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Zhao DW, Tian M, Yang JZ, Du P, Bi J, Zhu X, Li T. Hemostatic mechanism underlying microbubble-enhanced non-focused ultrasound in the treatment of a rabbit liver trauma model. Exp Biol Med (Maywood) 2016; 242:231-240. [PMID: 27633577 DOI: 10.1177/1535370216669835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of our study was to investigate the hemostatic mechanism underlying microbubble-enhanced non-focused ultrasound treatment of liver trauma. Thirty rabbits with liver trauma were randomly divided into three groups-the microbubble-enhanced ultrasound (MEUS; further subdivided based on exposure intensity into MEUS1 [0.11 W/cm2], MEUS2 [0.55 W/cm2], and MEUS3 [1.1 W/cm2]), ultrasound without microbubbles (US), and microbubbles without ultrasound (MB) groups. The pre- and post-treatment bleeding weight and visual bleeding scores were evaluated. The serum liver enzyme concentrations as well as the blood perfusion level represented by mean peak contrast intensity (PI) ratio in the treatment area were analyzed. The hemostatic mechanism was evaluated by histological and transmission electron microscopic examination of liver tissue samples. The MEUS subgroups 1-3 (grade 0-1, grade 0-2, and grade 1-2, respectively) exhibited significantly lower post-treatment visual bleeding scores than the US and MB groups (both, grade 3-4; all, P < 0.05). Subgroups MEUS1 (0.346 ± 0.345 g) and MEUS2 (2.232 ± 2.256 g) exhibited significantly lower post-treatment bleeding weight than the US and MB groups (5.698 ± 1.938 and 5.688 ± 2.317 g, respectively; all, P < 0.05). Additionally, MEUS subgroups 1-3 exhibited significantly lower post-treatment blood perfusion levels (PI ratios, 0.64 ± 0.085, 0.73 ± 0.045, and 0.84 ± 0.034, respectively) than the US and MB groups (PI ratios, 1.00 ± 0.005 and 0.99 ± 0.005, respectively; all, P < 0.05). In the MEUS group, hepatic cells became edematous and compressed the hepatic sinus and associated blood vessels. However, the serum liver enzyme levels were not significantly altered. Microbubble-enhanced non-focused ultrasound does not significantly affect blood perfusion and liver function and can be used to induce rapid hemostasis in case of liver trauma.
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Affiliation(s)
- Da-Wei Zhao
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Meng Tian
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Jian-Zheng Yang
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Peng Du
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Jie Bi
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Xinjian Zhu
- 2 State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Tao Li
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
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Peng S, Zhou P, He W, Liao M, Chen L, Ma CM. Treatment of hepatic tumors by thermal versus mechanical effects of pulsed high intensity focused ultrasound in vivo. Phys Med Biol 2016; 61:6754-6769. [PMID: 27580168 DOI: 10.1088/0031-9155/61/18/6754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study is to comparatively assess the thermal versus mechanical effects of pulsed high intensity focused ultrasound (HIFU) treatment on hepatic tumors in vivo. Forty-five rabbits with hepatic VX2 tumors were randomly separated into three groups (15 animals per group) before HIFU ablation. The total HIFU energy (in situ) of 1250 J was used for each tumor for three groups. In groups I and II, animals were treated with 1 MHz pulsed ultrasound at 1 Hz pulsed repetition frequency (PRF), 0.5 duty cycle (0.5 s on and 0.5 s off) and10 s duration for one spot sonication. For group II, in addition to HIFU treatment, microbubbles (SonoVue, Bracco, Milan, Italy) were injected via vein before sonication acting as a synergist. In group III, animals were treated with 1 MHz pulsed ultrasound at 10 Hz PRF, 0.1 duty cycle (0.1 s on and 0.9 s off) and 10 s duration for one sonication. The total treatment spots were calculated according to the tumor volume. Tumors were examined with contrast-enhanced computed tomography (CECT) immediately prior to and post HIFU treatment. Histopathologic assessment was performed 3 h after treatment. Our study showed that all animals tolerated the HIFU treatment well. Our data showed that mechanical HIFU could lead to controlled injury in rabbit hepatic tumors with different histological changes in comparison to thermal HIFU with or without microbubbles.
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Affiliation(s)
- Song Peng
- Department of Diagnostic Imaging, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, People's Republic of China
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Scherrer A, Jakobsson S, Küfer KH. On the advancement and software support of decision-making in focused ultrasound therapy. JOURNAL OF MULTI-CRITERIA DECISION ANALYSIS 2016. [DOI: 10.1002/mcda.1596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alexander Scherrer
- Fraunhofer Institute for Industrial Mathematics (ITWM); Kaiserslautern Germany
| | | | - Karl-Heinz Küfer
- Fraunhofer Institute for Industrial Mathematics (ITWM); Kaiserslautern Germany
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Singal A, Ballard JR, Rudie EN, Cressman ENK, Iaizzo PA. A Review of Therapeutic Ablation Modalities. J Med Device 2016. [DOI: 10.1115/1.4033876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Understanding basic science and technical aspects is essential for scientists and engineers to develop and enhance ablative modalities, and for clinicians to effectively apply therapeutic ablative techniques. An overview of ablative modalities, anatomical locations, and indications for which ablations are performed is presented. Specifically, basic concepts, parameter selection, and underlying biophysics of tissue injury of five currently used therapeutic ablative modalities are reviewed: radiofrequency ablation (RFA), cryoablation (CRA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), and chemical ablation (CHA) (ablative agents: acetic acid, ethanol, hypertonic sodium chloride, and urea). Each ablative modality could be refined for expanding applications, either independently or in combination, for future therapeutic use.
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Affiliation(s)
- Ashish Singal
- Department of Biomedical Engineering, University of Minnesota, 420 Delaware Street SE, B172 Mayo Building, MMC 195, Minneapolis, MN 55455 e-mail:
| | - John R. Ballard
- Medical Devices Center, University of Minnesota, 420 Delaware Street SE, G217 Mayo Building, MMC 95, Minneapolis, MN 55455 e-mail:
| | - Eric N. Rudie
- Rudie Consulting LLC, 18466 Gladstone Boulevard, Maple Grove, MN 55311 e-mail:
| | - Erik N. K. Cressman
- Department of Interventional Radiology, MD Anderson Cancer Center, FCT 14.6012 Unit 1471, 1400 Pressler Street, Houston, TX 77030 e-mail:
| | - Paul A. Iaizzo
- Mem. ASME Department of Surgery, University of Minnesota, 420 Delaware Street SE, B172 Mayo, MMC 195, Minneapolis, MN 55455 e-mail:
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Fiber Optic Sensors for Temperature Monitoring during Thermal Treatments: An Overview. SENSORS 2016; 16:s16071144. [PMID: 27455273 PMCID: PMC4970186 DOI: 10.3390/s16071144] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 01/05/2023]
Abstract
During recent decades, minimally invasive thermal treatments (i.e., Radiofrequency ablation, Laser ablation, Microwave ablation, High Intensity Focused Ultrasound ablation, and Cryo-ablation) have gained widespread recognition in the field of tumor removal. These techniques induce a localized temperature increase or decrease to remove the tumor while the surrounding healthy tissue remains intact. An accurate measurement of tissue temperature may be particularly beneficial to improve treatment outcomes, because it can be used as a clear end-point to achieve complete tumor ablation and minimize recurrence. Among the several thermometric techniques used in this field, fiber optic sensors (FOSs) have several attractive features: high flexibility and small size of both sensor and cabling, allowing insertion of FOSs within deep-seated tissue; metrological characteristics, such as accuracy (better than 1 °C), sensitivity (e.g., 10 pm·°C−1 for Fiber Bragg Gratings), and frequency response (hundreds of kHz), are adequate for this application; immunity to electromagnetic interference allows the use of FOSs during Magnetic Resonance- or Computed Tomography-guided thermal procedures. In this review the current status of the most used FOSs for temperature monitoring during thermal procedure (e.g., fiber Bragg Grating sensors; fluoroptic sensors) is presented, with emphasis placed on their working principles and metrological characteristics. The essential physics of the common ablation techniques are included to explain the advantages of using FOSs during these procedures.
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106
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Selective killing of cancer cells by nanoparticle-assisted ultrasound. J Nanobiotechnology 2016; 14:46. [PMID: 27301243 PMCID: PMC4906686 DOI: 10.1186/s12951-016-0194-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/18/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Intense ultrasound, such as that used for tumor ablation, does not differentiate between cancerous and normal cells. A method combining ultrasound and biocompatible gold or magnetic nanoparticles (NPs) was developed under in vitro conditions using human breast and lung epithelial cells, which causes ultrasound to preferentially destroy cancerous cells. RESULTS Co-cultures of BEAS-2B normal lung cells and A549 cancerous lung cells labeled with green and red fluorescent proteins, respectively, were treated with focused ultrasound beams with the addition of gold and magnetic nanoparticles. There were significantly more necrotic A549 cells than BEAS-2 cells when gold nanoparticles were added to the culture medium [(50.6 ± 15.1) vs. (7.4 ± 2.9) %, respectively, P < 0.01]. This selective damage to cancer cells was also observed for MDA-MB231 breast cancer cells relative to MCF-10A normal breast cells after treatment with magnetic nanoparticles. CONCLUSIONS The data obtained for different cell lines indicate that nanoparticle-assisted ultrasound therapy (NAUT) could be an effective new tool for cancer-specific treatment and could potentially be combined with conventional methods of cancer diagnosis and therapy to further increase the overall cancer cure rate.
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107
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Lv W, Yan T, Wang G, Zhao W, Zhang T, Zhou D. High-intensity focused ultrasound therapy in combination with gemcitabine for unresectable pancreatic carcinoma. Ther Clin Risk Manag 2016; 12:687-91. [PMID: 27194912 PMCID: PMC4859417 DOI: 10.2147/tcrm.s90567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To investigate the therapeutic effect and safety of high-intensity focused ultrasound (HIFU) therapy combined with gemcitabine in treating unresectable pancreatic carcinoma. Methods The 45 patients suffering from pancreatic carcinoma were randomized into two groups. The patients in the experimental group (n=23) received HIFU in combination with gemcitabine and those in the control group (n=22) received gemcitabine alone. The effect and clinical benefit rates in the two groups were compared. The median survival time and 6-month and 12-month survival rates were calculated by Kaplan–Meier method and log-rank test. Results The median survival time and 6-month survival rate were significantly higher in the experimental group than in the control group (8.91 months vs 5.53 months, 73.9% vs 40.9%, respectively P<0.05), but 12-month survival rate was not statistically different between the two groups (13.0% vs 4.5%, P>0.05). The clinical benefit rates in the experimental group and the control group were 69.6% and 36.3%, respectively (P<0.05). The pain remission rate in the experimental group was significantly higher than that in the control group (65.2% vs 31.8%, P<0.05). Conclusion HIFU in combination with gemcitabine is better than gemcitabine alone. This combinatorial therapy may become a better and effective treatment for unresectable pancreatic carcinoma.
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Affiliation(s)
- Wei Lv
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Tao Yan
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Guojin Wang
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Wei Zhao
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Tao Zhang
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
| | - Dinghua Zhou
- Hepatobiliary Surgery Department, Second Artillery General Hospital, Xicheng District, Beijing, People's Republic of China
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108
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Rodriguez S, Jacob X, Gibiat V. Selective focusing through target identification and experimental acoustic signature extraction: Numerical experiments. ULTRASONICS 2016; 68:8-16. [PMID: 26890791 DOI: 10.1016/j.ultras.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/17/2016] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
Using transducer arrays and appropriate emission delays allow to focus acoustic waves at a chosen location in a medium. The focusing spatial accuracy depends on the accurate knowledge of its acoustic properties. When those properties are unknown, methods based on the Time-Reversal principle allow accurate focusing. Still, these methods are either intrusive (an active source has to be introduced at the target location first), either blind (the target cannot be selected in the presence of several objects.) The purpose of the present work is to achieve non-invasive accurate focusing on a selected target using inaccurate acoustic properties for the investigated medium. Potential applications are for instance noninvasive surgery based on High Intensity Focused Ultrasound (HIFU). Numerical experiments are presented and demonstrate accurate focusing on a previously designated target located in an unknown heterogeneous medium.
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Affiliation(s)
- S Rodriguez
- Univ. Bordeaux, I2M, UMR 5295, F-33400 Talence, France; CNRS, I2M, UMR 5295, F-33400 Talence, France; Bordeaux INP, I2M, UMR 5295, F-33400 Talence, France; Arts et métiers Paris Tech, I2M, UMR 5295, F-33400 Talence, France.
| | - X Jacob
- PHASE Laboratory (EA 3028), Paul Sabatier University - Toulouse 3, 118 route de Narbonne, 31062 Toulouse Cedex 9, France.
| | - V Gibiat
- PHASE Laboratory (EA 3028), Paul Sabatier University - Toulouse 3, 118 route de Narbonne, 31062 Toulouse Cedex 9, France.
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109
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110
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She WH, Cheung TT. Bridging and downstaging therapy in patients suffering from hepatocellular carcinoma waiting on the list of liver transplantation. Transl Gastroenterol Hepatol 2016; 1:34. [PMID: 28138601 DOI: 10.21037/tgh.2016.03.04] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/04/2016] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a common primary malignancy worldwide especially in the patients with the background of chronic liver disease. Liver transplantation (LT) is the only curative treatment effective for both malignancy as well as the cirrhosis and portal hypertension. Unfortunately, living donor is not always possible and the deceased graft is scarce. Neoadjuvant therapies, therefore, have been developed as a downstaging treatment to try to downstage the tumor within the transplant criteria, or as a bridging therapy to control the tumor growth in patients while waiting in the transplant list. This paper reviewed the common modalities used as bridging and downstaging therapies for patients suffering from HCC before undergoing LT.
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Affiliation(s)
- Wong Hoi She
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Tan To Cheung
- Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong
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111
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Suzuki R, Oda Y, Omata D, Nishiie N, Koshima R, Shiono Y, Sawaguchi Y, Unga J, Naoi T, Negishi Y, Kawakami S, Hashida M, Maruyama K. Tumor growth suppression by the combination of nanobubbles and ultrasound. Cancer Sci 2016; 107:217-23. [PMID: 26707839 PMCID: PMC4814255 DOI: 10.1111/cas.12867] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 12/03/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022] Open
Abstract
We previously developed novel liposomal nanobubbles (Bubble liposomes [BL]) that oscillate and collapse in an ultrasound field, generating heat and shock waves. We aimed to investigate the feasibility of cancer therapy using the combination of BL and ultrasound. In addition, we investigated the anti-tumor mechanism of this cancer therapy. Colon-26 cells were inoculated into the flank of BALB/c mice to induce tumors. After 8 days, BL or saline was intratumorally injected, followed by transdermal ultrasound exposure of tumor tissue (1 MHz, 0-4 W/cm2 , 2 min). The anti-tumor effects were evaluated by histology (necrosis) and tumor growth. In vivo cell depletion assays were performed to identify the immune cells responsible for anti-tumor effects. Tumor temperatures were significantly higher when treated with BL + ultrasound than ultrasound alone. Intratumoral BL caused extensive tissue necrosis at 3-4 W/cm2 of ultrasound exposure. In addition, BL + ultrasound significantly suppressed tumor growth at 2-4 W/cm2 . In vivo depletion of CD8+ T cells (not NK or CD4+ T cells) completely blocked the effect of BL + ultrasound on tumor growth. These data suggest that CD8+ T cells play a critical role in tumor growth suppression. Finally, we concluded that BL + ultrasound, which can prime the anti-tumor cellular immune system, may be an effective hyperthermia strategy for cancer treatment.
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Affiliation(s)
- Ryo Suzuki
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Yusuke Oda
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Daiki Omata
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Norihito Nishiie
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Risa Koshima
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Yasuyuki Shiono
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | | | - Johan Unga
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Tomoyuki Naoi
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Yoichi Negishi
- Department of Drug Delivery and Molecular Biopharmaceutics, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Shigeru Kawakami
- Department of Pharmaceutical Informatics, Department of Clinical Pharmacy, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Mitsuru Hashida
- Department of Drug Delivery Research, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan.,Institute of Integrated Cell-Material Sciences, Kyoto University, Kyoto, Japan
| | - Kazuo Maruyama
- Laboratory of Drug Delivery System, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
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112
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Qin J, Wang TY, Willmann JK. Sonoporation: Applications for Cancer Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:263-91. [PMID: 26486343 DOI: 10.1007/978-3-319-22536-4_15] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Therapeutic efficacy of both traditional chemotherapy and gene therapy in cancer is highly dependent on the ability to deliver drugs across natural barriers, such as the vessel wall or tumor cell membranes. In this regard, sonoporation induced by ultrasound-guided microbubble (USMB) destruction has been widely investigated in the enhancement of therapeutic drug delivery given it can help overcome these natural barriers, thereby increasing drug delivery into cancer. In this chapter we discuss challenges in current cancer therapy and how some of these challenges could be overcome using USMB-mediated drug delivery. We particularly focus on recent advances in delivery approaches that have been developed to further improve therapeutic efficiency and specificity of various cancer treatments. An example of clinical translation of USMB-mediated drug delivery is also shown.
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Affiliation(s)
- Jiale Qin
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Tzu-Yin Wang
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Jürgen K Willmann
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA.
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113
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Chen Y, Ma M, Chen H, Shi J. Multifunctional Hollow Mesoporous Silica Nanoparticles for MR/US Imaging-Guided Tumor Therapy. ADVANCES IN NANOTHERANOSTICS II 2016. [DOI: 10.1007/978-981-10-0063-8_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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114
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Liu X, Wang W, Wang Y, Wang Y, Li Q, Tang J. Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis: A Retrospective Study. Medicine (Baltimore) 2016; 95:e2443. [PMID: 26817877 PMCID: PMC4998251 DOI: 10.1097/md.0000000000002443] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The long-term outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation treatment for adenomyosis and the relevant factors affecting the durability of symptom relief were assessed in this study.A total of 230 women with adenomyosis who were treated with USgHIFU ablation between January 2007 and December 2013 were retrospectively analyzed. The contrast-enhanced ultrasonography (CEUS) was performed immediately after the treatment to evaluate the ablation effect, and the nonperfused volume (NPV) ratio was then calculated. Regular follow-up was conducted and the visual analog scale (VAS) score was used to assess the changes in dysmenorrhea. The effect of treatment was evaluated after an average follow-up length of 3 months and the factors affecting clinical success and symptom relapse were identified.Of the 230 treated patients, 208 (90.4%) were followed up regularly, with a median follow-up length of 40 months (range, 18-94 months). Mean value of the NPV ratio calculated immediately after the treatment was 57.4 ± 24.4%. Varying degrees of symptomatic relief of dysmenorrhea based on the VAS scores were observed in 173 (83.2%) patients and 71.0% of the patients were asymptomatic during follow-up. Women with higher NPV ratio (OR = 0.964, 95% CI = 0.947-0.982, P = 0.000) and older age (OR = 0.342, 95% CI = 0.143-0.819, P = 0.016) were more likely to achieve clinical success. Dysmenorrhea recurred in 45 (26%) out of 173 cases; the median recurrence time was 12 months after treatment. The lower BMI (OR = 1.221, 95% CI = 1.079-1.381, P = 0.001) and the higher acoustic power (OR = 0.992, 95% CI = 0.986-0.998, P = 0.007) were associated with less risk of relapse. Twelve of the 14 patients who were retreated by USgHIFU ablation after experiencing dysmenorrhea recurrence achieved clinical success.USgHIFU ablation is an effective uterus-conserving treatment for symptomatic adenomyosis with an acceptable long-term success rate. Higher chance of clinical success can be achieved in patients with larger NPV ratio and older age, whereas higher BMI and lower acoustic power may result in a higher chance of recurrence. These factors are helpful in selecting suitable patients for USgHIFU and in predicting the durability of symptom relief.
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Affiliation(s)
- Xin Liu
- From the Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
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115
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Vannozzi L, Ricotti L, Filippeschi C, Sartini S, Coviello V, Piazza V, Pingue P, La Motta C, Dario P, Menciassi A. Nanostructured ultra-thin patches for ultrasound-modulated delivery of anti-restenotic drug. Int J Nanomedicine 2015; 11:69-91. [PMID: 26730191 PMCID: PMC4694686 DOI: 10.2147/ijn.s92031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This work aims to demonstrate the possibility to fabricate ultra-thin polymeric films loaded with an anti-restenotic drug and capable of tunable drug release kinetics for the local treatment of restenosis. Vascular nanopatches are composed of a poly(lactic acid) supporting membrane (thickness: ~250 nm) on which 20 polyelectrolyte bilayers (overall thickness: ~70 nm) are alternatively deposited. The anti-restenotic drug is embedded in the middle of the polyelectrolyte structure, and released by diffusion mechanisms. Nanofilm fabrication procedure and detailed morphological characterization are reported here. Barium titanate nanoparticles (showing piezoelectric properties) are included in the polymeric support and their role is investigated in terms of influence on nanofilm morphology, drug release kinetics, and cell response. Results show an efficient drug release from the polyelectrolyte structure in phosphate-buffered saline, and a clear antiproliferative effect on human smooth muscle cells, which are responsible for restenosis. In addition, preliminary evidences of ultrasound-mediated modulation of drug release kinetics are reported, thus evaluating the influence of barium titanate nanoparticles on the release mechanism. Such data were integrated with quantitative piezoelectric and thermal measurements. These results open new avenues for a fine control of local therapies based on smart responsive materials.
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Affiliation(s)
- Lorenzo Vannozzi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Leonardo Ricotti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Carlo Filippeschi
- Center for MicroBioRobotics at SSSA, Istituto Italiano di Tecnologia, Pontedera, Italy
| | | | - Vito Coviello
- Department of Pharmacy, University of Pisa, Pisa, Italy
| | - Vincenzo Piazza
- Center for Nanotechnology Innovation at NEST, Istituto Italiano di Tecnologia, Pisa, Italy
| | | | | | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
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116
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Copelan A, Hartman J, Chehab M, Venkatesan AM. High-Intensity Focused Ultrasound: Current Status for Image-Guided Therapy. Semin Intervent Radiol 2015; 32:398-415. [PMID: 26622104 DOI: 10.1055/s-0035-1564793] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Image-guided high-intensity focused ultrasound (HIFU) is an innovative therapeutic technology, permitting extracorporeal or endocavitary delivery of targeted thermal ablation while minimizing injury to the surrounding structures. While ultrasound-guided HIFU was the original image-guided system, MR-guided HIFU has many inherent advantages, including superior depiction of anatomic detail and superb real-time thermometry during thermoablation sessions, and it has recently demonstrated promising results in the treatment of both benign and malignant tumors. HIFU has been employed in the management of prostate cancer, hepatocellular carcinoma, uterine leiomyomas, and breast tumors, and has been associated with success in limited studies for palliative pain management in pancreatic cancer and bone tumors. Nonthermal HIFU bioeffects, including immune system modulation and targeted drug/gene therapy, are currently being explored in the preclinical realm, with an emphasis on leveraging these therapeutic effects in the care of the oncology patient. Although still in its early stages, the wide spectrum of therapeutic capabilities of HIFU offers great potential in the field of image-guided oncologic therapy.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jason Hartman
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Monzer Chehab
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
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Abstract
Although a surgical procedure is performed by visual inspection with histopathological assessment of the excised tumor and margins, percutaneous and noninvasive thermal ablation is performed strictly with the aid of imaging. Applicator guidance into the target zone, treatment monitoring and verification, and clinical follow-up rely on effective imaging. Detailed discussion of imaging is beyond the scope of this article, but the influence of imaging on the choice of thermal ablation or procedural approach will be discussed as needed. More information on imaging for interventional therapies can be found in other articles in this issue of IEEE Pulse.
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118
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Sagias G, Yiallouras C, Ioannides K, Damianou C. An MRI-conditional motion phantom for the evaluation of high-intensity focused ultrasound protocols. Int J Med Robot 2015; 12:431-41. [PMID: 27593511 DOI: 10.1002/rcs.1709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The respiratory motion of abdominal organs is a serious obstacle in high-intensity focused ultrasound (HIFU) treatment with magnetic resonance imaging (MRI) guidance. In this study, a two-dimensional (2D) MRI-conditional motion phantom device was developed in order to evaluate HIFU protocols in synchronized and non-synchronized ablation of moving targets. MATERIALS AND METHODS The 2D phantom device simulates the respiratory motion of moving organs in both the left-right and craniocaudal directions. The device consists of MR-conditional materials which have been produced by a three-dimensional (3D) printer. RESULTS The MRI compatibility of the motion phantom was tested successfully in an MRI scanner. In vitro experiments were carried out to evaluate HIFU ablation protocols that are minimally affected by target motion. CONCLUSION It was shown that only in synchronized mode does HIFU produce thermal lesions, as tested on a gel phantom mimicking the moving target. The MRI-conditional phantom device was shown to be functional for its purpose and can be used as an evaluation tool for testing HIFU protocols for moving targets in an MRI environment. Copyright © 2015 John Wiley & Sons, Ltd.
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Development of a high-field MR-guided HIFU setup for thermal and mechanical ablation methods in small animals. J Ther Ultrasound 2015; 3:14. [PMID: 26269744 PMCID: PMC4533796 DOI: 10.1186/s40349-015-0035-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 08/07/2015] [Indexed: 01/05/2023] Open
Abstract
Background Thermal and mechanical high intensity focused ultrasound (HIFU) ablation techniques are in development for non-invasive treatment of cancer. However, knowledge of in vivo histopathologic and immunologic reactions after HIFU ablation is still limited. This study aims to create a setup for evaluation of different HIFU ablation methods in mouse tumors using high-field magnetic resonance (MR) guidance. An optimized MR-guided-HIFU setup could be used to increase knowledge of the different pathologic and immunologic reactions to different HIFU ablation methods. Methods Three different HIFU treatment strategies were applied in mouse melanomas (B16): a thermal (continuous wave), a mechanical (5 ms pulsed wave), and an intermediate setting (20 ms pulsed wave) for HIFU ablation, all under MR guidance using a 7 tesla animal MR system. Histopathologic evaluation was performed 3 days after treatment. Results The focus of the ultrasound transducer could accurately be positioned within the tumor under MR image guidance, without substantial damage to the surrounding tissue and skin. All mice retained complete use of the treated leg after treatment. Temperatures of >60, <50, and <44 °C were reached during thermal, intermediate, and mechanical HIFU ablation, respectively. Thermal-treated tumors showed large regions of coagulative necrosis. Tumors of both the mechanical and intermediate groups showed fractionated tissue with islands of necrosis and some pseudocysts with hemorrhage. Conclusion A stable small animal MR-guided HIFU setup was designed and evaluated for follow-up MR imaging and histopathologic responses of the treated tumors. This will facilitate further studies with a larger number of mice for detailed evaluation of the pathologic and immunologic response to different HIFU strategies.
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Hectors SJCG, Jacobs I, Moonen CTW, Strijkers GJ, Nicolay K. MRI methods for the evaluation of high intensity focused ultrasound tumor treatment: Current status and future needs. Magn Reson Med 2015; 75:302-17. [PMID: 26096859 DOI: 10.1002/mrm.25758] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/14/2015] [Accepted: 04/10/2015] [Indexed: 01/17/2023]
Abstract
Thermal ablation with high intensity focused ultrasound (HIFU) is an emerging noninvasive technique for the treatment of solid tumors. HIFU treatment of malignant tumors requires accurate treatment planning, monitoring and evaluation, which can be facilitated by performing the procedure in an MR-guided HIFU system. The MR-based evaluation of HIFU treatment is most often restricted to contrast-enhanced T1 -weighted imaging, while it has been shown that the non-perfused volume may not reflect the extent of nonviable tumor tissue after HIFU treatment. There are multiple studies in which more advanced MRI methods were assessed for their suitability for the evaluation of HIFU treatment. While several of these methods seem promising regarding their sensitivity to HIFU-induced tissue changes, there is still ample room for improvement of MRI protocols for HIFU treatment evaluation. In this review article, we describe the major acute and delayed effects of HIFU treatment. For each effect, the MRI methods that have been-or could be-used to detect the associated tissue changes are described. In addition, the potential value of multiparametric MRI for the evaluation of HIFU treatment is discussed. The review ends with a discussion on future directions for the MRI-based evaluation of HIFU treatment.
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Affiliation(s)
- Stefanie J C G Hectors
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Igor Jacobs
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Chrit T W Moonen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gustav J Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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121
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Couling R. HIFU for prostate cancer - a nursing perspective. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2015. [DOI: 10.1111/ijun.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khokhlova VA, Fowlkes JB, Roberts WW, Schade GR, Xu Z, Khokhlova TD, Hall TL, Maxwell AD, Wang YN, Cain CA. Histotripsy methods in mechanical disintegration of tissue: towards clinical applications. Int J Hyperthermia 2015; 31:145-62. [PMID: 25707817 PMCID: PMC4448968 DOI: 10.3109/02656736.2015.1007538] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In high intensity focused ultrasound (HIFU) therapy, an ultrasound beam is focused within the body to locally affect the targeted site without damaging intervening tissues. The most common HIFU regime is thermal ablation. Recently there has been increasing interest in generating purely mechanical lesions in tissue (histotripsy). This paper provides an overview of several studies on the development of histotripsy methods toward clinical applications. Two histotripsy approaches and examples of their applications are presented. In one approach, sequences of high-amplitude, short (microsecond-long), focused ultrasound pulses periodically produce dense, energetic bubble clouds that mechanically disintegrate tissue. In an alternative approach, longer (millisecond-long) pulses with shock fronts generate boiling bubbles and the interaction of shock fronts with the resulting vapour cavity causes tissue disintegration. Recent preclinical studies on histotripsy are reviewed for treating benign prostatic hyperplasia (BPH), liver and kidney tumours, kidney stone fragmentation, enhancing anti-tumour immune response, and tissue decellularisation for regenerative medicine applications. Potential clinical advantages of the histotripsy methods are discussed. Histotripsy methods can be used to mechanically ablate a wide variety of tissues, whilst selectivity sparing structures such as large vessels. Both ultrasound and MR imaging can be used for targeting and monitoring the treatment in real time. Although the two approaches utilise different mechanisms for tissue disintegration, both have many of the same advantages and offer a promising alternative method of non-invasive surgery.
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Affiliation(s)
- Vera A Khokhlova
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington , Seattle, Washington , USA
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Civale J, Rivens I, ter Haar G. Quality assurance for clinical high intensity focused ultrasound fields. Int J Hyperthermia 2015; 31:193-202. [PMID: 25677839 DOI: 10.3109/02656736.2014.1002435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As the use of HIFU in the clinic becomes more widespread there is an ever increasing need to standardise quality assurance protocols, an important step in facilitating the wider acceptance of HIFU as a therapeutic modality. This article reviews pertinent aspects of HIFU treatment delivery, encompassing the closely related aspects of quality assurance and calibration. Particular attention is given to the description and characterisation of relevant acoustic field parameters and the measurement of acoustic power. Where appropriate, recommendations are made.
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Affiliation(s)
- John Civale
- Division of Radiotherapy and Imaging, Institute of Cancer Research , Sutton, Surrey , UK
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124
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Abstract
Microfocused ultrasound (MFU) has been recently developed to meet the ever-growing public demand for achieving significant, noninvasive skin lifting and tightening. MFU can be focused on subcutaneous tissue where the temperature briefly reaches greater than 60°C, producing small (<1 mm3) thermal coagulation points to a depth of up to 5 mm within the mid-to-deep reticular layer of the dermis and subdermis. The intervening papillary dermal and epidermal layers of skin remain unaffected. The application of heat at these discrete thermal coagulation points causes collagen fibers in the facial planes such as the superficial musculoaponeurotic system and platysma, as well as the deep reticular dermis, to become denatured, contracting and stimulating de novo collagen. A commercially available device combines MFU with high-resolution ultrasound imaging (MFU-V), which enables visualization of tissue planes to a depth of 8 mm and allows the user to see where the MFU energy will be applied (Ultherapy®; Ulthera Inc., Mesa, AZ, USA). Using different transducers, MFU-V treatment can be customized to meet the unique physical characteristics of each patient by adjusting energy and focal depth of the emitted ultrasound. By targeting the facial superficial musculoaponeurotic system, noninvasive tightening and lifting of sagging facial and neck skin and improvements in the appearance of wrinkles can be achieved. MFU-V can also improve lines and wrinkles of the décolleté. Treatment protocols for the use of MFU-V continue to be refined, and its use in combination with other rejuvenation techniques has been demonstrated. Brief discomfort that often occurs during treatment can be minimized with oral nonsteroidal anti-inflammatory drugs. Other treatment-related adverse events include transient erythema, edema, and occasional bruising. MFU-V is best suited for patients with mild-to-moderate skin and soft tissue laxity. For older patients with severe skin laxity and marked platysmal banding, surgical treatment should be considered.
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Affiliation(s)
- Sabrina Guillen Fabi
- Goldman, Butterwick, Fitzpatrick, Groff and Fabi, Cosmetic Laser Dermatology, San Diego, CA, USA
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125
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Endoscopic ultrasound-guided therapies in pancreatic neoplasms. BIOMED RESEARCH INTERNATIONAL 2015; 2015:731049. [PMID: 25802863 PMCID: PMC4329839 DOI: 10.1155/2015/731049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/22/2014] [Accepted: 12/25/2014] [Indexed: 12/18/2022]
Abstract
Endoscopic ultrasound (EUS) has evolved from being primarily a diagnostic modality into an interventional endoscopic tool for the management of both benign and malignant gastrointestinal illnesses. EUS-guided therapy has garnered particular interest as a minimally invasive approach for the treatment of pancreatic cancer, a disease often complicated by its aggressive course and poor survival. The potential advantage of an EUS-guided approach revolves around real-time imaging for targeted therapy of a difficult to reach organ. In this review, we focus on EUS-guided therapies for pancreatic neoplasms.
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Abstract
Image-guided ablation (IGA) techniques have evolved considerably over the past 20 years and are increasingly used to definitively treat small primary cancers of the liver and kidney. IGA is recommended by most guidelines as the best therapeutic choice for patients with early stage hepatocellular carcinoma (HCC)-defined as either a single tumour smaller than 5 cm or up to three nodules smaller than 3 cm-when surgical options are precluded, and has potential as first-line therapy, in lieu of surgery, for patients with very early stage tumours smaller than 2 cm. With regard to renal cell carcinoma, despite the absence of any randomized trial comparing the outcomes of IGA with those of standard partial nephrectomy, a growing amount of data demonstrate robust oncological outcomes for this minimally invasive approach and testify to its potential as a standard-of-care treatment. Herein, we review the various ablation techniques, the supporting evidence, and clinical application of IGA in the treatment of primary liver and kidney cancers.
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Affiliation(s)
- David J Breen
- Department of Radiology, University Hospitals of Southampton, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Riccardo Lencioni
- Department of Liver Transplantation, Hepatology and Infectious Diseases, Division of Diagnostic Imaging and Intervention, Pisa University Hospital and School of Medicine, Building No. 29, 2nd Floor, Via Paradisa 2, IT-56124 Pisa, Italy
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Chen Y, Chen H, Shi J. Nanobiotechnology promotes noninvasive high-intensity focused ultrasound cancer surgery. Adv Healthc Mater 2015; 4:158-65. [PMID: 24898413 DOI: 10.1002/adhm.201400127] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/12/2014] [Indexed: 01/20/2023]
Abstract
The successful cancer eradication in a noninvasive manner is the ultimate objective in the fight against cancer. As a "bloodless scalpel," high-intensity focused ultrasound (HIFU) is regarded as one of the most promising and representative noninvasive therapeutic modalities for cancer surgery. However, large-scale clinical applications of HIFU are still in their infancy because of critical efficiency and safety issues which remain to be solved. Fortunately, recently developed nanobiotechnology provides an alternative efficient approach to improve such important issues in HIFU, especially for cancer therapy. This Research News presents the very recent exciting progresses on the elaborate design and fabrication of organic, inorganic, and organic/inorganic hybrid nanoparticles for enhancing the HIFU ablation efficiency against tumor tissues. It is highly expected that this Research News can arouse more extensive research enthusiasm on the development of functional nanomaterials for highly efficient HIFU-based synergistic therapy, which will give a promising noninvasive therapeutic modality for the successful cancer therapy with minimal damage to surrounding normal tissues, due to the noninvasive and site-specific therapeutic features of HIFU.
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Affiliation(s)
- Yu Chen
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures; Shanghai Institute of Ceramics, Chinese Academy of Sciences; 1295 Ding-Xi Road Shanghai 200050 P. R. China
| | - Hangrong Chen
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures; Shanghai Institute of Ceramics, Chinese Academy of Sciences; 1295 Ding-Xi Road Shanghai 200050 P. R. China
| | - Jianlin Shi
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures; Shanghai Institute of Ceramics, Chinese Academy of Sciences; 1295 Ding-Xi Road Shanghai 200050 P. R. China
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128
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Fang YL, Chen XG, W T G. Gene delivery in tissue engineering and regenerative medicine. J Biomed Mater Res B Appl Biomater 2014; 103:1679-99. [PMID: 25557560 DOI: 10.1002/jbm.b.33354] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/07/2014] [Accepted: 11/18/2014] [Indexed: 12/13/2022]
Abstract
As a promising strategy to aid or replace tissue/organ transplantation, gene delivery has been used for regenerative medicine applications to create or restore normal function at the cell and tissue levels. Gene delivery has been successfully performed ex vivo and in vivo in these applications. Excellent proliferation capabilities and differentiation potentials render certain cells as excellent candidates for ex vivo gene delivery for regenerative medicine applications, which is why multipotent and pluripotent cells have been intensely studied in this vein. In this review, gene delivery is discussed in detail, along with its applications to tissue engineering and regenerative medicine. A definition of a stem cell is compared to a definition of a stem property, and both provide the foundation for an in-depth look at gene delivery investigations from a germ lineage angle.
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Affiliation(s)
- Y L Fang
- Department of Chemical & Biomolecular Engineering, Laboratory for Gene Therapy and Cellular Engineering, Tulane University, 300 Lindy Boggs Center, New Orleans, Louisiana, 70118
| | - X G Chen
- Department of Chemical & Biomolecular Engineering, Laboratory for Gene Therapy and Cellular Engineering, Tulane University, 300 Lindy Boggs Center, New Orleans, Louisiana, 70118
| | - Godbey W T
- Department of Chemical & Biomolecular Engineering, Laboratory for Gene Therapy and Cellular Engineering, Tulane University, 300 Lindy Boggs Center, New Orleans, Louisiana, 70118
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Rombouts SJE, Vogel JA, van Santvoort HC, van Lienden KP, van Hillegersberg R, Busch ORC, Besselink MGH, Molenaar IQ. Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer. Br J Surg 2014; 102:182-93. [PMID: 25524417 DOI: 10.1002/bjs.9716] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/14/2014] [Accepted: 10/23/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Locally advanced pancreatic cancer (LAPC) is associated with a very poor prognosis. Current palliative (radio)chemotherapy provides only a marginal survival benefit of 2-3 months. Several innovative local ablative therapies have been explored as new treatment options. This systematic review aims to provide an overview of the clinical outcomes of these ablative therapies. METHODS A systematic search in PubMed, Embase and the Cochrane Library was performed to identify clinical studies, published before 1 June 2014, involving ablative therapies in LAPC. Outcomes of interest were safety, survival, quality of life and pain. RESULTS After screening 1037 articles, 38 clinical studies involving 1164 patients with LAPC, treated with ablative therapies, were included. These studies concerned radiofrequency ablation (RFA) (7 studies), irreversible electroporation (IRE) (4), stereotactic body radiation therapy (SBRT) (16), high-intensity focused ultrasound (HIFU) (5), iodine-125 (2), iodine-125-cryosurgery (2), photodynamic therapy (1) and microwave ablation (1). All strategies appeared to be feasible and safe. Outcomes for postoperative, procedure-related morbidity and mortality were reported only for RFA (4-22 and 0-11 per cent respectively), IRE (9-15 and 0-4 per cent) and SBRT (0-25 and 0 per cent). Median survival of up to 25·6, 20·2, 24·0 and 12·6 months was reported for RFA, IRE, SBRT and HIFU respectively. Pain relief was demonstrated for RFA, IRE, SBRT and HIFU. Quality-of-life outcomes were reported only for SBRT, and showed promising results. CONCLUSION Ablative therapies in patients with LAPC appear to be feasible and safe.
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Affiliation(s)
- S J E Rombouts
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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130
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Ma CM, Chen X, Cvetkovic D, Chen L. An in-vivo investigation of the therapeutic effect of pulsed focused ultrasound on tumor growth. Med Phys 2014; 41:122901. [PMID: 25471980 DOI: 10.1118/1.4901352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE High-intensity focused ultrasound (HIFU) has been investigated for ablative therapy and drug enhancement for gene therapy and chemotherapy. The aim of this work is to explore the feasibility of pulsed focused ultrasound (pFUS) for cancer therapy using an in vivo animal model. METHODS A clinical HIFU system (InSightec ExAblate 2000) integrated with a 1.5 T GE MR scanner was used in this study. Suitable ultrasound parameters were investigated to perform nonthermal sonications, keeping the temperature elevation below 4 °C as measured in real time by MR thermometry. LNCaP cells (10(6)) were injected into the prostates of male mice (n = 20). When tumors reached a diameter of about 5 mm in 3D as measured on magnetic resonance imaging (MRI), the tumor-bearing mice (n = 8) were treated with pFUS (1 MHz frequency; 25 W acoustic power; 0.1 duty cycle; 60 s duration). A total of 4-6 sonications were used to cover the entire tumor volume under MR image guidance. The animals were allowed to survive for 4 weeks after the treatment. The tumor growth was monitored on high-resolution (0.2 mm) MRI weekly post treatment and was compared with that of the control group (n = 12). RESULTS Significant tumor growth delay was observed in the tumor-bearing mice treated with pFUS. The mean tumor volume for the pFUS treated mice remained the same 1 week after the treatment while the mean tumor volume of the control mice grew 42% over the same time. Two weeks after the pFUS treatment, the control group had a mean tumor volume 40% greater than that of the treated group. There was a greater variation in tumor volume at 4 weeks post treatment for both treated and control mice and a slightly faster tumor growth for the pFUS treated mice. CONCLUSIONS The authors' results demonstrated that pFUS may have a great potential for cancer therapy. Further experiments are warranted to understand the predominantly nonthermal cell killing mechanisms of pFUS and to derive optimal ultrasound parameters and fractionation schemes to maximize the therapeutic effect of pFUS.
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Affiliation(s)
- C-M Ma
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
| | - Xiaoming Chen
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
| | - Dusica Cvetkovic
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
| | - Lili Chen
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
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Mahmoud MZ, Alkhorayef M, Alzimami KS, Aljuhani MS, Sulieman A. High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study. Pol J Radiol 2014; 79:384-90. [PMID: 25371765 PMCID: PMC4218899 DOI: 10.12659/pjr.891110] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 05/29/2014] [Indexed: 12/04/2022] Open
Abstract
Background High-intensity focused ultrasound (HIFU) is a highly precise medical procedure used locally to heat and destroy diseased tissue through ablation. This study intended to review HIFU in uterine fibroid therapy, to evaluate the role of HIFU in the therapy of leiomyomas as well as to review the actual clinical activities in this field including efficacy and safety measures beside the published clinical literature. Material/Methods An inclusive literature review was carried out in order to review the scientific foundation, and how it resulted in the development of extracorporeal distinct devices. Studies addressing HIFU in leiomyomas were identified from a search of the Internet scientific databases. The analysis of literature was limited to journal articles written in English and published between 2000 and 2013. Results In current gynecologic oncology, HIFU is used clinically in the treatment of leiomyomas. Clinical research on HIFU therapy for leiomyomas began in the 1990s, and the majority of patients with leiomyomas were treated predominantly with HIFUNIT 9000 and prototype single focus ultrasound devices. HIFU is a non-invasive and highly effective standard treatment with a large indication range for all sizes of leiomyomas, associated with high efficacy, low operative morbidity and no systemic side effects. Conclusions Uterine fibroid treatment using HIFU was effective and safe in treating symptomatic uterine fibroids. Few studies are available in the literature regarding uterine artery embolization (UAE). HIFU provides an excellent option to treat uterine fibroids.
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Affiliation(s)
- Mustafa Z Mahmoud
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Salman bin Abdulaziz University, Al-Kharj, Saudi Arabia ; Department of Basic Sciences, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Mohammed Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Khalid S Alzimami
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Manal Saud Aljuhani
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdelmoneim Sulieman
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Salman bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Penetrating the cell membrane, thermal targeting and novel anticancer drugs: the development of thermally targeted, elastin-like polypeptide cancer therapeutics. Ther Deliv 2014; 5:429-45. [PMID: 24856169 DOI: 10.4155/tde.14.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Therapeutic peptides offer important cancer treatment approaches. Designed to inhibit oncogenes and other oncoproteins, early therapeutic peptides applications were hampered by pharmacokinetic properties now addressed through tumor targeting strategies. Active targeting with environmentally responsive biopolymers or macromolecules enhances therapeutics accumulation at tumor sites; passive targeting with macromolecules, or liposomes, exploits angiogenesis and poor lymphatic drainage to preferentially accumulate therapeutics within tumors. Genetically engineered, thermally-responsive, elastin-like polypeptides use both strategies and cell-penetrating peptides to further intratumoral cell uptake. This review describes the development and application of cell-penetrating peptide-elastin-like polypeptide therapeutics for the thermally targeted delivery of therapeutic peptides.
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Tzu-Yin W, Wilson KE, Machtaler S, Willmann JK. Ultrasound and microbubble guided drug delivery: mechanistic understanding and clinical implications. Curr Pharm Biotechnol 2014; 14:743-52. [PMID: 24372231 DOI: 10.2174/1389201014666131226114611] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/03/2013] [Accepted: 10/03/2013] [Indexed: 12/11/2022]
Abstract
Ultrasound mediated drug delivery using microbubbles is a safe and noninvasive approach for spatially localized drug administration. This approach can create temporary and reversible openings on cellular membranes and vessel walls (a process called "sonoporation"), allowing for enhanced transport of therapeutic agents across these natural barriers. It is generally believed that the sonoporation process is highly associated with the energetic cavitation activities (volumetric expansion, contraction, fragmentation, and collapse) of the microbubble. However, a thorough understanding of the process was unavailable until recently. Important progress on the mechanistic understanding of sonoporation and the corresponding physiological responses in vitro and in vivo has been made. Specifically, recent research shed light on the cavitation process of microbubbles and fluid motion during insonation of ultrasound, on the spatio-temporal interactions between microbubbles and cells or vessel walls, as well as on the temporal course of the subsequent biological effects. These findings have significant clinical implications on the development of optimal treatment strategies for effective drug delivery. In this article, current progress in the mechanistic understanding of ultrasound and microbubble mediated drug delivery and its implications for clinical translation is discussed.
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Affiliation(s)
| | | | | | - Jurgen K Willmann
- Department of Radiology and Molecular Imaging Program at Stanford, School of Medicine, Stanford University, 300 Pasteur Drive, Room H1307, Stanford, CA 94305-5621, USA.
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134
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Abstract
Thermal ablative technologies have evolved considerably in the recent past and are now an important component of current clinical guidelines for the treatment of small renal masses. Both radiofrequency ablation and cryoablation have intermediate-term oncologic control that rivals surgical options, with favorable complication profiles. Studies comparing cryoablation and radiofrequency ablation show no significant difference in oncologic control or complication profile between the two modalities. Early data from small series with microwave ablation have shown similar promising results. Newer technologies including irreversible electroporation and high-intensity-focused ultrasound have theoretical advantages, but will require further research before becoming a routine part of the ablation armamentarium. The purpose of this review article is to discuss the current ablative technologies available, briefly review their mechanisms of action, discuss technical aspects of each, and provide current data supporting their use.
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Affiliation(s)
- Vishal Khiatani
- Coastal Radiology Associates, Department of Radiology, Carolina East Medical Center, New Bern, North Carolina
| | - Robert G Dixon
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
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135
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Abstract
Ultrasound-mediated gene delivery with microbubbles has emerged as an attractive nonviral vector system for site-specific and noninvasive gene therapy. Ultrasound promotes intracellular uptake of therapeutic agents, particularly in the presence of microbubbles, by increasing vascular and cell membrane permeability. Several preclinical studies have reported successful gene delivery into solid tumors with significant therapeutic effects using this novel approach. This review provides background information on gene therapy and ultrasound bioeffects and discusses the current progress and overall perspectives on the application of ultrasound and microbubble-mediated gene delivery in cancer.
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136
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Ende AR, Hwang JH. Endoscopic ultrasound-guided tumor ablation. GASTROINTESTINAL INTERVENTION 2014. [DOI: 10.1016/j.gii.2014.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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137
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Ultrasound-guided tissue fractionation by high intensity focused ultrasound in an in vivo porcine liver model. Proc Natl Acad Sci U S A 2014; 111:8161-6. [PMID: 24843132 DOI: 10.1073/pnas.1318355111] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The clinical use of high intensity focused ultrasound (HIFU) therapy for noninvasive tissue ablation has been recently gaining momentum. In HIFU, ultrasound energy from an extracorporeal source is focused within the body to ablate tissue at the focus while leaving the surrounding organs and tissues unaffected. Most HIFU therapies are designed to use heating effects resulting from the absorption of ultrasound by tissue to create a thermally coagulated treatment volume. Although this approach is often successful, it has its limitations, such as the heat sink effect caused by the presence of a large blood vessel near the treatment area or heating of the ribs in the transcostal applications. HIFU-induced bubbles provide an alternative means to destroy the target tissue by mechanical disruption or, at its extreme, local fractionation of tissue within the focal region. Here, we demonstrate the feasibility of a recently developed approach to HIFU-induced ultrasound-guided tissue fractionation in an in vivo pig model. In this approach, termed boiling histotripsy, a millimeter-sized boiling bubble is generated by ultrasound and further interacts with the ultrasound field to fractionate porcine liver tissue into subcellular debris without inducing further thermal effects. Tissue selectivity, demonstrated by boiling histotripsy, allows for the treatment of tissue immediately adjacent to major blood vessels and other connective tissue structures. Furthermore, boiling histotripsy would benefit the clinical applications, in which it is important to accelerate resorption or passage of the ablated tissue volume, diminish pressure on the surrounding organs that causes discomfort, or insert openings between tissues.
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138
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Xiaoping L, Leizhen Z. Advances of high intensity focused ultrasound (HIFU) for pancreatic cancer. Int J Hyperthermia 2014; 29:678-82. [PMID: 24102396 DOI: 10.3109/02656736.2013.837199] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
High intensity focused ultrasound (HIFU) is a novel therapeutic modality. Several preclinical and clinical studies have investigated the safety and efficacy of HIFU for treating solid tumours, including pancreatic cancer. Preliminary studies suggest that HIFU may be useful for the palliative therapy of cancer-related pain in patients with unresectable pancreatic cancer. This review provides a brief overview of HIFU, describes current clinical applications of HIFU for pancreatic cancer, and discusses future applications and challenges.
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Affiliation(s)
- Li Xiaoping
- Department of Oncology, Xinhua Hospital, Shanghai Jiaotong University , Shanghai 200092 , China
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139
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Ge HY, Miao LY, Xiong LL, Yan F, Zheng CS, Wang JR, Jia JW, Cui LG, Chen W. High-intensity focused ultrasound treatment of late-stage pancreatic body carcinoma: optimal tumor depth for safe ablation. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:947-55. [PMID: 24462161 DOI: 10.1016/j.ultrasmedbio.2013.11.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/12/2013] [Accepted: 11/16/2013] [Indexed: 06/03/2023]
Abstract
Objective criteria are currently not available for assessing the extent of ablation by high-intensity focused ultrasound (HIFU). A retrospective review was conducted in Chinese patients with late-stage pancreatic body carcinoma treated with 1 h/d intermittent HIFU at a single center. Clinical and procedure-related characteristics were examined in relation to tumor posterior depth. Clinically, tumor ablation was negatively correlated with posterior tumor depth, with a 1-cm increase in depth decreasing ablation by 30.7%. At a computed tomography (CT)-determined 7-cm posterior tumor depth (considered the critical value for the procedure), ablation sensitivity and specificity were 77.8% and 72.7%, respectively. Tumor ablation >30% in patients with a CT-determined posterior tumor depth ≤7 cm was 9.333 times better than that in patients with a CT-determined posterior tumor depth >7 cm. Adverse effects did not affect the efficacy of HIFU. Tumors with posterior depths <7 cm may effectively be treated with HIFU-induced ablation with minimal adverse events.
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Affiliation(s)
- Hui-Yu Ge
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Li-Ying Miao
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China.
| | - Liu-Lin Xiong
- Department of Urology, Peking University People's Hospital, Xicheng District, Beijing, China.
| | - Fang Yan
- Clinic Epidemiology Research Group, Beijing Anding Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Cui-Shan Zheng
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jin-Rui Wang
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Jian-Wen Jia
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
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140
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Xia R, Thittai AK. Real-time monitoring of high-intensity focused ultrasound treatment using axial strain and axial-shear strain elastograms. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:485-495. [PMID: 24361216 DOI: 10.1016/j.ultrasmedbio.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 10/07/2013] [Accepted: 10/09/2013] [Indexed: 06/03/2023]
Abstract
Axial strain elastograms (ASEs) have been found to help visualize sonographically invisible thermal lesions. However, in most studies involving high-intensity focused ultrasound (HIFU)-induced thermal lesions, elastography imaging was performed separately later, after the lesion was formed. In this article, the feasibility of monitoring, in real time, tissue elasticity variation during HIFU treatment and immediately thereafter is explored using quasi-static elastography. Further, in addition to ASEs, we also explore the use of simultaneously acquired axial-shear strain elastograms (ASSEs) for HIFU lesion visualization. Experiments were performed on commercial porcine liver samples in vitro. The HIFU experiments were conducted at two applied acoustic power settings, 35 and 20 W. The experimental setup allowed us to interrupt the HIFU pulse momentarily several different times during treatment to perform elastographic compression and data acquisition. At the end of the experiments, the samples were cut along the imaging plane and photographed to compare size and location of the formed lesion with those visualized on ASEs and ASSEs. Single-lesion and multiple-lesion experiments were performed to assess the contribution of ASEs and ASSEs to lesion visualization and treatment monitoring tasks. At both power settings, ASEs and ASSEs provided accurate location information during HIFU treatment. At the low-power setting case, ASEs and ASSEs provide accurate lesion size in real-time monitoring. Lesion appearance in ASEs and ASSEs was affected by the cavitation bubbles produced at the high-power setting. The results further indicate that the cavitation bubbles influence lesion appearance more in ASEs than in ASSEs. Both ASEs and ASSEs provided accurate size information after a waiting period that allowed the cavitation bubbles to disappear. The results indicate that ASSEs not only improve lesion visualization and size measurement of a single lesion, but, under certain conditions, also help to identify untreated gaps between adjacent lesions with high contrast.
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Affiliation(s)
- Rongmin Xia
- Ultrasonics Laboratory, Department of Diagnostic and Interventional Imaging, University of Texas Medical School, Houston, Texas, USA
| | - Arun K Thittai
- Ultrasonics Laboratory, Department of Diagnostic and Interventional Imaging, University of Texas Medical School, Houston, Texas, USA.
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141
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Liu XW, Zhou DH. Application status of high intensity focused ultrasound in treatment of colorectal cancer liver metastases. Shijie Huaren Xiaohua Zazhi 2014; 22:807-812. [DOI: 10.11569/wcjd.v22.i6.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The liver is the most common and important site of metastases for colorectal cancer, and liver metastasis is one of the important factors leading to treatment failure in colorectal cancer. The traditional methods for treating liver metastases of colorectal cancer (CRLM) are not satisfactory and are often associated with a poor prognosis. High intensity focused ultrasound (HIFU) as a new technique for local ablation of solid tumors not only has advantages of less trauma, fewer complications, faster recovery and definite tumor necrosis, but also can preserve and enhance the host anti-tumor immunity. In recent years, HIFU ablation has been increasingly used for the therapy of tumors in clinical settings. This paper gives an overview of mechanisms of action and application status of HIFU in the treatment of colorectal cancer liver metastases, and explores current challenges and future perspectives.
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142
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Liu L, Xiao Z, Xiao Y, Wang Z, Li F, Li M, Peng X. Potential enhancement of intravenous nano-hydroxyapatite in high-intensity focused ultrasound ablation for treating hepatocellular carcinoma in a rabbit model. Oncol Lett 2014; 7:1485-1492. [PMID: 24765161 PMCID: PMC3997670 DOI: 10.3892/ol.2014.1900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 01/15/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to evaluate the safety and efficiency of an intravenously delivered nano-hydroxyapatite (Nano-HA) solution into a rabbit model (Oryctolagus cuniculus) to determine the potential enhancement of high-intensity focused ultrasound (HIFU) for the ablation of hepatocellular carcinoma (HCC) in liver tissue. The present study clearly indicated that the intravenous delivery of large quantities of Nano-HA into the body of the rabbit model over relatively short periods of time may be absorbed by the hepatic reticuloendothelial system. Subsequent HIFU treatment for HCC, as well as intravenous Nano-HA, produced a rapid increase in temperature and an enlargement of the coagulated necrotic area during ablation in the in vivo and ex vivo environments. In addition, it was found that the therapeutic doses of Nano-HA produced mild and transient abnormalities in the normal renal function and hepatic enzymes during the first 24 h following administration. The results of the current study indicated that the combination of Nano-HA and HIFU may provide a safe and effective alternative to conventional surgical procedures.
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Affiliation(s)
- Liping Liu
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Ziwen Xiao
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Yanbing Xiao
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Zhibiao Wang
- Department of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Faqi Li
- Department of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Maoping Li
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiaoqiong Peng
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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143
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144
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Kyriakou A, Neufeld E, Werner B, Paulides MM, Szekely G, Kuster N. A review of numerical and experimental compensation techniques for skull-induced phase aberrations in transcranial focused ultrasound. Int J Hyperthermia 2013; 30:36-46. [PMID: 24325307 DOI: 10.3109/02656736.2013.861519] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The development of phased array transducers and their integration with magnetic resonance (MR) guidance and thermal monitoring has established transcranial MR-guided focused ultrasound (tcMRgFUS) as an attractive non-invasive modality for neurosurgical interventions. The presence of the skull, however, compromises the efficiency of transcranial FUS (tcFUS) therapy, as its heterogeneous nature and acoustic characteristics induce significant phase aberrations and energy attenuation, especially at the higher acoustic frequencies employed in tcFUS thermal therapy. These aberrations may distort and shift the acoustic focus as well as induce heating at the patient's scalp and skull bone. Phased array transducers feature hundreds of elements that can be driven individually, each with its own phase and amplitude. This feature allows for compensation of skull-induced aberrations by calculation and application of appropriate phase and amplitude corrections. In this paper, we illustrate the importance of precise refocusing and provide a comprehensive review of the wide variety of numerical and experimental techniques that have been used to estimate these corrections.
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Affiliation(s)
- Adamos Kyriakou
- IT'IS Foundation for Research on Information Technologies in Society , Zurich , Switzerland
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145
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Ma WH, Ho WY, Lai ASH, Wong KK, Law M. Characteristic uptake pattern of bone scintigraphy in patients with hepatocellular carcinoma following treatment with high-intensity focused ultrasound. Nucl Med Mol Imaging 2013; 47:273-7. [PMID: 24900124 PMCID: PMC4035169 DOI: 10.1007/s13139-013-0221-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE This study retrospectively reviews the characteristic bone scintigraphic findings in 18 patients with hepatocellular carcinoma (HCC) following treatment with high-intensity focused ultrasound (HIFU). A potential complication of HIFU is damage to the tissues along the path of the ultrasound beam and structures superficial to the lesion of interest. METHODS Patients with hepatocellular carcinoma who underwent a bone scan between 1st December 2005 and 31st December 2011 were considered for this study. Among these patients, only those who had bone scans after the HIFU treatment were included. The time between HIFU treatment and bone scans, HIFU energy, HCC sites, tumour sizes and related radiological findings were evaluated. RESULTS In total, 20 bone scans of 18 patients were reviewed. Of these scans, two patients were normal; three patients showed decreased uptake, four patients showed increased uptake and nine patients showed mixed uptakes of the bony tracer in their rib cages. The defects were located in the anterior, lateral, anterolateral or posterolateral aspects of the rib cage. The majority of those cold defects were in the right anterior rib cages. SPECT/CT was used to localise the decreased uptake in ribs. The magnetic resonance imaging in individual patients invariably showed ill-defined rim enhancement along the right chest wall, signifying chest wall injury. CONCLUSIONS The results showed that tissue ablation using HIFU caused tissue injury along the pathway of high-intensity ultrasound beams. The harm to tissues is presented as photopenic area on the rib cages due to necrosis or hot spots due to rib fractures in the bone scan. Since these cold defects are subtle, they are easily overlooked or mistaken as aggressive bony metastasis.
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Affiliation(s)
- Wai-Han Ma
- />Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Wai-Yin Ho
- />Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Andrew S. H. Lai
- />Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Kwong-Kuen Wong
- />Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Martin Law
- />Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong
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146
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Watson N, Johal R, Glover Z, Reinwald Y, White L, Ghaemmaghami A, Morgan S, Rose F, Povey M, Parker N. Post-processing of polymer foam tissue scaffolds with high power ultrasound: A route to increased pore interconnectivity, pore size and fluid transport. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2013; 33:4825-32. [DOI: 10.1016/j.msec.2013.07.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 07/22/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
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147
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Bucknor MD, Rieke V, Do L, Majumdar S, Link TM, Saeed M. MRI-guided high-intensity focused ultrasound ablation of bone: evaluation of acute findings with MR and CT imaging in a swine model. J Magn Reson Imaging 2013; 40:1174-80. [PMID: 24925593 DOI: 10.1002/jmri.24451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/12/2013] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate hyperacute (<1 hour) changes on magnetic resonance (MR) and computed tomography (CT) imaging following MR-guided high-intensity focused ultrasound (MRgHIFU) in a swine bone model as a function of sonication number and energy. MATERIALS AND METHODS Experimental procedures received approval from the local Institutional Animal Care and Use Committee. MRgHIFU was used to create distal and proximal ablations in the right femur of eight pigs. Each target was dosed with four or six sonications within similar volumes. The energy dosed to the distal target was higher (419 ± 19 J) than the proximal target (324 ± 17 J). The targeted femur and contralateral control were imaged before and after ablation using MR at 3T. Qualitative changes in signal on T1-weighted, T2-weighted, and T1-weighted postcontrast images were assessed. Ablation dimensions were calculated from postcontrast MRI. The 64-slice CT images were also obtained before and after ablation and qualitative changes were assessed. RESULTS MRgHIFU bone ablation size measured on average 8.5 × 21.1 × 16.2 mm (transverse × craniocaudal × anteroposterior). Interestingly, within similar prescribed volumes, increasing the number of sonications from 4 to 6 increased the depth of the intramedullary hypoenhanced zone from 2.9 mm to 6.5 mm (P < 0.001). There was no difference in the appearance of low versus high energy ablations. CT imaging did not show structural abnormalities. CONCLUSION The number of MRgHIFU focal sonications can be used to increase the depth of treatment within the targeted bone. Unlike CT, T2-weighted and contrast-enhanced MR demonstrated the hyperacute structural changes in the femur and surrounding soft tissue.
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Affiliation(s)
- Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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148
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Wang Y, Wang W, Tang J. Primary malignant tumours of the bony pelvis: US-guided high intensity focused ultrasound ablation. Int J Hyperthermia 2013; 29:683-7. [DOI: 10.3109/02656736.2013.840806] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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149
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Rong S, Woo K, Zhou Q, Zhu Q, Wu Q, Wang Q, Deng C, Liu D, Yang G, Jiang Y, Wang Z, Huang J. Septal Ablation Induced by Transthoracic High-Intensity Focused Ultrasound in Canines. J Am Soc Echocardiogr 2013; 26:1228-1234. [DOI: 10.1016/j.echo.2013.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 10/26/2022]
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150
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Rossi M, Orgera G, Hatzidakis A, Krokidis M. Minimally invasive ablation treatment for locally advanced pancreatic adenocarcinoma. Cardiovasc Intervent Radiol 2013; 37:586-91. [PMID: 23989503 DOI: 10.1007/s00270-013-0724-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/06/2013] [Indexed: 12/15/2022]
Abstract
Pancreatic adenocarcinoma is an aggressive tumour with an extremely poor prognosis, which has not changed significantly during the last 30 years. Prolonged survival is achieved only by R0 resection with macroscopic tumour clearance. However, the majority of the cases are considered inoperable at diagnosis due to local spread or presence of metastatic disease. Chemoradiotherapy is not tolerated by all patients and still fails to prolong survival significantly; neoadjuvant treatment also has limited results on pain control or tumour downstaging. In recent years, there has been a growing interest in the use of ablation therapy for the treatment of nonresectable tumours in various organs. Ablation techniques are based on direct application of chemical, thermal, or electrical energy to a tumour, which leads to cellular necrosis. With ablation, tumour cytoreduction, local control, and relief from symptoms are obtained in the majority of the patients. Inoperable cases of pancreatic adenocarcinoma have been treated by various ablation techniques in the last few years with promising results. The purpose of this review is to present the current status of local ablative therapies in the treatment of pancreatic adenocarcinoma and to investigate on the efficiency and the future trends.
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Affiliation(s)
- Michele Rossi
- Unit of Interventional Radiology, S. Andrea University Hospital "Sapienza", Rome, Italy
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