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Hay AN, Ruger L, Hsueh A, Vickers E, Klahn S, Vlaisavljevich E, Tuohy J. A review of the development of histotripsy for extremity tumor ablation with a canine comparative oncology model to inform human treatments. Int J Hyperthermia 2023; 40:2274802. [PMID: 37994796 PMCID: PMC10669778 DOI: 10.1080/02656736.2023.2274802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/19/2023] [Indexed: 11/24/2023] Open
Abstract
Cancer is a devasting disease resulting in millions of deaths worldwide in both humans and companion animals, including dogs. Treatment of cancer is complex and challenging and therefore often multifaceted, as in the case of osteosarcoma (OS) and soft tissue sarcoma (STS). OS predominantly involves the appendicular skeleton and STS commonly develops in the extremities, resulting in treatment challenges due to the need to balance wide-margin resections to achieve local oncological control against the functional outcomes for the patient. To achieve wide tumor resection, invasive limb salvage surgery is often required, and the patient is at risk for numerous complications which can ultimately lead to impaired limb function and mobility. The advent of tumor ablation techniques offers the exciting potential of developing noninvasive or minimally invasive treatment options for extremity tumors. One promising innovative tumor ablation technique with strong potential to serve as a noninvasive limb salvage treatment for extremity tumor patients is histotripsy. Histotripsy is a novel, noninvasive, non-thermal, and non-ionizing focused ultrasound technique which uses controlled acoustic cavitation to mechanically disintegrate tissue with high precision. In this review, we present the ongoing development of histotripsy as a non-surgical alternative for extremity tumors and highlight the value of spontaneously occurring OS and STS in the pet dog as a comparative oncology research model to advance this field of histotripsy research.
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Affiliation(s)
- Alayna N. Hay
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
| | - Lauren Ruger
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Andy Hsueh
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
| | - Elliana Vickers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA
- Graduate program in Translation Biology, Medicine and Health, Virginia Polytechnic Institute and State University, Roanoke, VA
| | - Shawna Klahn
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Joanne Tuohy
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
- Virginia Tech Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, VA
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Antoniou A, Spanoudes K, Damianou C. Treatment of mammary cancer with focused ultrasound: A pilot study in canine and feline patients. ULTRASONICS 2023; 132:106974. [PMID: 36917874 DOI: 10.1016/j.ultras.2023.106974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/30/2023] [Accepted: 02/27/2023] [Indexed: 05/29/2023]
Abstract
In recent years, veterinary medicine has expanded its practices beyond conventional methods, gradually integrating the Focused Ultrasound (FUS) technology in the care of companion animals like dogs and cats. The current study aimed to examine the feasibility and provide insights into the application of thermal FUS in canine and feline mammary cancer therapy. FUS was delivered by a 2-MHz single-element spherically focused ultrasonic transducer as integrated with an existing robotic positioning device. The functionality of the FUS system and sonication protocol in efficiently and safely ablating live tissue was initially validated in a rabbit thigh model in a laboratory environment. Nine (9) dogs and cats with superficial mammary cancer were recruited through a dedicated campaign according to specific safety criteria. The veterinary patients underwent FUS ablation followed by immediate surgical resection of the entire malignancy. Histopathology examination demonstrated well-defined regions of coagulative necrosis in all treated tumors with no off-target damage. Further study with a larger patient population is needed to confirm the current findings and demonstrate the safety and feasibility of complete FUS ablation of deep-seated tumors.
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Affiliation(s)
- Anastasia Antoniou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Kyriakos Spanoudes
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Christakis Damianou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
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Ruger L, Yang E, Gannon J, Sheppard H, Coutermarsh-Ott S, Ziemlewicz TJ, Dervisis N, Allen IC, Daniel GB, Tuohy J, Vlaisavljevich E, Klahn S. Mechanical High-Intensity Focused Ultrasound (Histotripsy) in Dogs With Spontaneously Occurring Soft Tissue Sarcomas. IEEE Trans Biomed Eng 2023; 70:768-779. [PMID: 36006886 PMCID: PMC9969335 DOI: 10.1109/tbme.2022.3201709] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Histotripsy is a non-invasive focused ultrasound therapy that uses controlled acoustic cavitation to mechanically disintegrate tissue. To date, there are no reports investigating histotripsy for the treatment of soft tissue sarcoma (STS). OBJECTIVE This study aimed to investigate the in vivo feasibility of ablating STS with histotripsy and to characterize the impact of partial histotripsy ablation on the acute immunologic response in canine patients with spontaneous STS. METHODS A custom 500 kHz histotripsy system was used to treat ten dogs with naturally occurring STS. Four to six days after histotripsy, tumors were surgically resected. Safety was determined by monitoring vital signs during treatment and post-treatment physical examinations, routine lab work, and owners' reports. Ablation was characterized using radiologic and histopathologic analyses. Systemic immunological impact was evaluated by measuring changes in cytokine concentrations, and tumor microenvironment changes were evaluated by characterizing changes in infiltration with tumor-associated macrophages (TAMs) and tumor-infiltrating lymphocytes (TILs) using multiplex immunohistochemistry and differential gene expression. RESULTS Results showed histotripsy ablation was achievable and well-tolerated in all ten dogs. Immunological results showed histotripsy induced pro-inflammatory changes in the tumor microenvironment. Conclusion & Significance: Overall, this study demonstrates histotripsy's potential as a precise, non-invasive treatment for STS.
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Antoniou A, Evripidou N, Panayiotou S, Spanoudes K, Damianou C. Treatment of canine and feline sarcoma using MR-guided focused ultrasound system. J Ultrasound 2022; 25:895-904. [PMID: 35277843 PMCID: PMC9705640 DOI: 10.1007/s40477-022-00672-5] [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: 10/25/2021] [Accepted: 02/27/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE In recent years, veterinary medicine has enhanced its applications beyond traditional approaches, progressively incorporating the Focused Ultrasound (FUS) technology. This study investigated the ability of FUS to precisely ablate naturally occurring canine and feline soft tissue sarcomas (STS). METHODS Six dogs and four cats with superficial tumours were enrolled in the study. The tumours were treated with a Magnetic Resonance guided FUS (MRgFUS) robotic system featuring a single element spherically focused transducer of 2.6 MHz. The tumours were then removed by surgery and sent for hematoxylin and eosin (H&E) staining. RESULTS The MRgFUS system was capable of inflicting well-defined overlapping lesions in the tumours. The anatomical sites of the treated tumours were the neck, leg, face, back and belly. Coagulative necrosis was evidenced by histopathology assessment in 80% of cases. CONCLUSION Therefore, this technology can be a therapeutic solution for veterinary cancer and a model for advancing the knowledge on human STS.
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Affiliation(s)
- Anastasia Antoniou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus
| | - Nikolas Evripidou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus
| | - Stelios Panayiotou
- SGS Diagnostic Centre of Histopathology and Cytology Limited, 21 Thessalonikis, 3025, Limassol, Cyprus
| | - Kyriakos Spanoudes
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus
| | - Christakis Damianou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, 30 Archbishop Kyprianou Street, 3036, Limassol, Cyprus.
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Zhu L, Huang Y, Lam D, Gach HM, Zoberi I, Hallahan DE, Grigsby PW, Chen H, Altman MB. Targetability of cervical cancer by magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-mediated hyperthermia (HT) for patients receiving radiation therapy. Int J Hyperthermia 2021; 38:498-510. [PMID: 33757406 DOI: 10.1080/02656736.2021.1895330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the targetability of late-stage cervical cancer by magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-induced hyperthermia (HT) as an adjuvant to radiation therapy (RT). METHODS Seventy-nine cervical cancer patients (stage IIIB-IVA) who received RT with lesions visible on positron emission tomography-computed tomography (PET-CT) were retrospectively analyzed for targetability using a commercially-available HT-capable MRgHIFU system. Targetability was assessed for both primary targets and/or any metastatic lymph nodes using both posterior (supine) and anterior (prone) patient setups relative to the transducer. Thirty-four different angles of rotation along subjects' longitudinal axis were analyzed. Targetability was categorized as: (1) Targetable with/without minimal intervention; (2) Not targetable. To determine if any factors could be used for prospective screening of patients, potential associations between demographic/anatomical factors and targetability were analyzed. RESULTS 72.15% primary tumors and 33.96% metastatic lymph nodes were targetable from at least one angle. 49.37% and 39.24% of primary tumors could be targeted with patient laying in supine and prone positions, respectively. 25°-30° rotation and 0° rotation had the highest rate of the posterior and anterior targetability, respectively. The ventral depth of the tumor and its distance to the coccyx were statistically correlated with the anterior and posterior targetability, respectively. CONCLUSION Most late-stage cervical cancer primaries were targetable by MRgHIFU HT requiring either no/minimal intervention. A rotation of 0° or 25°-30° relative to the transducer might benefit anterior and posterior targetability, respectively. Certain demographic/anatomic parameters might be useful in screening patients for treatability.
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Affiliation(s)
- Lifei Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Yi Huang
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - Dao Lam
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA
| | - H Michael Gach
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.,Siteman Comprehensive Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Dennis E Hallahan
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.,Siteman Comprehensive Cancer Center, Washington University in St. Louis, St. Louis, MO, USA.,Institute of Clinical and Translational Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.,Siteman Comprehensive Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Hong Chen
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.,Siteman Comprehensive Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael B Altman
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.,Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, USA.,Siteman Comprehensive Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
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Latifi M, Hay A, Carroll J, Dervisis N, Arnold L, Coutermarsh-Ott SL, Kierski KR, Klahn S, Allen IC, Vlaisavljevich E, Tuohy J. Focused ultrasound tumour ablation in small animal oncology. Vet Comp Oncol 2021; 19:411-419. [PMID: 34057278 DOI: 10.1111/vco.12742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022]
Abstract
The cancer incidence rates for humans and animals remain high, and efforts to improve cancer treatment are crucial. Cancer treatment for solid tumours includes both treatment of the primary tumour and of metastasis. Surgery is commonly employed to resect primary and metastatic tumours, but is invasive, and is not always the optimal treatment modality. Prevention and treatment of metastatic disease often utilizes a multimodal approach, but metastasis remains a major cause of death for both human and veterinary cancer patients. Focused ultrasound (FUS) tumour ablation techniques represent a novel non-invasive approach to treating cancer. FUS ablation is precise, thus sparing adjacent critical structures while ablating the tumour. FUS ablation can occur in a thermal or non-thermal fashion. Thermal FUS ablation, also known as high intensity focused ultrasound (HIFU) ablation, destroys tumour cells via heat, whereas non-thermal FUS, known as histotripsy, ablates tumour cells via mechanical disintegration of tissue. Not only can HIFU and histotripsy ablate tumours, they also demonstrate potential to upregulate the host immune system towards an anti-tumour response. The aim of this report is provide a description of HIFU and histotripsy tumour ablation, with a focus on the basic principles of their ablation mechanisms and their clinical applicability in the field of veterinary oncology.
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Affiliation(s)
- Max Latifi
- Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, Virginia, USA.,Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Alayna Hay
- Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, Virginia, USA
| | - Jennifer Carroll
- Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, Virginia, USA
| | - Nikolaos Dervisis
- Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, Virginia, USA
| | - Lauren Arnold
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Sheryl L Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Katharine R Kierski
- Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, Virginia, USA
| | - Shawna Klahn
- Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, Virginia, USA
| | - Irving C Allen
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Joanne Tuohy
- Animal Cancer Care and Research Center, Virginia-Maryland College of Veterinary Medicine, Roanoke, Virginia, USA
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Zhu L, Lam D, Pacia CP, Gach HM, Partanen A, Talcott MR, Greco SC, Zoberi I, Hallahan DE, Chen H, Altman MB. Characterization of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-induced large-volume hyperthermia in deep and superficial targets in a porcine model. Int J Hyperthermia 2020; 37:1159-1173. [DOI: 10.1080/02656736.2020.1825836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Lifei Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Dao Lam
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christopher Pham Pacia
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - H. Michael Gach
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
| | - Ari Partanen
- Clinical Science, Profound Medical Inc, Mississauga, Ontario, Canada
| | - Michael R. Talcott
- Division of Comparative Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Suellen C. Greco
- Division of Comparative Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
| | - Dennis E. Hallahan
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
| | - Hong Chen
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
| | - Michael B. Altman
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
- Siteman Comprehensive Cancer Center, St. Louis, St. Louis, Missouri, USA
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