In the past decade, HIFU ablation has emerged as a modality for palliative treatment of pancreatic tumors. Multiple preclinical and non-randomized clinical trials. HIFU appears to be an effective tool for pain palliation in advanced pancreatic cancer. Studies assessing treatment in patients with pancreatic. Request PDF on ResearchGate | HIFU for Palliative Treatment of Pancreatic Cancer | High intensity focused ultrasound (HIFU) is a novel.
|Published (Last):||1 December 2017|
|PDF File Size:||9.71 Mb|
|ePub File Size:||20.94 Mb|
|Price:||Free* [*Free Regsitration Required]|
Although ablation with evidence of necrosis was observed in A peritoneal washing cytology PWC revealed the presence of neoplastic cells Figure 1. Another problem that is inherent to any HIFU system with ultrasound guidance is the absence of direct operator control over the thermal dose that the target tissue received.
He SX and Wang GM The noninvasive treatment of cases of advanced pancreatic cancer with focused ultrasound surgery. Illustration of extracorporeal high intensity focused ultrasound treatment of a pancreatic tumor using a transducer that is located above the patient that is in the supine position.
To log in you will need to enable cookies and reload the page Policy Document. It has been reported to have a high capacity to infiltrate tissues and a strong tendency to metastasise hufu 1 ].
HIFU for palliative treatment of pancreatic cancer
Ultrasound imaging used in current clinical devices does not have the capability of performing thermometry, but it provides real-time imaging using the gifu energy modality as HIFU.
At the sixth month of follow-up after the HIFU ablation his GHS improved to 42 and the pancreatic pain was significantly reduced to The patient was asymptomatic and was treated with somatostatin for one week. In two studies HIFU was used in combination with systemic chemotherapy gemcitabineand similar findings were reported in terms of pain relief and safety, even suggesting a survival benefit 14 The focal temperature can be rapidly increased causing cell death at the focal region.
Twelve months after the combination treatment with HIFU and chemotherapy the liver metastases were significantly reduced on the contrast control CT. Another important characteristic of an ultrasound wave is its intensity, or the amount of ultrasound energy per unit surface, which is proportional to the square of the wave amplitude.
This study demonstrates that there were no severe complications or adverse events related to HIFU therapy seen in trestment of the patients treated. Both devices operate at similar ultrasound frequencies — 0. Combination of thermal and cavitation effects to generate deep lesions with an endocavitary applicator using a plane transducer: A forty eight-year old, male patient with significant weight loss and dyspepsia underwent diagnostic CT scan in July which revealed a tumor mass in the body of the pancreas.
HIFU for palliative treatment of pancreatic cancer
The treatment was performed with computerised axial scanning and power Doppler to evaluate the effect of ablation on the artery engaged. Respiratory motion tracking techniques that would allow for rapid focal adjustment in sync with the target position are currently in development A A single-element HIFU transducer has a spherically curved surface to focus ultrasound energy into a small focal region in which ablation takes place, leaving the surrounding tissue unaffected.
A multicenter non-randomized clinical study of high intensity focused ultrasound in treating patients with local advanced pancreatic carcinoma. Because of focusing, the acoustic intensities are high only within the focal region; however, outside the focal region the acoustic intensities are substantially lower, minimizing the risk of unintended injury to tissue outside the focal region.
HIFU for Palliative Treatment of Pancreatic Cancer.
In addition, there is an electrical cqncer system and water treatment system not pictured. In pancreatic cancer patients pain control is one of the most important clinical issues, usually achieved by means of opioids.
Examples of HIFU lesions produced in ex vivo bovine liver tissue with different sonication reigimes. Furthermore, physicians should be comfortable with ultrasound imaging of pzncreatic structures.
Survivals were evaluated by means of the Kaplan-Meir method. Since cell death due to apoptosis occurs at lower thermal dose than thermal necrosis, the tissue adjacent to the HIFU target might be at risk from this effect One method that is sometimes used for confirmation of general targeting accuracy is the appearance of a hyperechoic region on the ultrasound palilative during treatment.
The contrast enhanced CT image before HIFU showed a treatmebt lesion of a liver metastasis about 14mm in diameter in the right lobe segment seven. There were no severe complications or adverse events related to high intensity focused ultrasound therapy seen in any of the patients treated. After day one of the second cycle, treatment was delayed because of thrombocytopaenia, and definitively discontinued because of unstable clinical status for acute lower limb peripheral neuropathy and appearance of upper abdominal pain.
All four images are taken from the same patient. Peritoneal washing cytology PWC with Papanicolaou stain C detects cells with malignant features such as nuclear displacement, irregular nuclear pncreatic, small and eccentric nucleoli 40x.
Treatment spots treatkent placed in an overlapping fashion. Methods Pain relief, local tumor control rate, median survival and complications were observed after high intensity focused ultrasound treatment. Radiation force and streaming Radiation force is exerted on an object when a wave is either absorbed or reflected from that object.
The thermal hypothesis of the mechanism of ultrasonic focal destruction in organized tissues. Pancreatc HIFU ablation the distance was 8. Received Jun 13; Accepted Jul Because of a shorter duration compared with radiotherapy, a less invasive approach compared to intra-arterial chemotherapy and our local interventional radiology expertise [ 101112 ], we believed that HIFU would be the most feasible, potentially effective, and a safer approach.
Can’t read the image?
HIFU for palliative treatment of pancreatic cancer.
High intensity focused ultrasound HIFU is a novel non-invasive modality for ablation of various solid tumors including uterine fibroids, prostate cancer, hepatic, renal, breast and pancreatic tumors.
For comparison, one atmosphere is equal to 0. Reproduced with permission Yuande Biomedical Engineering Corp. Challenges and future directions The major factors that complicate HIFU ablation of pancreatic tumors are the presence of bowel gas, respiratory motion and the absence of ultrasound-based temperature monitoring methods. Lele P, Pierce A.
However, several studies have reported that HIFU can also induce cell apoptosis through hyperthermia, i. Several reports in the literature suggest that contrast enhanced-CT or MRI scan can be used to evaluate the efficacy of thermal ablation [ 2425 ]; however, contrast enhanced-CT scan or MRI can only assess for necrosis by noting the absence of vascularity within the tumor and is unable pancreatlc assess the metabolic activity of the tumor. It is worth mentioning here that ultrasound absorption in tissue increases nearly linearly with ultrasound frequency; hence, more heating occurs at higher frequencies.
Cantore M et al Phase II study of hepatic intraarterial epirubicin and cisplatin, with systemic 5-fluorouracil in patients with unresectable biliary tract tumors Cancer 7 —7 DOI: Early clinical experience using high intensity focused ultrasound for palliation of inoperable pancreatic cancer. In HIFU the radiating surface is usually spherically curved, so that the ultrasound wave is focused at the center of curvature in a similar fashion to the way a magnifying lens can focus a broad light beam into a small focal spot Figure 2A.
As a result, tissue is heated much faster than it would if nonlinear effects did not occur. Surgery of the Liver, Biliary Tract, and Pancreas.