- Panagiotis Tsagozis
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
- Section of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Solna, 17176, Stockholm, Sweden
- Corresponding author. Present address: Section of Orthopaedics, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden.Section of OrthopaedicsDepartment of Molecular Medicine and SurgeryKarolinska University HospitalStockholmSweden
| | | | - Robert Grimer
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - Simon Carter
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
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Minimally invasive techniques for pain palliation in extraspinal bone metastases: a review of magnetic resonance imaging-guided focused ultrasound (MRgFUS) and series conclusion. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bucknor MD, Ozhinsky E, Shah R, Krug R, Rieke V. Effect of Sonication Duration and Power on Ablation Depth During MR-Guided Focused Ultrasound of Bone. J Magn Reson Imaging 2017; 46:1418-1422. [PMID: 28225581 DOI: 10.1002/jmri.25676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 02/02/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To evaluate the effect of differences in sonication duration and power on the size of postcontrast ablation zone following magnetic resonance-guided focused ultrasound (MRgFUS) of bone in a swine femoral bone model. MATERIALS AND METHODS Experimental procedures received approval from the Institutional Committee on Animal Research. MRgFUS was used to create two thermal lesions in the left femur of six pigs. Each target was subjected to six sonications. 400J of energy was used for each sonication. However, the distal target received the standard sonication duration of 20 seconds (20W), while the proximal target received a longer sonication duration of 40 seconds (10W). MRgFUS lesions were imaged with fat-saturated spoiled gradient echo sequence at 3.0T MRI 10 minutes following the administration of contrast. Maximum three-plane dimensions of the hypoenhanced ablation area were measured. RESULTS Postcontrast MR images demonstrated ovoid regions of hypoenhancement at each target. The average depth of ablation was significantly greater for the shorter high-power sonications (7.3 mm), compared to the longer lower-power sonications (4.5 mm), P = 0.026. The craniocaudal dimension was also greater for the shorter ablations 26.7 mm compared to the longer sonications 21.0 mm, P = 0.006. CONCLUSION Contrary to anecdotal clinical experience, this preclinical model suggests that during MRgFUS of bone, standard duration, higher-power sonications resulted in deeper ablation volumes compared to long duration, lower-power sonications. These results suggest that to achieve deeper ablations, if longer sonications are used, then the power should be relatively maintained, for a net energy increase. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2017;46:1418-1422.
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Affiliation(s)
- Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Eugene Ozhinsky
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Rutwik Shah
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Viola Rieke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Bucknor MD, Rieke V. MRgFUS for desmoid tumors within the thigh: early clinical experiences. J Ther Ultrasound 2017; 5:4. [PMID: 28174660 PMCID: PMC5290631 DOI: 10.1186/s40349-017-0081-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Desmoid tumors are benign but locally aggressive non-malignant tumors derived from fibroblasts. Surgery, chemotherapy, and radiation therapy have been the mainstay of treatment, but recurrence is common and side effects can result in significant morbidity. In this case series, we highlight our experiences performing treatments in the thigh, including strategies for optimizing ablation size and safety. CASE PRESENTATION Since December 2014, 14 magnetic resonance-guided focused ultrasound (MRgFUS) treatments for desmoid tumors were performed at our institution in seven patients. Nine of these treatments were completed in three patients with large tumors within the posterior thigh. The first was a 7-year-old boy who had previously been treated with surgical resection, intra-operative radiation, along with courses of vinblastine/methotrexate and sorafenib. Pretreatment tumor volume was 770 cm3 with 75% non-enhancing volume following the initial treatment. The first treatment was complicated by a third-degree far-field skin burn. Enhanced safety measures were developed to protect the far-field skin. The patient had four subsequent treatments over 14 months, without complication, with non-perfused volume of 85% on current imaging. The second patient was a 21-year-old woman who had previously taken sulindac and celecoxib but had no other therapy. Pretreatment tumor volume was 740 cm3. The lateral decubitus position was used to minimize the amount of energy through the sciatic nerve. The first treatment resulted in a relatively low non-perfused volume of 30%. A follow-up treatment resulted in 75-80% ablation of the target. The third patient was a 14-year-old girl with no prior treatment. Pretreatment tumor volume was approximately 440 cm3. The sciatic nerve was encased by the anteromedial portion of the mass. A lateral decubitus position and enhanced safety measures were again used. The first treatment resulted in a relatively low non-perfused volume of 30%, likely related to low energies. The second treatment resulted in 70-80% ablation. CONCLUSIONS MRgFUS is an effective treatment for desmoid tumors of the thigh with a favorable side effect profile, allowing for repeated treatments if necessary. Ablation size and safety can be improved with far-field coupling devices, careful patient positioning, and optimized sonication planning.
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Affiliation(s)
- Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107-5705 USA
| | - Viola Rieke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107-5705 USA
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