1
|
Boeer B, Oberlechner E, Rottscholl R, Gruber I, Guergan S, Brucker S, Hahn M. Five-year follow-up after a single US-guided high intensity focused ultrasound treatment of breast fibroadenoma. Sci Rep 2024; 14:18370. [PMID: 39112604 PMCID: PMC11306253 DOI: 10.1038/s41598-024-68827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
The aim of this study was to evaluate the long-term efficacy of a single ultrasound-guided high-intensity focused ultrasound (US-HIFU) treatment in patients with breast fibroadenoma (FA) in terms of volume and pain reduction as well as palpation findings. From december 2013 until november 2014 27 women with a symptomatic FA were treated in one HIFU-session. Follow-up visits were performed after 7 days, 6 months and 1, 2, 3 and 5 years with clinical examination and ultrasound. One year after the procedure, a core needle biopsy of the residual lesion was offered. There was a significant volume reduction 6 months after HIFU from 1083.10 to 347.13 mm3 (p < 0.0001) with a mean volume reduction ratio (VRR) of 61.63%. Thereafter the FAs showed a further, but no longer significant decrease in size. One patient with an initial incomplete ablation and histologically confirmed persistent vital cells after 1 year showed a strong regrowth after 3 years. Excluding this patient from analysis, the mean VRR at months 12, 24, 36, and 60 was 86.44%, 94.44%, 94.90%, and 97.85%, respectively. Before HIFU, 59.26% of the patients had pain (22.33/100 VAS) which decreased to 6.56/100 after 12 months and remained reduced over the 5 year follow up period. A decrease in palpability from 85.19 to 7.69% was observed within 24 months. A single HIFU intervention let to a substantial reduction in size, pain, and palpability with its most potential effect during the first 12 months. Subsequently, the observed effect remained stable over a 5 year follow up period. Incomplete initial treatment was associated with the risk of regrowth.
Collapse
Affiliation(s)
- B Boeer
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany.
| | - E Oberlechner
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - R Rottscholl
- Department of Pathology, University Hospital of Tuebingen, Tübingen, Germany
| | - I Gruber
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - S Guergan
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - S Brucker
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - M Hahn
- Department of Women's Health, University Hospital of Tuebingen, Calwerstraße 7, 72076, Tübingen, Germany
| |
Collapse
|
2
|
Dai Y, Jiang J, Liang P, Yu X, Han Z, Liu F, Tan S, Bi M, Wu C, Cai Q, Li J, Yu J. Percutaneous microwave ablation: a viable local therapy for breast cancer involving the skin/nipple-areola complex? Curr Probl Surg 2024; 61:101483. [PMID: 38823890 DOI: 10.1016/j.cpsurg.2024.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Yuqing Dai
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Jiang
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - XiaoLing Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - ZhiYu Han
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shuilian Tan
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingsen Bi
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chong Wu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qian Cai
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jianming Li
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
3
|
Sun T, Li J, Zhou Y, Zeng C, Luo C, Luo X, Li H. Metal-Organic Framework-Mediated Synergistic Hypoxia-Activated Chemo-Immunotherapy Induced by High Intensity Focused Ultrasound for Enhanced Cancer Theranostics. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2306338. [PMID: 38072817 DOI: 10.1002/smll.202306338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/04/2023] [Indexed: 05/03/2024]
Abstract
High intensity focused ultrasound (HIFU) has attracted considerable attention as a noninvasive, efficient, and economic therapeutic modality for solid tumors. However, HIFU surgery has its intrinsic limitation in completely ablating tumors, leading to residual tumor tissue. Furthermore, the severely hypoxic environment ensuring after surgery can exacerbate the unrestricted proliferation and metabolism of residual tumor cells, leading to tumor recurrence and metastasis. To address these limitations, a versatile HIFU-specific metal-organic framework nanosystem (called ADMOFs) is developed by coordinating hypoxia-activated prodrug AQ4N, Mn2+, and DOX based on the postoperative response to changes in the tumor microenvironment. ADMOFs loaded with AQ4N/Mn2+ exhibited remarkable tumor-targeting behavior in vivo and enhanced photoacoustic/magnetic resonance imaging effects, enabling more accurate guidance for HIFU surgery. After surgery, the ADMOFs exploited the severely hypoxic tumor environment induced by HIFU, overcoming hypoxia-associated drug resistance, and inducing immunogenic cell death. Finally, it effectively inhibited tumor growth and eliminated lung metastasis. Transcriptome studies revealed that this strategy significantly up-regulated genes involved in apoptosis, cell cycle, and HIF-1 signaling pathway while downregulating genes related to tumor proliferation and metastasis. These findings suggest that combining hypoxia-activated chemo-immunotherapy with HIFU is a promising strategy for enhancing cancer theranostics.
Collapse
Affiliation(s)
- Tingyu Sun
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Jingnan Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Yinglin Zhou
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Chao Zeng
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Chengyan Luo
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Xirui Luo
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, P. R. China
| | - Huanan Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, P. R. China
| |
Collapse
|
4
|
Wang Z, Sun W, Hua R, Wang Y, Li Y, Zhang H. Promising dawn in tumor microenvironment therapy: engineering oral bacteria. Int J Oral Sci 2024; 16:24. [PMID: 38472176 DOI: 10.1038/s41368-024-00282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/06/2024] [Accepted: 01/07/2024] [Indexed: 03/14/2024] Open
Abstract
Despite decades of research, cancer continues to be a major global health concern. The human mouth appears to be a multiplicity of local environments communicating with other organs and causing diseases via microbes. Nowadays, the role of oral microbes in the development and progression of cancer has received increasing scrutiny. At the same time, bioengineering technology and nanotechnology is growing rapidly, in which the physiological activities of natural bacteria are modified to improve the therapeutic efficiency of cancers. These engineered bacteria were transformed to achieve directed genetic reprogramming, selective functional reorganization and precise control. In contrast to endotoxins produced by typical genetically modified bacteria, oral flora exhibits favorable biosafety characteristics. To outline the current cognitions upon oral microbes, engineered microbes and human cancers, related literatures were searched and reviewed based on the PubMed database. We focused on a number of oral microbes and related mechanisms associated with the tumor microenvironment, which involve in cancer occurrence and development. Whether engineering oral bacteria can be a possible application of cancer therapy is worth consideration. A deeper understanding of the relationship between engineered oral bacteria and cancer therapy may enhance our knowledge of tumor pathogenesis thus providing new insights and strategies for cancer prevention and treatment.
Collapse
Affiliation(s)
- Zifei Wang
- Key Laboratory of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Wansu Sun
- Department of Stomatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ruixue Hua
- Key Laboratory of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Yuanyin Wang
- Key Laboratory of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China
| | - Yang Li
- Department of Genetics, School of Life Science, Anhui Medical University, Hefei, China.
| | - Hengguo Zhang
- Key Laboratory of Oral Diseases Research of Anhui Province, College & Hospital of Stomatology, Anhui Medical University, Hefei, China.
| |
Collapse
|
5
|
De Maio A, Alfieri G, Mattone M, Ghanouni P, Napoli A. High-Intensity Focused Ultrasound Surgery for Tumor Ablation: A Review of Current Applications. Radiol Imaging Cancer 2024; 6:e230074. [PMID: 38099828 PMCID: PMC10825716 DOI: 10.1148/rycan.230074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023]
Abstract
The management of cancer with alternative approaches is a matter of clinical interest worldwide. High-intensity focused ultrasound (HIFU) surgery is a noninvasive technique performed under US or MRI guidance. The most studied therapeutic uses of HIFU involve thermal tissue ablation, demonstrating both palliative and curative potential. However, concurrent mechanical bioeffects also provide opportunities in terms of augmented drug delivery and immunosensitization. The safety and efficacy of HIFU integration with current cancer treatment strategies are being actively investigated in managing primary and secondary tumors, including cancers of the breast, prostate, pancreas, liver, kidney, and bone. Current primary HIFU indications are pain palliation, complete ablation of localized earlystage tumors, or debulking of unresectable late-stage cancers. This review presents the latest HIFU applications, from investigational to clinically approved, in the field of tumor ablation. Keywords: Ultrasound, Ultrasound-High Intensity Focused (HIFU), Interventional-MSK, Interventional-Body, Oncology, Technology Assessment, Tumor Response, MR Imaging © RSNA, 2023.
Collapse
Affiliation(s)
- Alessandro De Maio
- From the Department of Radiological, Pathological, and Oncological
Sciences, Sapienza University of Rome, viale Regina Elena 324, 00100 Rome, Italy
(A.D.M., G.A., M.M., A.N.); and Department of Radiology, Stanford University,
Stanford, Calif (P.G.)
| | - Giulia Alfieri
- From the Department of Radiological, Pathological, and Oncological
Sciences, Sapienza University of Rome, viale Regina Elena 324, 00100 Rome, Italy
(A.D.M., G.A., M.M., A.N.); and Department of Radiology, Stanford University,
Stanford, Calif (P.G.)
| | - Monica Mattone
- From the Department of Radiological, Pathological, and Oncological
Sciences, Sapienza University of Rome, viale Regina Elena 324, 00100 Rome, Italy
(A.D.M., G.A., M.M., A.N.); and Department of Radiology, Stanford University,
Stanford, Calif (P.G.)
| | - Pejman Ghanouni
- From the Department of Radiological, Pathological, and Oncological
Sciences, Sapienza University of Rome, viale Regina Elena 324, 00100 Rome, Italy
(A.D.M., G.A., M.M., A.N.); and Department of Radiology, Stanford University,
Stanford, Calif (P.G.)
| | - Alessandro Napoli
- From the Department of Radiological, Pathological, and Oncological
Sciences, Sapienza University of Rome, viale Regina Elena 324, 00100 Rome, Italy
(A.D.M., G.A., M.M., A.N.); and Department of Radiology, Stanford University,
Stanford, Calif (P.G.)
| |
Collapse
|
6
|
Ya Z, Guo S, Li Y, Zhu M, Zhang L, Zong Y, Wan M. Focused acoustic vortex-mediated sonochemotherapy for the amplification of immunogenic cell death combined with checkpoint blockade to potentiate cancer immunotherapy. Biomaterials 2023; 301:122278. [PMID: 37598439 DOI: 10.1016/j.biomaterials.2023.122278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/03/2023] [Accepted: 08/12/2023] [Indexed: 08/22/2023]
Abstract
Sonodynamic therapy (SDT) as an auxiliary modality of cancer immunotherapy enhances systemic anti-tumor immunity. However, the efficiency of SDT-mediated immunotherapy based on conventional focused ultrasound (FUS) is restricted by the tiny focal region of FUS. Focused acoustic vortex (FAV) possessing a larger focal region, can induce stronger cavitation and thermal effects than FUS with the same parameters, having the potential to overcome this issue. This research investigated the feasibility of FAV-mediated sonochemotherapy combined with the immune checkpoint blockade (ICB) to reshape immunosuppressive tumor microenvironment (TME), inhibit tumor growth and lung metastasis. Sonosensitizer chlorin e6 (Ce6) and chemotherapeutic agent doxorubicin (Dox) were co-loaded into microbubble-liposome complex to compose Ce6/Dox@Lip@MBs (CDLM) for "all-in-one" synergistic sonochemotherapy, whose main components were clinical approved. FAV-activated CDLM significantly enriched immunogenic cell death (ICD) inducers in tumors and amplified ICD of cancer cells compared with FUS-activated CDLM. Furthermore, the amplified-ICD combined with ICB increased the infiltration of cytotoxic T lymphocytes and natural killer cells, polarized M2 macrophages to M1 macrophages, and decreased regulatory T cells. This study provides a multifunctional strategy for enriching ICD inducers in tumors and amplifying ICD to ameliorate immunosuppressive TME and potentiate systemic anti-tumor immunity.
Collapse
Affiliation(s)
- Zhen Ya
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Shifang Guo
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Yan Li
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Mingting Zhu
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Lei Zhang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Yujin Zong
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
| | - Mingxi Wan
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
| |
Collapse
|
7
|
Feng X, Yang M, Li J, Liao H, Zhang Z, Wang Q, Du Y. Experimental study of HIFU incomplete ablation on the damage effect and prognosis of rabbit VX2 breast cancer model. Int J Hyperthermia 2023; 40:2255760. [PMID: 37726101 DOI: 10.1080/02656736.2023.2255760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE High-intensity focused ultrasound (HIFU) represents an emerging noninvasive modality for tumor treatment. While biological responses and immunological change associated with incomplete ablation have not been thoroughly investigated. This study aims to evaluate the damage effect of HIFU incomplete ablation via establishing animal model and further explore its possible mechanism to inhibit tumor growth. METHODS The rabbit VX2 breast cancer model was established and received HIFU treatment with complete ablation (100% tumor volume) and incomplete ablation (about 80% tumor volume) under real-time B-ultrasound monitoring. Histopathological alterations, dynamics of tumor cell apoptosis and proliferation, expression levels of VEGF, MMP-9, IL-2R, TGF-β1, HSP-70, IL-6, IL-8, and INF-γ, and the presence of circulating tumor cells (CTCs) were evaluated post-HIFU incomplete ablation. RESULTS For HIFU 80% ablation group, there was an 85.85% reduction in tumor volume 21 days post-intervention. A marked increase in tumor cell apoptosis and a concomitant decrease in proliferation were observed. Notably, distant tumor metastasis rates, CTC counts, and expression levels of VEGF, MMP-9, IL-2R, TGF-β1, IL-6, and IL-8 were significantly reduced. In contrast, INF-γ and HSP-70 expressions were notably elevated, aligning with findings from the 100% ablation group. CONCLUSIONS HIFU incomplete ablation, with an 80% tumor ablation rate, induces substantial tumor damage, augments tumor cell apoptosis, and triggers an anti-tumor immune response, curtailing metastasis. These insights may underpin further investigations into the therapeutic implications of HIFU incomplete ablation.
Collapse
Affiliation(s)
- Xiaoling Feng
- State Key Laboratory of Ultrasound in Medical and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Min Yang
- State Key Laboratory of Ultrasound in Medical and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jianhu Li
- State Key Laboratory of Ultrasound in Medical and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Hongjian Liao
- State Key Laboratory of Ultrasound in Medical and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zhifei Zhang
- State Key Laboratory of Ultrasound in Medical and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Qi Wang
- State Key Laboratory of Ultrasound in Medical and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yonghong Du
- State Key Laboratory of Ultrasound in Medical and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| |
Collapse
|
8
|
Zulkifli D, Manan HA, Yahya N, Hamid HA. The Applications of High-Intensity Focused Ultrasound (HIFU) Ablative Therapy in the Treatment of Primary Breast Cancer: A Systematic Review. Diagnostics (Basel) 2023; 13:2595. [PMID: 37568958 PMCID: PMC10417478 DOI: 10.3390/diagnostics13152595] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This study evaluates the role of high-intensity focused ultrasound (HIFU) ablative therapy in treating primary breast cancer. METHODS PubMed and Scopus databases were searched according to the PRISMA guidelines to identify studies from 2002 to November 2022. Eligible studies were selected based on criteria such as experimental study type, the use of HIFU therapy as a treatment for localised breast cancer with objective clinical evaluation, i.e., clinical, radiological, and pathological outcomes. Nine studies were included in this study. RESULTS Two randomised controlled trials and seven non-randomised clinical trials fulfilled the inclusion criteria. The percentage of patients who achieved complete (100%) coagulation necrosis varied from 17% to 100% across all studies. Eight of the nine studies followed the treat-and-resect protocol in which HIFU-ablated tumours were surgically resected for pathological evaluation. Most breast cancers were single, solitary, and palpable breast tumours. Haematoxylin and eosin stains used for histopathological evaluation showed evidence of coagulation necrosis. Radiological evaluation by MRI showed an absence of contrast enhancement in the HIFU-treated tumour and 1.5 to 2 cm of normal breast tissue, with a thin peripheral rim of enhancement indicative of coagulation necrosis. All studies did not report severe complications, i.e., haemorrhage and infection. Common complications related to HIFU ablation were local mammary oedema, pain, tenderness, and mild to moderate burns. Only one third-degree burn was reported. Generally, the cosmetic outcome was good. The five-year disease-free survival rate was 95%, as reported in two RCTs. CONCLUSIONS HIFU ablation can induce tumour coagulation necrosis in localised breast cancer, with a favourable safety profile and cosmetic outcome. However, there is variable evidence of complete coagulation necrosis in the HIFU-treated tumour. Histopathological evidence of coagulation necrosis has been inconsistent, and there is no reliable radiological modality to assess coagulation necrosis confidently. Further exploration is needed to establish the accurate ablation margin with a reliable radiological modality for treatment and follow-up. HIFU therapy is currently limited to single, palpable breast tumours. More extensive and randomised clinical trials are needed to evaluate HIFU therapy for breast cancer, especially where the tumour is left in situ.
Collapse
Affiliation(s)
- Dania Zulkifli
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (D.Z.); (H.A.H.)
| | - Hanani Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (D.Z.); (H.A.H.)
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging and Radiotherapy Program, Centre for Diagnostic, Therapeutic and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Hamzaini Abdul Hamid
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (D.Z.); (H.A.H.)
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| |
Collapse
|
9
|
Gonnah AR, Masoud O, AbdelWahab M, ElMosalamy A, Al-Naseem A. The Role of High Intensity Focused Ultrasound in the Treatment of Fibroadenomas: A Systematic Review. Breast Care (Basel) 2023; 18:279-288. [PMID: 37900548 PMCID: PMC10601662 DOI: 10.1159/000524738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/21/2022] [Indexed: 10/31/2023] Open
Abstract
Introduction Fibroadenomas are solid, mobile, and non-tender benign breast lumps, with highest prevalence amongst young women aged between 15 and 35. Symptoms can include discomfort, and they can become problematic, particularly when they enlarge, resulting in many referrals for biopsies, with fibroadenomas accounting for 30-75% of the cases. Diagnosis is based on triple assessment that involves a clinical examination, ultrasound imaging, and mammography, as well as core needle biopsies. Current management includes observation for 6-12 months, with the indication of definitive surgery, in cases that are older than 35 years or with fibroadenoma persistence. Serious adverse effects of surgery might include nipple areolar distortion, scarring, and damage to the breast tissue, as well as the risks associated with surgery and anesthesia, making it a non-feasible option. Methods A literature search was performed on the databases Embase, MEDLINE/PubMed, Google Scholar, and Ovid for English language papers published between January 1, 2000, and March 17, 2021. A structured protocol was employed to devise a comprehensive search strategy with keywords and Boolean operators defined by the research question. The keywords used for the search were "HIFU", "High Intensity Focused Ultrasound," "Fibroadenoma," "Breast," "Lesion." This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Recently, a thermal ablative technique, high intensity focused ultrasound (HIFU), was found to be a safe, noninvasive, and technically successful alternative, having displayed promising outcomes in reducing the volume of fibroadenomas, pain experienced by patients, and the length of hospitalization. Quality of life improvement was also evidenced, exhibited by the disappearance of symptoms, and enhanced physical activity post-intervention, in addition to patients' satisfaction with the cosmetic results and future recommendation of the procedure to other patients. Conclusion Overall, HIFU is a well-tolerated treatment associated, with low risk of complications, that can potentially include erythema, skin discoloration, and bruising with the majority of these self-resolving shortly after the procedure.
Collapse
Affiliation(s)
| | - Omar Masoud
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | | | | |
Collapse
|
10
|
Sadeghi-Goughari M, Han SW, Kwon HJ. Real-time monitoring of focused ultrasound therapy using intelligence-based thermography: A feasibility study. ULTRASONICS 2023; 134:107100. [PMID: 37421699 DOI: 10.1016/j.ultras.2023.107100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/10/2023]
Abstract
Focused ultrasound (FUS) therapy has been widely studied for breast cancer treatment due to its potential as a fully non-invasive method to improve cosmetic and oncologic results. However, real-time imaging and monitoring of the therapeutic ultrasound delivered to the target area remain challenges for precision breast cancer therapy. The main objective of this study is to propose and evaluate a novel intelligence-based thermography (IT) method that can monitor and control FUS treatment using thermal imaging with the fusion of artificial intelligence (AI) and advanced heat transfer modeling. In the proposed method, a thermal camera is integrated into FUS system for thermal imaging of the breast surface, and an AI model is employed for the inverse analysis of the surface thermal monitoring, thereby estimating the features of the focal region. This paper presents experimental and computational studies conducted to assess the feasibility and efficiency of IT-guided FUS (ITgFUS). Tissue phantoms, designed to mimic the properties of breast tissue, were used in the experiments to investigate detectability and the impact of temperature rise at the focal region on the tissue surface. Additionally, an AI computational analysis employing an artificial neural network (ANN) and FUS simulation was carried out to provide a quantitative estimation of the temperature rise at the focal region. This estimation was based on the observed temperature profile on the breast model's surface. The results proved that the effects of temperature rise at the focused area could be detected by the thermal images acquired with thermography. Moreover, it was demonstrated that the AI analysis of the surface temperature measurement could result in near real-time monitoring of FUS by quantitative estimation of the temporal and spatial temperature rise profiles at the focal region.
Collapse
Affiliation(s)
- Moslem Sadeghi-Goughari
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada.
| | - Sang-Wook Han
- Department of Automotive Engineering, Shinhan University, 95 Hoam-ro, Uijeongbu, Gyeonggi-do 480-701, Republic of Korea
| | - Hyock-Ju Kwon
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1, Canada
| |
Collapse
|
11
|
Shibamoto Y, Takano S. Non-Surgical Definitive Treatment for Operable Breast Cancer: Current Status and Future Prospects. Cancers (Basel) 2023; 15:cancers15061864. [PMID: 36980750 PMCID: PMC10046665 DOI: 10.3390/cancers15061864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
This article reviews the results of various non-surgical curative treatments for operable breast cancer. Radiotherapy is considered the most important among such treatments, but conventional radiotherapy alone and concurrent chemoradiotherapy do not achieve high cure rates. As a radiosensitization strategy, intratumoral injection of hydrogen peroxide before radiation has been investigated, and high local control rates (75-97%) were reported. The authors treated 45 patients with whole-breast radiotherapy, followed by stereotactic or intensity-modulated radiotherapy boost, with or without a radiosensitization strategy employing either hydrogen peroxide injection or hyperthermia plus oral tegafur-gimeracil-oteracil potassium. Stages were 0-I in 23 patients, II in 19, and III in 3. Clinical and cosmetic outcomes were good, with 5-year overall, progression-free, and local recurrence-free survival rates of 97, 86, and 88%, respectively. Trials of carbon ion radiotherapy are ongoing, with promising interim results. Radiofrequency ablation, focused ultrasound, and other image-guided ablation treatments yielded complete ablation rates of 20-100% (mostly ≥70%), but long-term cure rates remain unclear. In these treatments, combination with radiotherapy seems necessary to treat the extensive intraductal components. Non-surgical treatment of breast cancer is evolving steadily, with radiotherapy playing a major role. In the future, proton therapy with the ultra-high-dose-rate FLASH mode is expected to further improve outcomes.
Collapse
Affiliation(s)
- Yuta Shibamoto
- Department of Radiation Oncology, Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi 441-8021, Japan
- Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita-shi 565-0871, Japan
| | - Seiya Takano
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| |
Collapse
|
12
|
Dahan M, Cortet M, Lafon C, Padilla F. Combination of Focused Ultrasound, Immunotherapy, and Chemotherapy: New Perspectives in Breast Cancer Therapy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:559-573. [PMID: 35869903 DOI: 10.1002/jum.16053] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
Focused ultrasound is a treatment modality increasingly used for diverse therapeutic applications, and currently approved for several indications, including prostate cancers and uterine fibroids. But what about breast cancer? Breast cancer is the most common and deadliest cancer in women worldwide. While there are different treatment strategies available, there is a need for development of more effective and personalized modalities, with fewer side effects. Therapeutic ultrasound is such an option, and this review summarizes the state of the art in their use for the treatment of breast cancer and evaluate potentials of novel treatment approaches combining therapeutic ultrasound, immuno- and chemo-therapies.
Collapse
Affiliation(s)
- Myléva Dahan
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France
| | - Marion Cortet
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France
- Service de Gynécologie Obstétrique, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Cyril Lafon
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France
| | - Frédéric Padilla
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, Lyon, France
- Focused Ultrasound Foundation, Charlottesville, Virginia, USA
- Department of Radiology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| |
Collapse
|
13
|
Liang M, Zhang Z, Zhang C, Chen R, Xiao Y, Li Z, Li T, Liu Y, Ling L, Xie H, Chen L, Liu X, Wang S, Xia T. Feasibility and efficacy of ultrasound-guided high-intensity focused ultrasound of breast fibroadenoma. Int J Hyperthermia 2023; 40:2240548. [PMID: 37544652 DOI: 10.1080/02656736.2023.2240548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This nonrandomized prospective clinical trial aimed to assess the efficacy, safety and follow-up outcomes of ultrasound-guided high-intensity focused ultrasound (USgHIFU) surgery in patients with breast fibroadenoma. METHODS With the approval of the institutional ethics committee and written informed consent, a total of 113 patients diagnosed with breast fibroadenoma by core-needle biopsy in our hospital were recruited. USgHIFU surgery was performed under local anesthesia. Contrast-enhanced ultrasound (CEUS) or contrast-enhanced MRI (CEMRI) was performed to evaluate the nonperfused volume (NPV). The patients were followed up with physical examination and ultrasound imaging. RESULTS The clinical outcome of 85 patients with 147 fibroadenomas with a follow-up time of more than 3 months was analyzed in this study. Fifty-two patients had one lesion, twenty-one patients had two lesions and twelve patients had more than two lesions. During USgHIFU, the median localization time for all fibroadenomas was 3 (interquartile range: 1, 5) min, and the median treatment time was 9 (interquartile range: 5, 15) min. Under local anesthesia, all the patients tolerated the treatment well. No serious epidermal burns were observed in any of the patients. Based on CEUS or CEMRI imaging evaluation, the median NPV ratio was 100% (interquartile range: 79.2%, 116.8%). The VRR were 26.77 ± 50.05%, 50.22 ± 42.01% and 72.74 ± 35.39% at 3-6 months, 6-12 months and >12 months, respectively, which showed significant statistical difference (p < .001). CONCLUSION Ultrasound-guided HIFU surgery is an effective and safe noninvasive alternative technique for the treatment of breast fibroadenoma.
Collapse
Affiliation(s)
- Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhizheng Zhang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Cai Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Haifu Hospital, Chongqing, China
- National Engineering Research Center of Ultrasound Medicine, Chongqing, China
| | - Rui Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yao Xiao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Zi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Tao Li
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yuelin Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lin Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| |
Collapse
|
14
|
Liang M, Zhang C, Xia T, Chen R, Wang X, Weng M, Xie H, Chen L, Liu X, Wang S. Ultrasound radiomics features predicting the dosimetry for focused ultrasound surgery of benign breast tumor: A retrospective study. Front Genet 2022; 13:969409. [PMID: 36118892 PMCID: PMC9479455 DOI: 10.3389/fgene.2022.969409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To investigate the correlation between pre-ablation ultrasound radiomics features and the sonication energy for focused ultrasound surgery (FUS) of benign breast tumors. Method: 53 benign breast tumors of 28 patients treated by ultrasound-guided focused ultrasound surgery (USgFUS) were included in this study. The sonication energy per unit volume of each tumor was calculated. Three-quarter point was chosen as the cut-off to divide the 53 included tumors into high sonication energy (HSE, n = 14) and low sonication energy (LSE, n = 39) groups. For each tumor, the region of interest (ROI) of both the tumor itself (tROI) and the near field tissue (nfROI) were delineated and analyzed separately using ImageJ software. Pearson correlation coefficient and multiple linear regression analysis were used for radiomics feature selection. To explore the diagnostic performance of different ultrasound radiomics features, a receiver operating characteristic (ROC) curve analysis was performed. Results: In total of 68 radiomics features were extracted from pre-ablation ultrasound images of each tumor. Of all radiomics features, BX in tROI (p < 0.001), BX (p = 0.001) and Circ (p = 0.019) in nfROI were independently predictive features of sonication energy per unit volume. The ROC curves showed that the area under the curve (AUC) values of BX in tROI, BX, and Circ in nfROI were 0.797, 0.787 and 0.822, respectively. Conclusion: This study provided three radiomics features of pre-ablation ultrasound image as predictors of sonication dose for FUS in benign breast tumors. Further clinical trials are needed to confirm the predictive effect of these radiomics features.
Collapse
Affiliation(s)
- Mengdi Liang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Cai Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Tiansong Xia
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Rui Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xinyang Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Miaomiao Weng
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lin Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaoan Liu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- *Correspondence: Xiaoan Liu, ; Shui Wang,
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- *Correspondence: Xiaoan Liu, ; Shui Wang,
| |
Collapse
|
15
|
Chen Y, Du M, Yuan Z, Chen Z, Yan F. Spatiotemporal control of engineered bacteria to express interferon-γ by focused ultrasound for tumor immunotherapy. Nat Commun 2022; 13:4468. [PMID: 35918309 PMCID: PMC9345953 DOI: 10.1038/s41467-022-31932-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
Bacteria-based tumor therapy has recently attracted wide attentions due to its unique capability in targeting tumors and preferentially colonizing the core area of the tumor. Various therapeutic genes are also harbored into these engineering bacteria to enhance their anti-tumor efficacy. However, it is difficult to spatiotemporally control the expression of these inserted genes in the tumor site. Here, we engineer an ultrasound-responsive bacterium (URB) which can induce the expression of exogenous genes in an ultrasound-controllable manner. Owing to the advantage of ultrasound in tissue penetration, an acoustic remote control of bacterial gene expression can be realized by designing a temperature-actuated genetic switch. Cytokine interferon-γ (IFN-γ), an important immune regulatory molecule that plays a significant role in tumor immunotherapy, is used to test the system. Our results show that brief hyperthermia induced by focused ultrasound promotes the expression of IFN-γ gene, improving anti-tumor efficacy of URB in vitro and in vivo. Our study provides an alternative strategy for bacteria-mediated tumor immunotherapy.
Collapse
Affiliation(s)
- Yuhao Chen
- The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Faculty of Health Sciences, Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macau SAR, China
| | - Meng Du
- The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Zhen Yuan
- Faculty of Health Sciences, Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macau SAR, China
| | - Zhiyi Chen
- The First Affiliated Hospital, Medical Imaging Centre, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
- Institute of Medical Imaging, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
| | - Fei Yan
- Center for Cell and Gene Circuit Design, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
| |
Collapse
|
16
|
Alphandéry E. Ultrasound and nanomaterial: an efficient pair to fight cancer. J Nanobiotechnology 2022; 20:139. [PMID: 35300712 PMCID: PMC8930287 DOI: 10.1186/s12951-022-01243-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/02/2022] [Indexed: 01/12/2023] Open
Abstract
Ultrasounds are often used in cancer treatment protocols, e.g. to collect tumor tissues in the right location using ultrasound-guided biopsy, to image the region of the tumor using more affordable and easier to use apparatus than MRI and CT, or to ablate tumor tissues using HIFU. The efficacy of these methods can be further improved by combining them with various nano-systems, thus enabling: (i) a better resolution of ultrasound imaging, allowing for example the visualization of angiogenic blood vessels, (ii) the specific tumor targeting of anti-tumor chemotherapeutic drugs or gases attached to or encapsulated in nano-systems and released in a controlled manner in the tumor under ultrasound application, (iii) tumor treatment at tumor site using more moderate heating temperatures than with HIFU. Furthermore, some nano-systems display adjustable sizes, i.e. nanobubbles can grow into micro-bubbles. Such dual size is advantageous since it enables gathering within the same unit the targeting properties of nano bubbles via EPR effect and the enhanced ultrasound contrasting properties of micro bubbles. Interestingly, the way in which nano-systems act against a tumor could in principle also be adjusted by accurately selecting the nano-system among a large choice and by tuning the values of the ultrasound parameters, which can lead, due to their mechanical nature, to specific effects such as cavitation that are usually not observed with purely electromagnetic waves and can potentially help destroying the tumor. This review highlights the clinical potential of these combined treatments that can improve the benefit/risk ratio of current cancer treatments.
Collapse
Affiliation(s)
- Edouard Alphandéry
- Sorbonne Université, Muséum National d'Histoire Naturelle, UMR CNRS, 7590, IRD, Institut de Minéralogie, de Physique des Matériaux et de. Cosmochimie, IMPMC, 75005, Paris, France. .,Nanobacterie SARL, 36 boulevard Flandrin, 75116, Paris, France. .,Institute of Anatomy, UZH University of Zurich, Instiute of Anatomy, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
| |
Collapse
|
17
|
Su C, Ren X, Wang H, Ding X, Guo J. Changing Pain Management Strategy from Opioid-Centric towards Improve Postoperative Cognitive Dysfunction with Dexmedetomidine. Curr Drug Metab 2021; 23:57-65. [PMID: 34791997 DOI: 10.2174/1389200222666211118115347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/21/2021] [Accepted: 09/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was aimed to investigate the effectiveness of dexmedetomidine (DEX) on improving the level of pain and disability to find out the possible correlation between psychological factors with pain management satisfaction and physical function in patients with femoral neck fractures. METHODS One hundred twenty-four adult patients with stable femoral neck fractures (type I and II, Garden classification) who underwent internal fixation, were prospectively enrolled including 62 patients in the DEX group and 62 patients in the control group. The magnitude of disability using Harris Hip Score, Postoperative Cognitive Dysfunction (POCD) using Mini-Mental State Examination (MMSE score), Quality of Recovery (QoR-40), pain-related anxiety (PASS-20), pain management and pain catastrophizing scale (PCS) were recorded on the first and second day after surgery. RESULTS The DEX group on the first and second days after surgery exhibited higher quality of recovery scores, greater satisfaction with pain management, low disability scores, less catastrophic thinking, lower pain anxiety, greater mini mental state examination scores and less opioid intake and the differences were statistically significant compared with the control group (P<0.001). Emergence agitation and incidence of POCD were significantly less in the DEX group (P<0.001). Decreased disability was associated with less catastrophic thinking and lower pain anxiety, but not associated with more opioid intake (P<0.001). Higher QoR-40 scores had a negative correlation with more catastrophic thinking and more opioid intake (P<0.001). Greater satisfaction with pain management was correlated with less catastrophic thinking and less opioid intake (P<0.001). CONCLUSION Using DEX as an adjunct to anesthesia could significantly improve postoperative cognitive dysfunction and the quality of recovery and these improvements were accompanied by decrease in pain, emergence agitation, and opioid consumption by DEX administration. Since pain relief and decreased disability were not associated with prescribing greater amounts of opioid intake in the patients, improving psychological factors, including reducing catastrophic thinking or self-efficacy about pain, could be a more effective strategy to reduce pain and disability, meanwhile reducing opioid prescription in the patients. Our findings showed that DEX administration is safe sedation with anti-inflammatory, analgesic and antiemetic effects and it could help change pain management strategy from opioid-centric towards improved postoperative cognitive dysfunction.
Collapse
Affiliation(s)
- Chunhong Su
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Xiaojun Ren
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Hongpei Wang
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Xiaomei Ding
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Jian Guo
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| |
Collapse
|
18
|
Sanchez M, Barrere V, Treilleux I, Chopin N, Melodelima D. Development of a noninvasive HIFU treatment for breast adenocarcinomas using a toroidal transducer based on preliminary attenuation measurements. ULTRASONICS 2021; 115:106459. [PMID: 33990009 DOI: 10.1016/j.ultras.2021.106459] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 06/12/2023]
Abstract
Breast cancer is the most commonly diagnosed type of cancer among women. For the last fifteen years, treatments that are less invasive than lumpectomy, such as high-intensity focused ultrasound (HIFU) therapy, have been developed, with encouraging results. In this study, a toroidal HIFU transducer was used to create lesions of at least 2 cm in diameter within less than one minute of treatment. The toroidal HIFU transducer created two focal zones that led to large, fast and homogeneous ablations (10.5 cc/min). The experiments were conducted in 30 human samples of normal breast tissues recovered from mastectomies to measure acoustic attenuation (N = 30), and then, HIFU lesions were created (N = 15). Eight HIFU ablations were performed to evaluate the reproducibility of the lesions. HIFU lesions were created in 45 s with a toroidal HIFU transducer working at 2.5 MHz. The longest and shortest axes of the HIFU lesions were 21.7 ± 3.1 mm and 23.5 ± 3.3 mm respectively, corresponding to an average volume of 7.3 ± 1.4 cm3. These HIFU lesions were performed at an average depth of 19.0 ± 1.5 mm, while the integrity of the skin was preserved. The HIFU-treated breast tissues had a higher level of attenuation (0.57 ± 0.11 Np.cm-1.MHz-1) when compared to the untreated tissues (0.21 ± 0.04 Np.cm-1.MHz-1). This study shows the feasibility of a fast and fully noninvasive treatment using a toroidal transducer for breast tumors measuring up to 15 mm in diameter.
Collapse
Affiliation(s)
- M Sanchez
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003 Lyon, France
| | - V Barrere
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003 Lyon, France
| | | | - N Chopin
- Centre Léon Bérard, F-69008 Lyon, France
| | - D Melodelima
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003 Lyon, France.
| |
Collapse
|
19
|
Roknsharifi S, Wattamwar K, Fishman MDC, Ward RC, Ford K, Faintuch S, Joshi S, Dialani V. Image-guided Microinvasive Percutaneous Treatment of Breast Lesions: Where Do We Stand? Radiographics 2021; 41:945-966. [PMID: 34197250 DOI: 10.1148/rg.2021200156] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation. Each modality involves the use of different mechanisms and requires specific considerations for application. To date, only cryoablation and vacuum-assisted excision have received U.S. Food and Drug Administration approval for treatment of fibroadenomas and have been implemented as part of the treatment algorithm by the American Society of Breast Surgeons. Several clinical studies on this topic have been performed on outcomes in patients with breast cancer who were treated with these techniques. The results are promising, with more data for radiofrequency ablation and cryoablation available than for other minimally invasive methods for treatment of early-stage breast cancer. Clinical decisions should be made on a case-by-case basis, according to the availability of the technique. MRI is the most effective imaging modality for postprocedural follow-up, with the pattern of enhancement differentiating residual or recurrent disease from postprocedural changes. ©RSNA, 2021.
Collapse
Affiliation(s)
- Shima Roknsharifi
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Kapil Wattamwar
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Michael D C Fishman
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Robert C Ward
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Kelly Ford
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Salomao Faintuch
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Surekha Joshi
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Vandana Dialani
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| |
Collapse
|
20
|
Hahn M, Preibsch H. [Interventional techniques for the breast]. Radiologe 2021; 61:159-165. [PMID: 33427890 DOI: 10.1007/s00117-020-00800-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interventional methods of the breast serve as percutaneous minimally invasive diagnostic tools in case of suspicious findings in the breast or axilla. Further indications are lesion localization and the minimally invasive therapeutic approach. OBJECTIVES Aim of this paper is to give an overview of the existing methods, their indications and the imaging techniques for guidance. On the basis of the most recent publications, clinical management is described.
Collapse
Affiliation(s)
- M Hahn
- Department für Frauengesundheit, Universitätsklinikum Tübingen, Calwerstr. 7, 72076, Tübingen, Deutschland.
| | - H Preibsch
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| |
Collapse
|
21
|
A Novel High-Intensity Focused Ultrasound-Treated Herpes Simplex Virus 2 Vaccine Induces Long-Term Protective Immunity against Lethal Challenge in Mice. mSphere 2020; 5:5/6/e00859-20. [PMID: 33361122 PMCID: PMC7763547 DOI: 10.1128/msphere.00859-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
High-intensity focused ultrasound (HIFU), a noninvasive ablation therapy that has been widely used clinically in ablation of solid tumors, induces immune sensitization. We therefore in this study investigated whether HIFU treatment could enhance the efficacy of a herpes simplex virus 2 (HSV-2) vaccine. First, we observed that in HSV-2-positive cervical intraepithelial neoplasia (CIN) II patients, HIFU treatment induced significantly higher anti-HSV-2 neutralization response than surgical removal. Next, we tested the efficacy of HIFU-treated, UV-inactivated HSV-2-infected cells as a proof-of-concept vaccine in mice. Our data showed that HIFU-treated formulation significantly enhanced HSV-2 antibody titers and neutralization titers, compared to UV-, microwave (MW)-, or freeze-thaw (FT)-treated formulations. HIFU treatment also promoted the Th1/2 cell-mediated response. A long-term full protection was observed in mice that received the HIFU-treated formulation, and no weight loss was detected. Our findings indicate that the novel application of HIFU in vaccine production may represent a rational way to improve vaccine efficacy.IMPORTANCE High-intensity focused ultrasound (HIFU) is mainly used in tumor ablation and tumor vaccinology study. It has been shown to induce immune sensitization and enhance tumor responsiveness to other therapies. Our study has shown enhanced anti-HSV-2 response in HIFU-treated CIN II patients. Furthermore, in a murine model, we have demonstrated that HIFU-treated HSV-2 vaccine induced long-term protective immunity against lethal challenge. Our findings indicate that the novel application of HIFU in vaccine production may represent a rational way to improve vaccine efficacy.
Collapse
|
22
|
Yu J, Han ZY, Li T, Feng WZ, Yu XL, Luo YC, Wu H, Jiang J, Wang JD, Liang P. Microwave Ablation Versus Nipple Sparing Mastectomy for Breast Cancer ≤5 cm: A Pilot Cohort Study. Front Oncol 2020; 10:546883. [PMID: 33117685 PMCID: PMC7576845 DOI: 10.3389/fonc.2020.546883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives Compared with nipple sparing mastectomy (NSM), microwave ablation (MWA) is one relatively new modality indicated for selected breast cancer with nipple sparing and with little of evidence-based medical research for decision-making. The objective of this study was to compare the effect of ultrasound-guided percutaneous MWA and NSM for breast cancer. Materials and Methods A retrospective cohort study was conducted in a single institution from 2014 to 2020. Women with invasive ductal carcinoma of the breast ≤ 5cm treated by MWA or NSM were enrolled. The primary end point was tumor progression and secondary end points included survival, cosmetic results, and complications. Results 21 patients in the MWA group and 43 in the NSM group were evaluated. The mean tumor size was 2.3 cm (range, 0.3-5.0 cm). Median follow-up was 26.7 months (range, 14.6-62.5 months). The mean age of MWA was 24 years older than that of the NSM group. All the patients achieved technique effectiveness. One local tumor progression and one ipsilateral breast recurrence occurred at 42 and 28 months after MWA, respectively. One ipsilateral breast recurrence and two bone metastasis occurred at 31.2, 34, and 30.5 months after NSM. Two groups had no significant difference in tumor progression (P = 0.16). No participants in both groups developed cancer related death (P > 0.99) and major complications (P > 0.99). However, MWA needed less hospitalization time (P < 0.001) and achieved better cosmetic results (P < 0.001). Conclusions MWA achieved similar short term effect for breast cancer control and better cosmetic satisfaction compared with NSM in selected patients. MWA provides appropriate option for elderly patients who are unfit for surgery.
Collapse
Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ting Li
- Department of Ultrasound, People's Hospital of Sanya, Sanya, China
| | - Wen-Zhe Feng
- Department of Laboratory Medicine, The Fourth Hospital of Baotou City, Baotou, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yan-Chun Luo
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Han Wu
- Department of Ultrasound, Qingdao Municipal Hospital, Qingdao, China
| | - Jian Jiang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jian-Dong Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
23
|
Adams C. HIFU Power Monitoring Using Combined Instantaneous Current and Voltage Measurement. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:239-247. [PMID: 31514135 PMCID: PMC7030945 DOI: 10.1109/tuffc.2019.2941185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
During high-intensity focused ultrasound (HIFU) therapy, it is important that the electrical power delivered to the transducer is monitored to avoid underexposure or overexposure, ensure patient safety, and to protect the transducer itself. Due to ease of measurement, the transducer's potential difference may be as an indicator of power delivery. However, even when a transducer's complex impedance is well characterized at small amplitudes and matching networks are used, voltage-only (VO) monitoring cannot account for the presence of drive waveform distortion, changes to the acoustic path, or damage to the transducer. In this study, combined current and voltage (CCV) is proposed as a magnetic resonance imaging (MRI)-compatible, miniature alternative to bidirectional power couplers, which is compatible with switched amplifiers. For CCV power measurement, current probe data were multiplied by the voltage waveform and integrated in the frequency domain. Transducer efficiency was taken into account to predict acoustic power. The technique was validated with a radiation force balance (RFB). When using a typical HIFU transducer and amplifier, VO predictions and acoustic power had a maximum difference of 20%. However, under the same conditions, CCV only had a maximum difference of 5%. The technique was applied to several lesioning experiments and it was shown that when VO was used as a control between two amplifiers, there was up to a 38% difference in lesion area. This greatly reduced to a maximum of 5% once CCV was used instead. These results demonstrate that CCV can accurately predict real-time electrical power delivery, leading to safer HIFU treatments.
Collapse
Affiliation(s)
- Chris Adams
- Sunnybrook Research Institute, Toronto, Canada
| |
Collapse
|
24
|
Tharkar P, Varanasi R, Wong WSF, Jin CT, Chrzanowski W. Nano-Enhanced Drug Delivery and Therapeutic Ultrasound for Cancer Treatment and Beyond. Front Bioeng Biotechnol 2019; 7:324. [PMID: 31824930 PMCID: PMC6883936 DOI: 10.3389/fbioe.2019.00324] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022] Open
Abstract
While ultrasound is most widely known for its use in diagnostic imaging, the energy carried by ultrasound waves can be utilized to influence cell function and drug delivery. Consequently, our ability to use ultrasound energy at a given intensity unlocks the opportunity to use the ultrasound for therapeutic applications. Indeed, in the last decade ultrasound-based therapies have emerged with promising treatment modalities for several medical conditions. More recently, ultrasound in combination with nanomedicines, i.e., nanoparticles, has been shown to have substantial potential to enhance the efficacy of many treatments including cancer, Alzheimer disease or osteoarthritis. The concept of ultrasound combined with drug delivery is still in its infancy and more research is needed to unfold the mechanisms and interactions of ultrasound with different nanoparticles types and with various cell types. Here we present the state-of-art in ultrasound and ultrasound-assisted drug delivery with a particular focus on cancer treatments. Notably, this review discusses the application of high intensity focus ultrasound for non-invasive tumor ablation and immunomodulatory effects of ultrasound, as well as the efficacy of nanoparticle-enhanced ultrasound therapies for different medical conditions. Furthermore, this review presents safety considerations related to ultrasound technology and gives recommendations in the context of system design and operation.
Collapse
Affiliation(s)
- Priyanka Tharkar
- Faculty of Medicine and Health, Sydney School of Pharmacy, Sydney Nano Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Ramya Varanasi
- Faculty of Medicine and Health, Sydney School of Pharmacy, Sydney Nano Institute, The University of Sydney, Camperdown, NSW, Australia
| | - Wu Shun Felix Wong
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig T Jin
- Faculty of Engineering, School of Electrical and Information Engineering, The University of Sydney, Sydney, NSW, Australia
| | - Wojciech Chrzanowski
- Faculty of Medicine and Health, Sydney School of Pharmacy, Sydney Nano Institute, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
25
|
Vyas V, Lemieux M, Knecht DA, Kolosov OV, Huey BD. Micro-Acoustic-Trap (µAT) for microparticle assembly in 3D. ULTRASONICS SONOCHEMISTRY 2019; 57:193-202. [PMID: 31208614 DOI: 10.1016/j.ultsonch.2019.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/01/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
Acoustic tweezers facilitate the manipulation of objects using sound waves. With the current state of the technology one can only control mobility for a single or few microparticles. This article presents a state of the art system where an Acoustic Lens was used for developing a Micro-Acoustic Trap for microparticle assembly in 3D. The model particles, 2 µm diameter polystyrene beads in suspension, were driven via acoustic pressure to form a monolayer at wavelength-defined distances above the substrate defined by the focal point of an Acoustic Lens The transducer was driven at 89 MHz, mixed with 100 ms pulses at a repetition rate of 2 Hz. Beyond a threshold drive amplitude sufficient to overcome Brownian motion, this led to 2D assembly of the microparticles into close-packed rafts >80 µm across (∼5 wavelengths of the carrier wave and >40 particles across). This methodology was further extended to manipulation of live Dictyostelium discoideum amoebae. This approach therefore offers maneuverability in controlling or assembling micrometer-scale objects using continuous or pulsed focused acoustic radiation pressure.
Collapse
Affiliation(s)
- Varun Vyas
- Materials Science and Engineering Department, University of Connecticut, Storrs, CT 06269, United States.
| | - Michael Lemieux
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT 06269, United States
| | - David A Knecht
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT 06269, United States.
| | - Oleg V Kolosov
- Department of Physics, Lancaster University, Lancaster LA1 4YB, UK.
| | - Bryan D Huey
- Materials Science and Engineering Department, University of Connecticut, Storrs, CT 06269, United States.
| |
Collapse
|
26
|
Zhang S, Zhao S, Fu X. Intensity modulated radiotherapy in combination with endocrinotherapy in the treatment of middle and advanced Prostatic Cancer. Pak J Med Sci 2019; 35:1264-1269. [PMID: 31488990 PMCID: PMC6717450 DOI: 10.12669/pjms.35.5.591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the clinical efficacy of intensity modulated radiation therapy and endocrinotherapy for middle and advanced prostate cancer. Methods: Total 104 elderly patients with middle and advanced prostate cancer who were admitted to our hospital from November 2014 to August 2015 were selected using random number table method. They were divided into intensity-modulated radiotherapy combined with endocrinotherapy group (observation group) and conventional radiotherapy combined with endocrinotherapy group (control group), 52 each. The serum levels of prostate specific antigen (PSA) and free prostate antigen (f PSA) were measured three months after treatment. The short-term efficacy and toxic and side effects of the patients were observed, and the survival rate was recorded through three-year follow up. Results: The clinical effective rate of the observation group was 92.68%, and that of the control group was 70.73%; there was a significant difference between the two groups (P<0.05). The serum PSA and f PSA levels of the two groups were similar before treatment, but there was no significant difference (P>0.05). The serum PSA and f PSA levels after treatment were significantly lower than before treatment. The incidence of adverse reactions in the observation group was lower than that in the control group (P<0.05). The one-year and three-year survival rates of the two groups were significantly different (90.0 vs. 80.0%, 60.0 vs. 43.3%, P>0.05). Conclusion: Intensity modulated radiotherapy combined with endocrinotherapy was safe and well tolerated in the treatment of middle and advanced prostate cancer. It can improve the short-term efficacy and effectively reduce the serum oncological index concentration of patients. It can be promoted in clinics.
Collapse
Affiliation(s)
- Sumei Zhang
- Sumei Zhang, Department of Radiotherapy, Binzhou People's Hospital, Shandong, 256610, China
| | - Shufen Zhao
- Shufen Zhao, Department of Oncology, Binzhou People's Hospital, Shandong, 256610, China
| | - Xinzhen Fu
- Xinzhen Fu, Department of Equipment, Binzhou People's Hospital, Shandong, 256610, China
| |
Collapse
|
27
|
Zhang L, Armstrong T, Li X, Wu HH. A variable flip angle golden-angle-ordered 3D stack-of-radial MRI technique for simultaneous proton resonant frequency shift and T 1 -based thermometry. Magn Reson Med 2019; 82:2062-2076. [PMID: 31257639 DOI: 10.1002/mrm.27883] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To develop and evaluate a variable-flip-angle golden-angle-ordered 3D stack-of-radial MRI technique for simultaneous proton resonance frequency shift (PRF) and T1 -based thermometry in aqueous and adipose tissues, respectively. METHODS The proposed technique acquires multiecho radial k-space data in segments with alternating flip angles to measure 3D temperature maps dynamically on the basis of PRF and T1 . A sliding-window k-space weighted image contrast filter is used to increase temporal resolution. PRF is measured in aqueous tissues and T1 in adipose tissues using fat/water masks. The accuracy for T1 quantification was evaluated in a reference T1 /T2 phantom. In vivo nonheating experiments were conducted in healthy subjects to evaluate the stability of PRF and T1 in the brain, prostate, and breast. The proposed technique was used to monitor high-intensity focused ultrasound (HIFU) ablation in ex vivo porcine fat/muscle tissues and compared to temperature probe readings. RESULTS The proposed technique achieved 3D coverage with 1.1-mm to 1.3-mm in-plane resolution and 2-s to 5-s temporal resolution. During 20 to 30 min of nonheating in vivo scans, the temporal coefficient of variation for T1 was <5% in the brain, prostate, and breast fatty tissues, while the standard deviation of relative PRF temperature change was within 3°C in aqueous tissues. During ex vivo HIFU ablation, the temperatures measured by PRF and T1 were consistent with temperature probe readings, with an absolute mean difference within 2°C. CONCLUSION The proposed technique achieves simultaneous PRF and T1 -based dynamic 3D MR temperature mapping in aqueous and adipose tissues. It may be used to improve MRI-guided thermal procedures.
Collapse
Affiliation(s)
- Le Zhang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Tess Armstrong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Physics in Biology and Medicine Interdepartmental Graduate Program, University of California Los Angeles, Los Angeles, California
| | - Xinzhou Li
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Bioengineering, University of California Los Angeles, Los Angeles, California
| | - Holden H Wu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Physics in Biology and Medicine Interdepartmental Graduate Program, University of California Los Angeles, Los Angeles, California.,Department of Bioengineering, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
28
|
Guo S, Zhuo J, Li G, Gandhi D, Dayan M, Fishman P, Eisenberg H, Melhem ER, Gullapalli RP. Feasibility of ultrashort echo time images using full-wave acoustic and thermal modeling for transcranial MRI-guided focused ultrasound (tcMRgFUS) planning. ACTA ACUST UNITED AC 2019; 64:095008. [DOI: 10.1088/1361-6560/ab12f7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
29
|
Gray MD, Lyon PC, Mannaris C, Folkes LK, Stratford M, Campo L, Chung DYF, Scott S, Anderson M, Goldin R, Carlisle R, Wu F, Middleton MR, Gleeson FV, Coussios CC. Focused Ultrasound Hyperthermia for Targeted Drug Release from Thermosensitive Liposomes: Results from a Phase I Trial. Radiology 2019; 291:232-238. [PMID: 30644817 DOI: 10.1148/radiol.2018181445] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose To demonstrate the feasibility and safety of using focused ultrasound planning models to determine the treatment parameters needed to deliver volumetric mild hyperthermia for targeted drug delivery without real-time thermometry. Materials and Methods This study was part of the Targeted Doxorubicin, or TARDOX, phase I prospective trial of focused ultrasound-mediated, hyperthermia-triggered drug delivery to solid liver tumors ( ClinicalTrials.gov identifier NCT02181075). Ten participants (age range, 49-68 years; average age, 60 years; four women) were treated from March 2015 to March 2017 by using a clinically approved focused ultrasound system to release doxorubicin from lyso-thermosensitive liposomes. Ultrasonic heating of target tumors (treated volume: 11-73 cm3 [mean ± standard deviation, 50 cm3 ± 26]) was monitored in six participants by using a minimally invasive temperature sensor; four participants were treated without real-time thermometry. For all participants, CT images were used with a patient-specific hyperthermia model to define focused ultrasound treatment plans. Feasibility was assessed by comparing model-prescribed focused ultrasound powers to those implemented for treatment. Safety was assessed by evaluating MR images and biopsy specimens for evidence of thermal ablation and monitoring adverse events. Results The mean difference between predicted and implemented treatment powers was -0.1 W ± 17.7 (n = 10). No evidence of focused ultrasound-related adverse effects, including thermal ablation, was found. Conclusion In this 10-participant study, the authors confirmed the feasibility of using focused ultrasound-mediated hyperthermia planning models to define treatment parameters that safely enabled targeted, noninvasive drug delivery to liver tumors while monitored with B-mode guidance and without real-time thermometry. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Dickey and Levi-Polyachenko in this issue.
Collapse
Affiliation(s)
- Michael D Gray
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Paul C Lyon
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Christophoros Mannaris
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Lisa K Folkes
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Michael Stratford
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Leticia Campo
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Daniel Y F Chung
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Shaun Scott
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Mark Anderson
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Robert Goldin
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Robert Carlisle
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Feng Wu
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Mark R Middleton
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Fergus V Gleeson
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| | - Constantin C Coussios
- From the Institute of Biomedical Engineering, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, England (M.D.G., P.C.L., C.M., R.C., C.C.C.); Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England (P.C.L., F.W.); Departments of Radiology (P.C.L., D.Y.F.C., M.A., F.V.G.) and Oncology (M.R.M.), Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England; Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, England (L.K.F., M.S., L.C.); Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation NHS Trust, Oxford, England (S.S.); and Centre for Pathology, Faculty of Medicine, Imperial College London, London, England (R.G.)
| |
Collapse
|
30
|
Adams C, Carpenter TM, Cowell D, Freear S, McLaughlan JR. HIFU Drive System Miniaturization Using Harmonic Reduced Pulsewidth Modulation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:2407-2417. [PMID: 30371363 PMCID: PMC6305628 DOI: 10.1109/tuffc.2018.2878464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/24/2018] [Indexed: 05/30/2023]
Abstract
Switched excitation has the potential to improve on the cost, efficiency, and size of the linear amplifier circuitry currently used in high-intensity focused ultrasound (HIFU) systems. Existing switching schemes are impaired by high harmonic distortion or lack array apodisation capability, so require adjustable supplies and/or large power filters to be useful. A multilevel pulsewidth modulation (PWM) topology could address both of these issues but the switching-speed limitations of transistors mean that there are a limited number of pulses available in each waveform cycle. In this study, harmonic reduction PWM (HRPWM) is proposed as an algorithmic solution to the design of switched waveforms. Its appropriateness for HIFU was assessed by design of a high power five-level unfiltered amplifier and subsequent thermal-only lesioning of ex vivo chicken breast. Three switched waveforms of different electrical powers (16, 26, 35 W) were generated using the HRPWM algorithm. Lesion sizes were measured and compared with those made at the same electrical power using a linear amplifier and bi-level excitation. HRPWM produced symmetric, thermal-only lesions that were the same size as their linear amplifier equivalents ( ). At 16 W, bi-level excitation produced smaller lesions but at higher power levels large transients in the acoustic waveform nucleated undesired cavitation. These results demonstrate that HRPWM can minimize HIFU drive circuity size without the need for filters to remove harmonics or adjustable power supplies to achieve array apodisation.
Collapse
|
31
|
Pediconi F, Marzocca F, Cavallo Marincola B, Napoli A. MRI-guided treatment in the breast. J Magn Reson Imaging 2018; 48:1479-1488. [DOI: 10.1002/jmri.26282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Federica Pediconi
- Department of Radiological; Oncological and Pathological Sciences - University of Rome, “Sapienza,”; Rome Italy
| | - Flaminia Marzocca
- Department of Radiological; Oncological and Pathological Sciences - University of Rome, “Sapienza,”; Rome Italy
| | - Beatrice Cavallo Marincola
- Department of Radiological; Oncological and Pathological Sciences - University of Rome, “Sapienza,”; Rome Italy
| | - Alessandro Napoli
- Department of Radiological; Oncological and Pathological Sciences - University of Rome, “Sapienza,”; Rome Italy
| |
Collapse
|
32
|
Hahn M, Fugunt R, Schoenfisch B, Oberlechner E, Gruber I, Hoopmann U, Roehm C, Helms G, Taran F, Hartkopf A, Warzecha H, Wiesinger B, Brucker S, Boeer B. High intensity focused ultrasound (HIFU) for the treatment of symptomatic breast fibroadenoma. Int J Hyperthermia 2018; 35:463-470. [DOI: 10.1080/02656736.2018.1508757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- M. Hahn
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - R. Fugunt
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - B. Schoenfisch
- Research Institute for Women’s Health, University of Tuebingen, Tuebingen, Germany
| | - E. Oberlechner
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - I.V. Gruber
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - U. Hoopmann
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - C. Roehm
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - G. Helms
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - F.A. Taran
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - A.D. Hartkopf
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| | - H. Warzecha
- Department of Pathology, University Hospital of Tuebingen, Tuebingen, Germany
| | - B. Wiesinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - S.Y. Brucker
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
- Research Institute for Women’s Health, University of Tuebingen, Tuebingen, Germany
| | - B. Boeer
- Department of Women’s Health, University Hospital of Tuebingen, Tuebingen, Germany
| |
Collapse
|
33
|
Short-Term Observation of Ultrasonic Cyclocoagulation in Chinese Patients with End-Stage Refractory Glaucoma: A Retrospective Study. J Ophthalmol 2018; 2018:4950318. [PMID: 30271627 PMCID: PMC6148825 DOI: 10.1155/2018/4950318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/25/2018] [Accepted: 06/10/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess the efficacy and safety of HIFU-based ultrasonic cyclocoagulation in Chinese patients with end-stage refractory glaucoma. Method Patients were recruited consecutively from May 2016 to May 2017 in the Zhongshan Ophthalmic Center. Ultrasonic cyclocoagulation was performed on every patient, using the EyeOP1 ultrasound emitting device. Return visits were set at 1 day, 7 days, 1 month, and 3 months after the treatment. An intraocular pressure (IOP) reduction of ≥20% while IOP ≥ 5 mmHg was deemed as success. Mean IOP change was assessed. Efficacy of two modes (6 sectors and 8 sectors) was also compared. Complications were recorded for safety evaluation. Results 61 eyes were treated in this study. The baseline IOP (mean ± SD) was 41.11 ± 10.65 mmHg. The percentage of IOP reduction after treatment was 29.2%, 43.2%, 34.8%, and 23.1% at 1 day, 7 days, 1 month, and 3 months, respectively. Overall success rate at 3 months was 50.0% (26/52). No significant difference was found between the 6 sectors group and the 8 sectors group in terms of the success rate (48.6% vs. 52.9%, p=0.768) as well as IOP reduction (p=0.417) at 3 months. Primary angle-closure glaucoma (PACG) had the highest success rate (80.0%, 12/15). Scleral thinning existed in 12 eyes, among which 2 developed hypotony (2 mmHg and 3 mmHg). Average pain score decreased massively compared with baseline data. Conclusion With high percentage of IOP reduction and a good safety profile observed in our study, HIFU-based ultrasonic cyclocoagulation might become a promising alternative to cyclodestructive methods. Long-term efficacy and safety need further assessment. The study was registered with Chinese Clinical Trial Registry (http://www.chictr.org.cn; Registration number: ChiCTR-OOC-17014028).
Collapse
|
34
|
Tavolaro S, Kermarrec É, Bazot M, Thomassin-Naggara I, Cornelis FH. Imagerie et radiologie interventionnelle chez la femme : nouveautés et perspectives. IMAGERIE DE LA FEMME 2018. [DOI: 10.1016/j.femme.2018.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
35
|
Peek MCL, Wu F. High-intensity focused ultrasound in the treatment of breast tumours. Ecancermedicalscience 2018; 12:794. [PMID: 29434660 PMCID: PMC5804717 DOI: 10.3332/ecancer.2018.794] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Indexed: 01/16/2023] Open
Abstract
High-intensity focused ultrasound (HIFU) is a minimally invasive technique that has been used for the treatment of both benign and malignant tumours. With HIFU, an ultrasound (US) beam propagates through soft tissue as a high-frequency pressure wave. The US beam is focused at a small target volume, and due to the energy building up at this site, the temperature rises, causing coagulative necrosis and protein denaturation within a few seconds. HIFU is capable of providing a completely non-invasive treatment without causing damage to the directly adjacent tissues. HIFU can be either guided by US or magnetic resonance imaging (MRI). Guided imaging is used to plan the treatment, detect any movement during the treatment and monitor response in real-time. This review describes the history of HIFU, the HIFU technique, available devices and gives an overview of the published literature in the treatment of benign and malignant breast tumours with HIFU.
Collapse
Affiliation(s)
- Mirjam C L Peek
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| | - Feng Wu
- HIFU Unit, The Churchill Hospital, Oxford University Hospitals, Headington, Oxford OX3 7LJ, UK
| |
Collapse
|
36
|
Advances in breast intervention: where are we now and where should we be? Clin Radiol 2017; 73:724-734. [PMID: 29224890 DOI: 10.1016/j.crad.2017.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/31/2017] [Indexed: 11/21/2022]
Abstract
In the past four decades, a variety of methods for minimal or non-invasive diagnosis and treatment of breast cancer have been introduced. Although breast imaging has become more and more specific for diagnosis, specimen biopsy with histopathological confirmation is still necessary. Core-needle biopsy under ultrasound guidance is the appropriate first choice for the diagnosis of most lesions. Fine-needle aspiration is of interest for identification of the presence of metastatic disease in abnormal lymph nodes. For microcalcifications, vacuum-assisted biopsy is recommended, especially with stereotactic guidance. In recent years different therapeutic techniques have been developed for the treatment of solid lesions, including breast cancer. Certainly, with the improvement of technology and medical scientific progress, it is becoming more common to use minimal- or non-invasive therapies. The proposed minimally invasive techniques may offer complete treatment of breast cancer, with better cosmetic results, less psychological stress, and shorter hospital stays. In this article, the strengths and weaknesses of the different diagnostic and therapeutic techniques are presented, and promising techniques for the future are discussed.
Collapse
|
37
|
Peek MCL, Ahmed M, Scudder J, Baker R, Charalampoudis P, Pinder SE, Douek M. High-intensity focused ultrasound in the treatment of breast fibroadenomata (HIFU-F trial). Int J Hyperthermia 2017; 34:1002-1009. [PMID: 28854826 DOI: 10.1080/02656736.2017.1373865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND High-intensity focussed ultrasound (HIFU) is a non-invasive ablative technique utilising the application of high frequency ultrasound (US) pressure waves to cause tissue necrosis. This emerging technology is currently limited by prolonged treatment times. The aim of the HIFU-F trial was to perform circumferential HIFU treatment as a means of shortening treatment times. METHODS A prospective trial was set up to treat 50 consecutive patients ≥18 years of age. Eligible patients possessed symptomatic fibroadenomata, visible on US. Patients ≥25 years of age required histological confirmation of the diagnosis. Primary outcome measures were reduction in treatment time, reduction in volume on US after 12 months and complication rates. RESULTS HIFU treatment was performed in 51 patients (53 treatments) with a mean age of 29.8 years (SD 7.2 years) and a diameter of 2.6 cm (SD 1.4 cm). Circumferential ablation reduced treatment times by an estimated 19.9 min (SD 25.1 min), which is a 29.4% (SD 15.2%) reduction compared with whole lesion ablation. Volume reduction of 43.2% (SD 35.4%; p < 0.005, paired t-test) was observed on US at 12 months post-treatment. Local complications completely resolved at 1 month apart from skin hyper-pigmentation, which persisted in nine cases at three months, six cases at 6 months and six at 12 months. CONCLUSION Circumferential HIFU treatment for breast fibroadenomata is feasible to reduce both lesion size and treatment time. HIFU is a non-invasive alternative technique for the treatment of breast fibroadenomata. ISRCTN registration: 76622747.
Collapse
Affiliation(s)
- M C L Peek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - M Ahmed
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - J Scudder
- b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - R Baker
- c School of Business , University of Salford , Salford , Great Britain
| | - P Charalampoudis
- b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - S E Pinder
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - M Douek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | | |
Collapse
|
38
|
Zhang W, Wang W, Chai W, Luo X, Li J, Shi J, Bi L, Niu L. Breast tissue ablation with irreversible electroporation in rabbits: A safety and feasibility study. PLoS One 2017; 12:e0181555. [PMID: 28732031 PMCID: PMC5521795 DOI: 10.1371/journal.pone.0181555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022] Open
Abstract
Background and aim Irreversible electroporation (IRE) was confirmed to control several solid tumors effectively in vivo. Our preclinical study aimed to assess the feasibility and safety of IRE in the breast of rabbit. Methods Thirty New Zealand white rabbits were randomly divided into 3 groups of 10 rabbits (control group, IRE group A, and B). Two mono-electrode needles were inserted into the breast tissue by percutaneous puncture. Electrocardiogram and vital signs were monitored before, during, and after ablation. Histopathology, immunohistochemistry, and transmission electron microscopy were examined at 0 hours, 12 hours, 24 hours, 4 days, 7 days, 14 days, and 28 days after ablation. Results All the rabbits survived the procedure with no significant adverse effects. Intra-operative ventricular arrhythmias occurred in 1 rabbit from IRE group B and was immediately relieved after ablation. Reversible subcutaneous hemorrhage was observed in 8 rabbits from IRE group A and 7 rabbits from IRE group B. No skin was burnt, however, pectoralis major muscle injuries were found in all rabbits. Histopathological and ultrastructural examination revealed the coexistence of cell necrosis and apoptosis. HE, TUNEL, and Masson staining revealed breast tissue injury and the recovery of damage by fibrous tissue and granulation tissue. Notably, the structures of mammary gland lobules and interstitial components of the breasts were well preserved. Conclusions Our study suggests that IRE destroys breast cancer while effectively preserving the skin, the structure of mammary gland lobules, and interstitial components. IRE may be a promising technique to locally control breast cancer and to maintain the esthetic of the breast.
Collapse
Affiliation(s)
- Wenlong Zhang
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wanning Wang
- Department of Nephrology, First Hospital of Jilin University, Changchun, China
| | - Wei Chai
- Department of Gynecology and Obstetrics, The First Hospital of Jilin University, Changchun, China
| | - Xiaomei Luo
- School of Medicine, Jinan University, Guangdong Province, Guangzhou, China
| | - Jiannan Li
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Jian Shi
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Liqi Bi
- Department of Rheumatology and Immunology, China-Japan Union Hospital of Jilin University, Changchun, China
- * E-mail: (LB); (LN)
| | - Lizhi Niu
- Fuda Cancer Hospital, Jinan University School of Medicine (Guangzhou Fuda Cancer Hospital), Guangzhou, China
- * E-mail: (LB); (LN)
| |
Collapse
|
39
|
Yu J, Chen BH, Zhang J, Han ZY, Wu H, Huang Y, Mu MJ, Liang P. Ultrasound guided percutaneous microwave ablation of benign breast lesions. Oncotarget 2017; 8:79376-79386. [PMID: 29108316 PMCID: PMC5668049 DOI: 10.18632/oncotarget.18123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/12/2017] [Indexed: 01/02/2023] Open
Abstract
The benign breast lesions (BBLs) share a high incidence for women and therapy methods with minimal invasion and better cosmetic outcome are thirsted for. In this study, 122 patients with 198 biopsy-proved BBLs were enrolled. Ultrasound (US)-guided microwave ablation (MWA) was performed with local anesthesia from November, 2013 to April, 2016. The mean longest tumor size assessed was 1.6±0.7 cm (ranging 0.7-4.9 cm). MWA was successfully performed in all cases including 85 lesions adjacent to the skin, pectoralis and areola. The mean ablation time was 3.2mins (ranging 0.5-18.3 mins). 99.5% of BBLs showed complete ablation when assessed by magnetic resonance imaging and 100% of them by US. At the median 14-month follow-up, the BBLs were not palpable in 45.9 % of the cases (palpable in 90.2 % of the cases before MWA) and the mean volume reduction ratio was 78.4±33.5% for total lesions and 89.3±20.8%, 84.7±27.6% and 55.9±32.9% for ≤1.0 cm, 1.1-2.0cm and >2.0 cm lesions in 12-month follow-up, respectively. Cosmesis were reported as good or excellent in 100 % by physician and patients. No side effect was found. The MWA of the BBLs proved feasible and effective, while showing meaningful reduction in volume, palpability and cosmetic satisfying outcomes.
Collapse
Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Bao-Hua Chen
- Department of General Surgery, The People's Liberation Army One Eight Four Hospital, Yingtan, China
| | - Jing Zhang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Han Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yan Huang
- Department of General Surgery, The People's Liberation Army One Eight Four Hospital, Yingtan, China
| | - Meng-Juan Mu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
40
|
|
41
|
Silvestrini MT, Ingham ES, Mahakian LM, Kheirolomoom A, Liu Y, Fite BZ, Tam SM, Tucci ST, Watson KD, Wong AW, Monjazeb AM, Hubbard NE, Murphy WJ, Borowsky AD, Ferrara KW. Priming is key to effective incorporation of image-guided thermal ablation into immunotherapy protocols. JCI Insight 2017; 2:e90521. [PMID: 28352658 DOI: 10.1172/jci.insight.90521] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Focal therapies play an important role in the treatment of cancers where palliation is desired, local control is needed, or surgical resection is not feasible. Pairing immunotherapy with such focal treatments is particularly attractive; however, there is emerging evidence that focal therapy can have a positive or negative impact on the efficacy of immunotherapy. Thermal ablation is an appealing modality to pair with such protocols, as tumors can be rapidly debulked (cell death occurring within minutes to hours), tumor antigens can be released locally, and treatment can be conducted and repeated without the concerns of radiation-based therapies. In a syngeneic model of epithelial cancer, we found that 7 days of immunotherapy (TLR9 agonist and checkpoint blockade), prior to thermal ablation, reduced macrophages and myeloid-derived suppressor cells and enhanced IFN-γ-producing CD8+ T cells, the M1 macrophage fraction, and PD-L1 expression on CD45+ cells. Continued treatment with immunotherapy alone or with immunotherapy combined with ablation (primed ablation) then resulted in a complete response in 80% of treated mice at day 90, and primed ablation expanded CD8+ T cells as compared with all control groups. When the tumor burden was increased by implantation of 3 orthotopic tumors, successive primed ablation of 2 discrete lesions resulted in survival of 60% of treated mice as compared with 25% of mice treated with immunotherapy alone. Alternatively, when immunotherapy was begun immediately after thermal ablation, the abscopal effect was diminished and none of the mice within the cohort exhibited a complete response. In summary, we found that immunotherapy begun before ablation can be curative and can enhance efficacy in the presence of a high tumor burden. Two mechanisms have potential to impact the efficacy of immunotherapy when begun immediately after thermal ablation: mechanical changes in the tumor microenvironment and inflammatory-mediated changes in immune phenotype.
Collapse
Affiliation(s)
| | | | | | | | - Yu Liu
- Department of Biomedical Engineering
| | | | | | | | | | | | | | | | - William J Murphy
- Department of Dermatology, Institute for Regenerative Cures, University of California, Davis, California, USA
| | | | | |
Collapse
|
42
|
Han Y, Wang S, Payen T, Konofagou E. Fast lesion mapping during HIFU treatment using harmonic motion imaging guided focused ultrasound (HMIgFUS) in vitro and in vivo. Phys Med Biol 2017; 62:3111-3123. [PMID: 28323638 DOI: 10.1088/1361-6560/aa6024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The successful clinical application of high intensity focused ultrasound (HIFU) ablation depends on reliable monitoring of the lesion formation. Harmonic motion imaging guided focused ultrasound (HMIgFUS) is an ultrasound-based elasticity imaging technique, which monitors HIFU ablation based on the stiffness change of the tissue instead of the echo intensity change in conventional B-mode monitoring, rendering it potentially more sensitive to lesion development. Our group has shown that predicting the lesion location based on the radiation force-excited region is feasible during HMIgFUS. In this study, the feasibility of a fast lesion mapping method is explored to directly monitor the lesion map during HIFU. The harmonic motion imaging (HMI) lesion map was generated by subtracting the reference HMI image from the present HMI peak-to-peak displacement map, as streamed on the computer display. The dimensions of the HMIgFUS lesions were compared against gross pathology. Excellent agreement was found between the lesion depth (r 2 = 0.81, slope = 0.90), width (r 2 = 0.85, slope = 1.12) and area (r 2 = 0.58, slope = 0.75). In vivo feasibility was assessed in a mouse with a pancreatic tumor. These findings demonstrate that HMIgFUS can successfully map thermal lesions and monitor lesion development in real time in vitro and in vivo. The HMIgFUS technique may therefore constitute a novel clinical tool for HIFU treatment monitoring.
Collapse
Affiliation(s)
- Yang Han
- Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | | | | | | |
Collapse
|
43
|
Knuttel FM, van den Bosch MAAJ, Young-Afat DA, Emaus MJ, van den Bongard DHJG, Witkamp AJ, Verkooijen HM. Patient Preferences for Minimally Invasive and Open Locoregional Treatment for Early-Stage Breast Cancer. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:474-480. [PMID: 28292493 DOI: 10.1016/j.jval.2016.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/20/2016] [Accepted: 10/23/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Noninvasive or minimally invasive treatments are being developed as alternatives to surgery for patients with early-stage breast cancer. Patients' preferences with regard to these new treatments have not been investigated. OBJECTIVES To assess preferences of patients with breast cancer and of healthy women regarding these new techniques, compared with conventional surgical treatments. METHODS Six hypothetical breast cancer treatment-outcome scenarios were developed: three standard surgical scenarios (mastectomy, mastectomy with immediate implant-based reconstruction, and breast-conserving therapy [BCT]) and three minimally invasive or noninvasive scenarios (radiofrequency ablation, magnetic resonance-guided high-intensity focused ultrasound ablation, and single-dose ablative radiotherapy). Participants rated treatment-outcome scenarios by visual analogue scale (VAS) and time trade-off (TTO). The Friedman and post hoc Wilcoxon signed-rank tests were used to test whether scores were significantly different from BCT. RESULTS Seventy-one patients with breast cancer and 50 healthy volunteers participated. Overall, BCT was rated the highest in terms of VAS (0.80) and TTO (0.90) scores. After stratification, BCT ranked the highest in most subgroups, with the exception of healthy individuals, who had given the highest score to ablative boost (VAS, 0.80; TTO, 0.88). Mastectomy with immediate reconstruction was the least preferred in most subgroups. CONCLUSIONS This study showed no significant preference for minimally invasive treatment for breast cancer. Using hypothetical scenarios, breast cancer survivors attributed the highest scores to BCT, whereas healthy volunteers showed a slight preference for minimally invasive treatments.
Collapse
Affiliation(s)
- Floortje M Knuttel
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Danny A Young-Afat
- Department of Clinical Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marleen J Emaus
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
44
|
|
45
|
|
46
|
Peek MCL, Ahmed M, Scudder J, Baker R, Pinder SE, Douek M. High intensity focused ultrasound in the treatment of breast fibroadenomata: results of the HIFU-F trial. Int J Hyperthermia 2016; 32:881-888. [DOI: 10.1080/02656736.2016.1212278] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- M. C. L. Peek
- Division of Cancer Studies, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Ahmed
- Division of Cancer Studies, King’s College London, London, UK
| | - J. Scudder
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - R. Baker
- School of Business, University of Salford, Salford, UK
| | - S. E. Pinder
- Division of Cancer Studies, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - M. Douek
- Division of Cancer Studies, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | |
Collapse
|
47
|
Borman PTS, Bos C, de Boorder T, Raaymakers BW, Moonen CTW, Crijns SPM. Towards real-time thermometry using simultaneous multislice MRI. Phys Med Biol 2016; 61:N461-77. [DOI: 10.1088/0031-9155/61/17/n461] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
48
|
Tyson MD, Penson DF, Resnick MJ. The comparative oncologic effectiveness of available management strategies for clinically localized prostate cancer. Urol Oncol 2016; 35:51-58. [PMID: 27133953 DOI: 10.1016/j.urolonc.2016.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 11/19/2022]
Abstract
The primary goal of modern prostate cancer treatment paradigms is to optimize the balance of predicted benefits associated with prostate cancer treatment against the predicted harms of therapy. However, given the limitations in the existing evidence as well as the significant tradeoffs posed by each treatment, there remain myriad challenges associated with individualized prostate cancer treatment decision-making. In this review, we summarize the existing comparative effectiveness evidence of treatments for localized prostate cancer with an emphasis on oncologic control. While we focus on the major treatment categories of radical prostatectomy, radiation therapy, and observation, we also provide a review of emerging therapies such as cryotherapy and high-intensity frequency ultrasound (HIFU).
Collapse
Affiliation(s)
- Mark D Tyson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Geriatric, Research, and Educational Center, Veterans Affairs Tennessee Valley Health Care System, Nashville, TN
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Geriatric, Research, and Educational Center, Veterans Affairs Tennessee Valley Health Care System, Nashville, TN
| |
Collapse
|
49
|
Yao Y, Yang K, Cao Y, Zhou X, Xu J, Liu J, Wang Q, Wang Z, Wang D. Comparison of the synergistic effect of lipid nanobubbles and SonoVue microbubbles for high intensity focused ultrasound thermal ablation of tumors. PeerJ 2016; 4:e1716. [PMID: 26925336 PMCID: PMC4768712 DOI: 10.7717/peerj.1716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/30/2016] [Indexed: 01/20/2023] Open
Abstract
Microbubbles (MBs) are considered as an important enhancer for high intensity focused ultrasound (HIFU) treatment of benign or malignant tumors. Recently, different sizes of gas-filled bubbles have been investigated to improve the therapeutic efficiency of HIFU thermal ablation and reduce side effects associated with ultrasound power and irradiation time. However, nanobubbles (NBs) as an ultrasound contrast agent for synergistic therapy of HIFU thermal ablation remain controversial due to their small nano-size in diameter. In this study, phospholipid-shell and gas-core NBs with a narrow size range of 500–600 nm were developed. The synergistic effect of NBs for HIFU thermal ablation was carefully studied both in excised bovine livers and in breast tumor models of rabbits, and made a critical comparison with that of commercial SonoVue microbubbles (SonoVue MBs). In addition, the pathological changes of the targeted area in tumor tissue after HIFU ablation were further investigated. Phosphate buffer saline (PBS) was used as the control. Under the same HIFU parameters, the quantitative echo intensity of B-mode ultrasound image and the volume of coagulative necrosis in lipid NBs groups were significantly higher and larger than that in PBS groups, but could not be demonstrated a difference to that in SonoVue MBs groups both ex vivo and in vivo. These results showed that the synergistic effect of lipid NBs for HIFU thermal ablation were similar with that of SonoVue MBs, and further indicate that lipid NBs could potentially become an enhancer for HIFU thermal ablation of tumors.
Collapse
Affiliation(s)
- Yuanzhi Yao
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Ke Yang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Yang Cao
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Xuan Zhou
- Department of Emergency, Chinese PLA General Hospital , Beijing , China
| | - Jinshun Xu
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Jianxin Liu
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Qi Wang
- Institute of Ultrasound Engineering in Medical of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Zhigang Wang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University , Chongqing , China
| | - Dong Wang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China; Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| |
Collapse
|
50
|
Hsiao YH, Kuo SJ, Tsai HD, Chou MC, Yeh GP. Clinical Application of High-intensity Focused Ultrasound in Cancer Therapy. J Cancer 2016; 7:225-31. [PMID: 26918034 PMCID: PMC4747875 DOI: 10.7150/jca.13906] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/03/2015] [Indexed: 12/25/2022] Open
Abstract
The treatment of cancer is an important issue in both developing and developed countries. Clinical use of ultrasound in cancer is not only for the diagnosis but also for the treatment. Focused ultrasound surgery (FUS) is a noninvasive technique. By using the combination of high-intensity focused ultrasound (HIFU) and imaging method, FUS has the potential to ablate tumor lesions precisely. The main mechanisms of HIFU ablation involve mechanical and thermal effects. Recent advances in HIFU have increased its popularity. Some promising results were achieved in managing various malignancies, including pancreas, prostate, liver, kidney, breast and bone. Other applications include brain tumor ablation and disruption of the blood-brain barrier. We aim at briefly outlining the clinical utility of FUS as a noninvasive technique for a variety of types of cancer treatment.
Collapse
Affiliation(s)
- Yi-Hsuan Hsiao
- 1. School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 2. Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Jen Kuo
- 3. Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Horng-Der Tsai
- 2. Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Chih Chou
- 1. School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Guang-Perng Yeh
- 1. School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 2. Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| |
Collapse
|