Ultrasound-guided high-intensity focused ultrasound treatment for needle-track seeding of hepatocellular carcinoma: preliminary results

The efficacy of low-power cumulative high-intensity focused ultrasound treatment for recurrent desmoid tumor

Background

Desmoid tumors are rare neoplasms that are locally invasive. However, optimal treatment strategies for recurrent desmoid tumors remain controversial. High‐intensity focused ultrasound (HIFU) has been reported as a noninvasive modality for treating recurrent desmoid tumors. However, its efficacy against massive desmoid tumors or those with complex anatomies remains unclear.

Methods

We developed a new therapeutic strategy called low‐power cumulative HIFU and applied it to treat recurrent desmoid tumors.

Results

We retrospectively collected data from 91 patients with recurrent desmoid tumors who underwent low‐power cumulative HIFU treatment after surgical treatment failure. The mean ablation proportion of the HIFU treatment was 69.5%, and the objective response rate was 47.3%. The 5‐year estimated progression‐free survival rate for these patients was 69.3%.

Conclusion

Low‐power cumulative HIFU treatment could achieve significant efficacy and long‐term control of recurrent desmoid tumors.

Systematic review of the role of high intensity focused ultrasound (HIFU) in treating malignant lesions of the hepatobiliary system

BACKGROUND

High Intensity Focused Ultrasound (HIFU) is an emerging non-invasive, targeted treatment of malignancy. The aim of this review was to assess the efficacy, safety and optimal technical parameters of HIFU to treat malignant lesions of the hepatobiliary system.

METHODS

A systematic search of the English literature was performed until March 2020, interrogating Pubmed, Embase and Cochrane Library databases. The following key-words were input in various combinations: 'HIFU', 'High intensity focussed ultrasound', 'Hepatobiliary', 'Liver', 'Cancer' and 'Carcinoma'. Extracted content included: Application type, Exposure parameters, Patient demographics, and Treatment outcomes.

RESULTS

Twenty-four articles reported on the clinical use of HIFU in 940 individuals to treat malignant liver lesions. Twenty-one studies detailed the use of HIFU to treat hepatocellular carcinoma only. Mean tumour size was 5.1 cm. Across all studies, HIFU resulted in complete tumour ablation in 55% of patients. Data on technical parameters and the procedural structure was very heterogeneous. Ten studies (n = 537 (57%) patients) described the use of HIFU alongside other modalities including TACE, RFA and PEI; 66% of which resulted in complete tumour ablation. Most common complications were skin burns (15%), local pain (5%) and fever (2%).

CONCLUSION

HIFU has demonstrated benefit as a treatment modality for malignant lesions of the hepatobiliary system. Combining HIFU with other ablative therapies, particularly TACE, increases the efficacy without increasing complications. Future human clinical studies are required to determine the optimal treatment parameters, better define outcomes and explore the risks and benefits of combination therapies.

Chest Wall Implantation Metastasis Caused by Percutaneous Interventional Procedure Appearing 12 Years After Liver Transplantation: A Case Report

Percutaneous treatments (mainly radiofrequency ablation and ethanol injection) are modes of treatment for hepatocellular carcinoma. Seeding of malignant cells along the percutaneous tract is a very rare complication. We present a case of chest wall metastasis caused by radiofrequency ablation appearing years after liver transplantation.

Ultrasound-Guided 125I Seed Implantation in Treatment of Abdominal Wall Metastases

Background: The treatment of abdominal wall metastasis presents a challenge, because resection can be followed by poor healing and external radiotherapy is associated with serious adverse events. This study aimed to evaluate the efficacy and safety of interstitial ¹²⁵I seed implantation under ultrasound (US) guidance for treating abdominal wall metastasis. Materials and Methods: The cases of 21 patients with 28 abdominal wall metastases who received brachytherapy with ¹²⁵I seeds at the department from August 2010 to March 2015 were retrospectively reviewed. ¹²⁵I seeds were implanted in the abdominal wall lesions under US guidance and with the help of a treatment planning system. Follow-up was performed using computed tomography at 1 d and at 3, 6, and 12 months after implantation. The lymphocyte count before the surgery was compared with the 3-month postoperative count. The main indicators observed were changes in tumor size, side effects, and complications. Results: All 21 patients were successfully treated with ¹²⁵I seed implantation under US guidance. The median follow-up since ¹²⁵I seed implantation was 15 months (range 6-23 months). The response rates and local tumor control after 3, 6, and 12 months were 78.6% and 89.3%, 64.3% and 85.7%, and 52.4% and 71.4%, respectively. The mean preoperative lymphocyte count was 0.262 ± 0.117 × 10⁹/L, which did not differ significantly from the postoperative count, which was 0.259 ± 0.094 × 10⁹/L (p = 0.122). Procedure-related complications included fever, bleeding, and pain, but all these were Grade 1-2. No severe side effects or complications were noted. Conclusions: Percutaneous interstitial implantation of ¹²⁵I seeds under US guidance is safe and feasible for abdominal wall metastases. However, its long-term efficacy requires further investigation.

Ultrasound-guided percutaneous microwave ablation vs. surgical resection for thoracoabdominal wall implants from hepatocellular carcinoma: intermediate-term results

OBJECTIVE

The aims of this study were to compare the clinical outcomes between ultrasound (US)-guided percutaneous microwave ablation (MWA) and surgical resection (SR) in patients with thoracoabdominal wall implants from hepatocellular carcinom (HCC) and to identify the prognostic factors associated with the two treatment methods.

MATERIALS AND METHODS

A total of 47 patients (mean age, 56.7 ± 15.9 years, range, 18-78 years; 34 men and 13 women) with 61 thoracoabdominal wall HCC seeding were included from April 2007 to May 2017. Twenty-five patients underwent US-guided MWA and 22 patients underwent SR. Survival, recurrence and liver function were compared between the two groups. Effect of changes in key parameters (i.e. overall survival (OS), disease-free survival (DFS) and local tumour reoccurrence-free (LTRF)) was statistically analysed with the log-rank test. Univariate and multivariate analyses were performed on several clinicopathological variables to identify factors affecting long-term outcome and recurrence.

RESULTS

The OS, DFS and LTRF after MWA were comparable to those of SR (p =0.493, p = 0.578 and p =0.270, respectively). Estimated 5-year overall survival rates were 63% after MWA and 48.1% after SR; for disease-free survival, estimated 5-year rates were 67.5% after MWA and 48.8% after SR; estimated 24-month LTRF rates were 71.3% after MWA and 87.8% after SR. The MWA group had less surgical time (p = <0.001), estimated blood loss (p = <0.001) and post-operative hospitalisation (p = 0.032) and cost (p = 0.015). Multivariate analysis showed remnant intrahepatic tumour (p =0.007), Child Pugh grade (p = 0.009) and metastasis (p= <0.001), were predictors for survival rate.

CONCLUSIONS

Ultrasound-guided percutaneous MWA is a safe and effective treatment method for metastatic HCC on the thoracoabdominal wall with similar outcomes to SR. Residual intrahepatic HCC, Child Pugh grade and distant metastasis are predictors for survival.

High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system-current state of the art and future perspectives

BACKGROUND

High intensity focused ultrasound (HIFU) is emerging as a valid minimally-invasive image-guided treatment of malignancies. We aimed to review to current state of the art of HIFU therapy applied to the digestive system and discuss some promising avenues of the technology.

METHODS

Pertinent studies were identified through PubMed and Embase search engines using the following keywords, combined in different ways: HIFU, esophagus, stomach, liver, pancreas, gallbladder, colon, rectum, and cancer. Experimental proof of the concept of endoluminal HIFU mucosa/submucosa ablation using a custom-made transducer has been obtained in vivo in the porcine model.

RESULTS

Forty-four studies reported on the clinical use of HIFU to treat liver lesions, while 19 series were found on HIFU treatment of pancreatic cancers and four studies included patients suffering from both liver and pancreatic cancers, reporting on a total of 1,682 and 823 cases for liver and pancreas, respectively. Only very limited comparative prospective studies have been reported.

CONCLUSIONS

Digestive system clinical applications of HIFU are limited to pancreatic and liver cancer. It is safe and well tolerated. The exact place in the hepatocellular carcinoma (HCC) management algorithm remains to be defined. HIFU seems to add clear survival advantages over trans arterial chemo embolization (TACE) alone and similar results when compared to radio frequency (RF). For pancreatic cancer, HIFU achieves consistent cancer-related pain relief. Further research is warranted to improve targeting accuracy and efficacy monitoring. Furthermore, additional work is required to transfer this technology on appealing treatments such as endoscopic HIFU-based therapies.

Ultrasound-guided microwave ablation for abdominal wall metastatic tumors: a preliminary study

AIM

To evaluate the feasibility, safety and efficacy of ultrasound-guided microwave (MW) ablation for abdominal wall metastatic tumors.

METHODS

From August 2007 to December 2010, a total of 11 patients with 23 abdominal wall nodules (diameter 2.59 cm ± 1.11 cm, range 1.3 cm to 5.0 cm) were treated with MW ablation. One antenna was inserted into the center of tumors less than 1.7 cm, and multiple antennae were inserted simultaneously into tumors 1.7 cm or larger. A 21 gauge thermocouple was inserted near important organs which required protection (such as bowel or gallbladder) for real-time temperature monitoring during MW ablation. Treatment outcome was observed by contrast-enhanced ultrasound and magnetic resonance imaging (MRI) [or computed tomography (CT)] during follow-up.

RESULTS

MW ablation was well tolerated by all patients. Six patients with 11 nodules had 1 thermocouple inserted near important organs for real-time temperature monitoring and the maximum temperature was 56 °C. Major complications included mild pain (54.5%), post-ablation fever (100%) and abdominal wall edema (25%). All 23 tumors (100%) in this group were completely ablated, and no residual tumor or local recurrence was observed at a median follow-up of 13 mo (range 1 to 32 mo). The ablation zone was well defined on contrast-enhanced imaging (contrast-enhanced CT, MRI and/or contrast-enhanced ultrasound) and gradually shrank with time.

CONCLUSION

Ultrasound-guided MW ablation may be a feasible, safe and effective treatment for abdominal wall metastatic tumors in selected patients.

Ultrasound-guided high intensity focused ultrasound treatment for extra-abdominal desmoid tumours: preliminary results

PURPOSE

The aim of this study was to evaluate the feasibility, safety and therapeutic effects of ultrasound (US)-guided high intensity focused US (HIFU) ablation in the treatment of extra-abdominal desmoid tumours.

MATERIALS AND METHODS

From May 2006 to May 2010, ten consecutive patients with pathologically proven extra-abdominal desmoid tumours were treated by US-guided HIFU ablation. Eight patients with multiple recurrent tumours were treated with a palliative aim, two patients with new solitary tumours were treated with a curative aim. The mean size of the largest tumour was 9.2 cm (range 5.9-12.8 cm). An acoustic power of 300-500 W was used according to the echogenic changes after energy exposure, intermittent HIFU exposure of 2-3 s was applied until the planned target area became hyperechoic on US. Outcome of HIFU ablation was observed by serial contrast-enhanced imaging examinations during follow up.

RESULTS

HIFU ablation was successfully performed without major complications. Large volume coagulation necrosis was obtained in all patients. During a mean follow up of 30 months (range 8-55 months), the treated tumours (n = 25) shrank significantly (>50% in volume). Complete tumour necrosis was observed in the two patients with solitary new tumours. Two patients received repeat HIFU ablation for enlarged residual tumours. No tumour spread along the treated area was observed in any patient.

CONCLUSION

US-guided HIFU ablation could be used as an effective minimally invasive therapy for local control of extra-abdominal desmoid tumours.