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Tang MJ, Ma XL, He XL, Pan WH, Zhang XH, Jiang SY, Gao J, Li F, Yao W, Gu S, Zhang WL, Zhao Q, Huang SH, Fang YJ, Liu W, Niu HZ, Wang CM, Sun LR, Gao H, Dai YP, Huang SG, Zhong ZY, Wang XG, Li ZR, Yang LC, Wu YM, Wang HM, Sun X, Yuan XJ. A multicenter prospective study on the management of hepatoblastoma in children: a report from the Chinese Children's Cancer Group. World J Pediatr 2024; 20:590-601. [PMID: 37770810 PMCID: PMC11239770 DOI: 10.1007/s12519-023-00750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND This study aimed to identify survival risk factors in Chinese children with hepatoblastoma (HB) and assess the effectiveness of the new treatment protocol proposed by the Chinese Children's Cancer Group (CCCG) in 2016. METHODS A multicenter, prospective study that included 399 patients with HB from January 2015 to June 2020 was conducted. Patient demographics, treatment protocols, and other related information were collected. Cox regression models and Kaplan-Meier curve methods were used. RESULTS The 4-year event-free survival (EFS) and overall survival (OS) were 76.9 and 93.5%, respectively. The 4-year EFS rates for the very-low-risk, low-risk, intermediate-risk, and high-risk groups were 100%, 91.6%, 81.7%, and 51.0%, respectively. The 4-year OS was 100%, 97.3%, 94.4%, and 86.8%, respectively. Cox regression analysis found that age, tumor rupture (R +), and extrahepatic tumor extension (E +) were independent prognostic factors. A total of 299 patients had complete remission, and 19 relapsed. Patients with declining alpha-fetoprotein (AFP) > 75% after the first two cycles of neoadjuvant chemotherapy had a better EFS and OS than those ≤ 75%. CONCLUSIONS The survival outcome of HB children has dramatically improved since the implementation of CCCG-HB-2016 therapy. Age ≥ 8 years, R + , and E + were independent risk factors for prognosis. Patients with a declining AFP > 75% after the first two cycles of neoadjuvant chemotherapy had better EFS and OS.
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Affiliation(s)
- Meng-Jie Tang
- Department of Pediatric Hematology/Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Xiao-Li Ma
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiang-Ling He
- Department of Hematology/Oncology, Children's Medical Center, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 41005, China
| | - Wei-Hua Pan
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xiao-Hong Zhang
- Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, National Children's Medical Center for South Central Region, Guangzhou, 510623, China
| | - Sha-Yi Jiang
- Department of Hematology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Ju Gao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Fu Li
- Department of Hematology/Oncology, Qilu Children's Hospital of Shandong University, Jinan, 250022, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Song Gu
- Department of General Surgery, Shanghai Children's Medical Center (National Children's Medical Center-Shanghai), Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Wei-Ling Zhang
- Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Qiang Zhao
- Department of Pediatric Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Shi-Hao Huang
- Department of Pediatric Hematology/Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Yong-Jun Fang
- Department of Hematology/Oncology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Wei Liu
- Department of Hematology/Oncology, Henan Children's Hospital, Zhengzhou, 450018, China
| | - Hui-Zhong Niu
- Department of Pediatric General Surgery, Hebei Children's Hospital of Hebei Medical University, Shijiazhuang City, 050031, China
| | - Chun-Mei Wang
- Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Li-Rong Sun
- Department of Paediatric Hematology/Oncology, the Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Hui Gao
- Department of Paediatric Hematology/Oncology, Dalian Women and Children's Medical Group, Dalian, 116037, China
| | - Yun-Peng Dai
- Department of Pediatric Hematology/Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Shun-Gen Huang
- Department of General Surgery, Children's Hospital of Soochow University, Suzhou, 215028, China
| | - Zhi-Yong Zhong
- Department of Pediatric Surgery, the Second Hospital of HeBei Medical University, Shijiazhuang, 050000, China
| | - Xi-Ge Wang
- Department of Paediatric Hematology/Oncology, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Zhong-Rong Li
- Department of Pediatric Surgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Liang-Chun Yang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, 410008, China
| | - Ye-Ming Wu
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Huan-Min Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Xin Sun
- Clinical Research and Innovation Unit, XinHua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Xiao-Jun Yuan
- Department of Pediatric Hematology/Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China.
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Zhou H, Li F, Luo L, Xiong X, Zhou K, Zhu H, Zhang J, Li P. Safety of Sonazoid in Assisting High-Intensity Focused Ultrasound Ablation Therapy for Advanced Liver Malignant Lesions: A Single-Arm Clinical Study. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:134-141. [PMID: 37865612 DOI: 10.1016/j.ultrasmedbio.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE The aim of the study described here was to evaluate the safety of Sonazoid-assisted high-intensity focused ultrasound (HIFU) in the treatment of advanced malignant liver lesions. METHODS A single-arm study was designed to enroll participants who were diagnosed with advanced primary liver cancer or liver metastases and proposed to receive Sonazoid assistance during HIFU treatment. Serological examination was conducted within 1 wk, and side effects in each patient were monitored for 1 mo. To evaluate therapeutic efficacy, the contrast-enhanced magnetic resonance imaging was performed 1 mo after treatment, and short-term follow-up was conducted a year later. RESULTS A total of 17 participants (12 male, 5 female) with an average age of 58 y (range: 46-73 y) were enrolled, including 11 patients with hepatocellular carcinoma, 2 patients with hepatic metastasis and 4 patients with cholangiocarcinoma. The total volume of tumor mass was 111.82 (11.01-272.30) cm3. The average total ablation time for a patient was 2021 ± 1030 s, and the energy efficiency factor was 5979.7 (3108.0, 45634.5) J/cm3. Immediately after HIFU treatment, 1 patient (5.9%) achieved complete response (CR), 4 patients (23.5%) had a moderate response, 8 patients (47.1%) had partial reperfusion and 4 patients (23.5%) had stable disease (SD). The average ablation rate for all the tumors was 51.5 ± 26.7%. The level of glutamic-pyruvic transaminase (ALT) was mildly increased in 71.6% (12/17) of patients after HIFU therapy. Mean ALT values before and after treatment were 22 (14, 35) U/L and 36 (25, 41) U/L, respectively (Z = 1.947, p = 0.051). Mild or obvious edema in skin and subcutaneous soft tissues were observed in 76.5% of patients, but no serious side effects were found. Twelve months after treatment, the follow-up results revealed that 1 patient (5.8%) achieved a CR, 8 patients (47.1%) had SD and 8 patients (47.1%) had progressive disease. The estimated median time to progression was 11 mo after treatment, with a 95% confidence interval of 6, 11 for all involved patients. CONCLUSION Use of Sonazoid is safe and feasible for improving HIFU ablation efficiency during the treatment of advanced malignant liver lesions. The therapeutic efficacy of Sonazoid-assisted HIFU needs to be explored in additional controlled clinical investigations.
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Affiliation(s)
- Hang Zhou
- Department of Ultrasound & Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Ultrasound, Chongqing University Cancer Hospital, Chongqing, China
| | - Fang Li
- Department of Ultrasound, Chongqing University Cancer Hospital, Chongqing, China
| | - Li Luo
- Department of Ultrasound, Chongqing University Cancer Hospital, Chongqing, China
| | - Xialin Xiong
- Department of Ultrasound & Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Zhou
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hui Zhu
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jun Zhang
- Clinical Center for Tumor Therapy, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Pan Li
- Department of Ultrasound & Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Wang D, Rao W. Bench-to-bedside development of multifunctional flexible embolic agents. Theranostics 2023; 13:2114-2139. [PMID: 37153738 PMCID: PMC10157739 DOI: 10.7150/thno.80213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/22/2022] [Indexed: 05/10/2023] Open
Abstract
Transarterial chemoembolization (TACE) has been demonstrated to provide a survival benefit for patients with unresectable hepatocellular carcinoma (HCC). However, conventional TACE still faces limitations associated with complications, side effects, unsatisfactory tumor responses, repeated treatment, and narrow indications. For further improvement of TACE, additional beneficial functions such as degradability, drug-loading and releasing properties, detectability, targetability, and multiple therapeutic modalities were introduced. The purpose here is to provide a comprehensive overview of current and emerging particulate embolization technology with respect to materials. Therefore, this review systematically identified and described typical features, various functions, and practical applications of recently emerging micro/nano materials as particulate embolic agents for TACE. Besides, new insights into the liquid metals-based multifunctional and flexible embolic agents were highlighted. The current development routes and future outlooks of these micro/nano embolic materials were also presented to promote advancement in the field.
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Affiliation(s)
- Dawei Wang
- Key Lab of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- Beijing Key Lab of CryoBiomedical Engineering, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- ✉ Corresponding author: Dr. Dawei Wang. ; Pro. Wei Rao.
| | - Wei Rao
- Key Lab of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- Beijing Key Lab of CryoBiomedical Engineering, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- ✉ Corresponding author: Dr. Dawei Wang. ; Pro. Wei Rao.
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Díaz-Alejo JF, González Gómez I, Earl J. Ultrasounds in cancer therapy: A summary of their use and unexplored potential. Oncol Rev 2022; 16:531. [PMID: 35340884 PMCID: PMC8941342 DOI: 10.4081/oncol.2022.531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Abstract
Ultrasounds (US) are a non-ionizing mechanical wave, with less adverse effects than conventional pharmacological or surgical treatments. Different biological effects are induced in tissues and cells by ultrasound actuation depending on acoustic parameters, such as the wave intensity, frequency and treatment dose. This non-ionizing radiation has considerable applications in biomedicine including surgery, medical imaging, physical therapy and cancer therapy. Depending on the wave intensity, US are applied as high-intensity ultrasounds (HIUS) and low-intensity pulsed ultrasounds (LIPUS), with different effects on cells and tissues. HIUS produce thermal and mechanical effects, resulting in a large localized temperature increase, leading to tissue ablation and even tumor necrosis. This can be achieved by focusing low intensity waves emitted from different electrically shifted transducers, known as high-intensity focused ultrasounds (HIFU). LIPUS have been used extensively as a therapeutic, surgical and diagnostic tool, with diverse biological effects observed in tissues and cultured cells. US represent a non-invasive treatment strategy that can be applied to selected areas of the body, with limited adverse effects. In fact, tumor ablation using HIFU has been used as a curative treatment in patients with an early-stage pancreatic tumor and is an effective palliative treatment in patients with advanced stage disease. However, the biological effects, dose standardization, benefit-risk ratio and safety are not fully understood. Thus, it is an emerging field that requires further research in order to reach its full potential.
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Affiliation(s)
- Jesús Frutos Díaz-Alejo
- Molecular Epidemiology and Predictive Tumor Markers Group, Ramón y Cajal Health Research Institute (IRYCIS), Madrid
- Faculty of Medicine and Health Sciences, University of Alcalá de Henares (UAH), Madrid
| | | | - Julie Earl
- Molecular Epidemiology and Predictive Tumor Markers Group, Ramón y Cajal Health Research Institute (IRYCIS), Madrid
- Biomedical Research Network in Cancer (CIBERONC), Madrid, Spain
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Hesh CA, Gill AE, Soler Rodriguez D, Clifton MS, Mitchell S, Hawkins CM. Percutaneous image-guided microwave ablation as primary therapy for PRETEXT II hepatoblastoma. Pediatr Blood Cancer 2020; 67:e28641. [PMID: 32776446 DOI: 10.1002/pbc.28641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher A Hesh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Anne E Gill
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Division of Vascular and Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Dellys Soler Rodriguez
- Division of Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Matthew S Clifton
- Division of Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Sarah Mitchell
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.,Division of Vascular and Interventional Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia
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Angelico R, Grimaldi C, Gazia C, Saffioti MC, Manzia TM, Castellano A, Spada M. How Do Synchronous Lung Metastases Influence the Surgical Management of Children with Hepatoblastoma? An Update and Systematic Review of the Literature. Cancers (Basel) 2019; 11:E1693. [PMID: 31683629 PMCID: PMC6895839 DOI: 10.3390/cancers11111693] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022] Open
Abstract
Approximately 20% of children with hepatoblastoma (HB) have metastatic disease at diagnosis, most frequently in the lungs. In children with HB, lung metastatic disease is associated with poorer prognosis. Its treatment has been approached with a variety of methods that integrate chemotherapy and surgical resection. The timing and feasibility of complete extirpation of lung metastases, by chemotherapy and/or metastasectomy, is crucial for the surgical treatment of the primary liver tumor, which can vary from major hepatic resections to liver transplantation (LT). In children with unresectable HB, which can be surgically treated only by LT, the persistence of unresectable metastases after neoadjuvant chemotherapy excludes the possibility of recurring to LT with consequent negative impact on patients' outcomes. Due to limited evidence and experience, there is no consensus amongst oncologists and surgeons across institutions regarding the surgical treatment for HB with synchronous metastatic lung disease. This narrative review aimed to update the current management of pulmonary metastasis in children with HB and to define its role in the decision-making strategy for the surgical approach to primary liver tumours.
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Affiliation(s)
- Roberta Angelico
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Chiara Grimaldi
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Carlo Gazia
- Department of Surgery Science, HPB and Transplantation Unit, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Maria Cristina Saffioti
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Tommaso Maria Manzia
- Department of Surgery Science, HPB and Transplantation Unit, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Aurora Castellano
- Division of Oncohematology, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
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Song TL, Chen H, Wang FR, Li YM. Combined treatment for solid pseudopapillary tumor of the pancreas with liver metastasis. Hepatobiliary Pancreat Dis Int 2019; 18:495-497. [PMID: 30987898 DOI: 10.1016/j.hbpd.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/29/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Tian-Liang Song
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730000, China
| | - Hao Chen
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730000, China
| | - Fu-Rong Wang
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou 730000, China
| | - Yu-Min Li
- Key Laboratory of Digestive System Tumors of Gansu Province, Lanzhou 730000, China; Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China.
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Di Candio G, Porcelli F, Campatelli A, Guadagni S, Vistoli F, Morelli L. High-Intensity Focused Ultrasonography and Radiofrequency Ablation of Renal Cell Carcinoma Arisen in Transplanted Kidneys: Single-Center Experience With Long-Term Follow-Up and Review of Literature. JOURNAL OF ULTRASOUND IN MEDICINE 2019; 38:2507-2513. [PMID: 30690771 DOI: 10.1002/jum.14938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/06/2018] [Accepted: 12/19/2018] [Indexed: 02/05/2023]
Abstract
The purpose of this article is to retrospectively evaluate the long-term outcome of patients treated with percutaneous thermoablation for renal cell carcinomas that have arisen in kidney grafts. Between April 2008 and February 2011, we treated 3 patients with renal cell carcinoma on a transplanted kidney: 2 cases were treated with high-intensity focused ultrasonography and 1 patient with radio frequency ablation. Postprocedural ultrasonography did not reveal any complications, and contrast-enhanced ultrasonography showed an avascular area in the treated nodules. None of the patients had recurrent tumors during a long-term clinical and radiologic follow-up (81, 73, and 43 months, respectively).
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Affiliation(s)
| | | | - Alessandro Campatelli
- Diagnostic and Interventional Ultrasound in Transplants Unit, University of Pisa, Pisa, Italy
| | | | - Fabio Vistoli
- General and Transplantation Surgery Unit, Pisa, Italy
| | - Luca Morelli
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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9
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Mauri G, Nicosia L, Xu Z, Di Pietro S, Monfardini L, Bonomo G, Varano GM, Prada F, Della Vigna P, Orsi F. Focused ultrasound: tumour ablation and its potential to enhance immunological therapy to cancer. Br J Radiol 2018; 91:20170641. [PMID: 29168922 PMCID: PMC5965486 DOI: 10.1259/bjr.20170641] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/16/2017] [Accepted: 11/16/2017] [Indexed: 12/27/2022] Open
Abstract
Various kinds of image-guided techniques have been successfully applied in the last years for the treatment of tumours, as alternative to surgical resection. High intensity focused ultrasound (HIFU) is a novel, totally non-invasive, image-guided technique that allows for achieving tissue destruction with the application of focused ultrasound at high intensity. This technique has been successfully applied for the treatment of a large variety of diseases, including oncological and non-oncological diseases. One of the most fascinating aspects of image-guided ablations, and particularly of HIFU, is the reported possibility of determining a sort of stimulation of the immune system, with an unexpected "systemic" response to treatments designed to be "local". In the present article the mechanisms of action of HIFU are described, and the main clinical applications of this technique are reported, with a particular focus on the immune-stimulation process that might originate from tumour ablations.
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Affiliation(s)
- Giovanni Mauri
- Deparmtent of interventional radiology, European istitute of oncology, Milan, Italy
| | - Luca Nicosia
- Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Salvatore Di Pietro
- Postgraduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Monfardini
- Department of Radiology and diagnotic imaging, Poliambulazna di Brescia, Brescia, Italy
| | - Guido Bonomo
- Deparmtent of interventional radiology, European istitute of oncology, Milan, Italy
| | | | | | - Paolo Della Vigna
- Deparmtent of interventional radiology, European istitute of oncology, Milan, Italy
| | - Franco Orsi
- Deparmtent of interventional radiology, European istitute of oncology, Milan, Italy
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Abstract
Although rare, hepatoblastoma is the most common pediatric liver tumor. Complete resection is a critical component for cure; however, most patients will have tumors that are not resected at diagnosis. For these patients, administration of neoadjuvant chemotherapy renders tumors resectable in most patients. For patients whose tumors remain unresectable after chemotherapy, liver transplantation is indicated (in the absence of active unresectable metastatic disease). In patients whose tumors remain unresectable after conventional chemotherapy, interventional techniques may serve as a promising option to reduce tumor size, decrease systemic toxicity, decrease need for liver transplantation, and increase feasibility of tumor resection.
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Affiliation(s)
- Angela D Trobaugh-Lotrario
- Department of Pediatric Hematology and Oncology, Providence Sacred Heart Children's Hospital, Spokane, WA
| | - Rebecka L Meyers
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | | | - James H Feusner
- Children's Hospital & Research Center Oakland, Oakland, CA, USA
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