高强度聚焦超声治疗原发恶性骨肿瘤的初步临床研究

目的：探讨非侵入性治疗肢体恶性骨肿瘤的保肢新方法。方法：对44例四肢原发恶性骨肿瘤采用单纯体外高强度聚焦超声（HIFU）或HIFU结合化疗进行治疗,并平均随访17．6个月。结果：44例的生存率为84．1％,并发症发生率为18．2％。Ⅱb期34例中,30例无瘤生存,2例死于肺、脑转移,2例局部复发;Ⅲb期10例中,带瘤生存5例,1例有局部复发,5例死于肺转移。Enneking综合功能评分≥15分者36例。结论：HIFU结合化疗治疗四肢原发恶性骨肿瘤是有效和安全的,保留的肢体功能良好,并发症少,有望成为一种新的保肢治疗方法。     

恶性骨肿瘤的高强度聚焦超声治疗研究进展

恶性骨肿瘤约占全身肿瘤的0．8％～1．2％,近年来发病率有上升趋势,其治疗一直是骨科临床的一个难题。高强度聚焦超声（HIFU）是一种既能聚焦定位,又能瞬间产生高温的局部治疗肿瘤的新技术。近年来,已成为继手术、放疗、化疗和免疫生物治疗等之后的又一治疗恶性骨肿瘤的新手段,并取得了较好的疗效。     

高强度聚焦超声治疗乳腺癌

目的：观察高强度聚焦超声(HIFU)体外治疗乳腺癌的临床安全性和有效性，并初步筛选判断治疗效果的检查手段。方法：24例乳腺癌患者在行乳腺癌改良根治术前1～2周行HIFU治疗，HIFU治疗中和治疗后，监测患者血压、呼吸、脉搏和外周血氧饱和度的变化。同时，观察HIFU对靶区处组织和皮肤的损伤作用、手术切除标本送病理检查．观察HIFU对靶区组织的破坏效应．其中3例患者在HIFU治疗前后行^99mTc-MIBI ECT检查．1例患者在HIFU治疗前后行MRI检查。结果：HIFU治疗对靶区外邻近组织和患者生命体征无明显影响，HIFU靶区内组织呈完全凝固性坏死。^99mTc-MIBI ECT和MRI显示靶区内组织坏死。结论：在实时超声引导下，HIFU治疗安全、有效，^99mTc-MIBI ECT和MRI可作为判断疗效的检查方法，HIFU技术可望成为乳腺癌保乳治疗方法之一．     

实体肿瘤高强度聚焦超声治疗及护理

目的观察高强度聚焦超声治疗恶性实体肿瘤的效果及护理。方法对30例恶性实体瘤应用HI-FUNIT-9000型超声聚焦肿瘤消融机分次逐层完全覆盖靶区组织进行治疗。结果治疗过程中出现胸闷、气喘1例,术后出现皮肤灼伤4例,血尿加重1例,发热1例。结论通过对30例患者的观察,应做好心理、饮食及治疗前、中、后的护理,密切配合医生完成治疗。     

单纯高强度聚焦超声治疗恶性实体肿瘤

目的　研究高强度聚焦超声 (HIFU)治疗恶性实体肿瘤的安全性和有效性。方法　 30例恶性实体肿瘤用单纯HIFU治疗 ,观察患者生命体征、主要脏器功能、影像学检查 (DSA、CT或MRI、SPECT等 )、穿刺活检、并发症和肿瘤转归的情况。结果　所有患者的生命体征平稳 ,心、肝、肾和肺功能正常 ,DSA示邻近的小动脉或小动脉以上的血管无损伤。平均随访 2 3.1个月 (10～ 38个月 ) ,存活2 6例 (87% )。 2 6例中 ,10例肿块完全消失 ;13例肿块缩小超过 5 0 % ,其中 8例行穿刺活检 ,病理证实为坏死的肿瘤细胞和 (或 )纤维组织 ;3例 (10 % )局部复发 ,其中 2例再次HIFU治疗 ,局部控制良好。2 6例中 ,有 5例出现新的远处转移 ,2例神经损伤 ,1例皮肤损伤。结论　单纯HIFU治疗恶性实体肿瘤是安全和有效的。     

高强度聚焦超声治疗骨肉瘤初步临床观察

目的：探讨HIFU治疗骨肉瘤的有效性和安全性。方法：用HIFU对5例已失去保肢条件的骨肉瘤患者进行部分覆盖治疗,通过主要脏器功能测定,临床症状体征变化、骨显像、DSA、组织病理学、彩色多普勒超声和血清ALP水平等指标,观察HIFU治疗的安全性有效性。结果：心、肝、肾功能正常,疼痛减轻,ALP下降,治疗区肿瘤血供减少和肿瘤血管染色消失、异常放射性浓聚消失,肿瘤细胞变性坏死。结论：HIFU治疗骨肉瘤是有效和安全的。     

高强度聚焦超声与肝癌的治疗

肝癌是消化系统发生率最高的恶性肿瘤之一 ,全球发病率每年一百万 ,自 90年代以来原发性肝癌已上升为我国恶性肿瘤的第二位 ;全球每年约有 31万患者、中国每年有 13万患者死于肝癌 ,占全球肝癌死亡总数的 42 % [1,2 ] 。目前对它的治疗仍首推早期手术切除。然而 ,仅有 10～ 2 0 %的肝癌患者可以接受以手术为主的综合治疗。对晚期肝癌 ,因肿瘤较大 ,多发结节并常伴有肝硬变、肝功不全等而无法手术。故局部非手术疗法更为重要。近些年来临床应用的经皮肝穿灶内酒精注射、激光、射频、微波等局部疗法已获一定疗效[2 ,3 ] 。但它们都需在肝癌组…     

高强度聚焦超声治疗前列腺癌的研究现状

 作为常见肿瘤的前列腺癌，其发病率逐年上升。手术是局限性病变的主要治疗手段，但仍然有一定的并发症和死亡率。放化疗等传统治疗手段也有其适应证和疗效的局限性，迫切需要有效的微创治疗方法。近年发展起来的高强度聚焦超声（HIFU）正日益受到人们的关注，对其作用机制、设备原理、适应证、治疗效果和局限性等问题作综述。     

高强度聚焦超声治疗肿瘤

近几年国内外开展了高强度聚焦超声(HIFU)治疗肿瘤新技术,现对其作用机制、适应证、疗效判断和影像学监测的评价、局限性等问题进行简要综述.     

Noninvasive treatment of malignant bone tumors using high‐intensity focused ultrasound

BACKGROUND:

High‐intensity focused ultrasound (HIFU) is a new, noninvasive technique with potential to ablate and inactivate tumors. Treatment of solid tumors with HIFU has been reported. In this study, the safety and effects of HIFU in the clinical therapy of malignant bone tumors were assessed.

METHODS:

Biochemical markers and magnetic resonance imaging (MRI) or positron emission tomography (PET)‐computed tomography (CT) were used to evaluate 25 patients with malignant bone tumors before and after HIFU treatment.

RESULTS:

HIFU resulted in significant improvement in biochemical markers, and no severe complications were observed. After HIFU treatment, 21 (87.5%) patients were completely relieved of pain, and 24 (100%) experienced significant relief. On the basis of MRI or PET‐CT, HIFU was effective: For patients with primary bone tumors, 6 (46.2%) had a complete response, 5 (38.4%) had a partial response, 1 (7.8%) had a moderate response, and 1 suffered progressive disease; the response rate was 84.6%. For patients with metastatic bone tumors, 5 (41.7%) had complete response, 4 (33.3%) had partial response, 1 (8.3%) had a moderate response, 1 (8.3%) had stable disease, and 1 suffered progressive disease; the response rate was 75.0%. The 1‐, 2‐, 3‐, and 5‐year survival rates were 100.0%, 84.6%, 69.2%, and 38.5%, respectively, for patients with primary bone tumors and 83.3%, 16.7%, 0%, and 0%, respectively, for patients with metastatic bone tumors. The survival rates for patients with primary bone tumors were significantly better than for those with metastatic tumors.

CONCLUSIONS:

HIFU safely and noninvasively ablated malignant bone tumors and relieved pain. HIFU ablation should be further investigated, as it appears to be successful in the treatment of primary malignant bone tumors. Cancer 2010. © 2010 American Cancer Society.     

高强度聚焦超声治疗腹部浅表转移性恶性肿瘤

目的　初步探讨高强度聚焦超声（ＨＩＦＵ）在腹部浅表转移性恶性肿瘤治疗中的应用。方法　对１８例腹部浅表恶性肿瘤给予ＨＩＦＵ治疗,治疗前后行Ｂ超、彩色多普勒血流成像（ＣＤＦＩ）、ＣＴ检查评价疗效。结果　４例部分缓解,１２例稳定,２例进展死亡。Ｂ超提示病灶回声呈增强、降低、再增强的变化趋势,１６例治疗后ＣＤＦＩ显示丰富血流信号明显减少或消失。增强ＣＴ显示２例治疗后病灶内仍有小片状增强区域及周边不均匀增强带。９例患者治疗后出现１级烧伤,未见其它严重毒副反应。结论　对于治疗复发、转移或局部侵犯的腹部浅表恶性肿瘤,ＨＩＦＵ是有效的局部治疗手段之一。     

高强度聚焦超声对恶性肿瘤患者血浆D-二聚体的影响

目的:探究高强度聚焦超声对肿瘤患者血浆D-二聚体水平的影响。方法:分析35例经高强度聚焦超声治疗的恶性肿瘤患者,检测治疗前后患者血浆D-二聚体水平,分析比较治疗前后浓度变化。结果:经高强度聚焦超声治疗的35例恶性肿瘤患者的血浆D-二聚体水平较治疗前降低,差异有统计学意义。60岁及以上的恶性肿瘤患者经高强度聚焦超声治疗后血浆D-二聚体水平有所下降,高强度聚焦超声可明显降低临床Ⅳ期的恶性肿瘤患者的血浆D-二聚体水平,治疗前后的D-二聚体水平均具有显著性差异。结论:高强度聚焦超声可降低恶性肿瘤患者血浆D-二聚体水平。     

Clinical and future applications of high intensity focused ultrasound in cancer

High intensity focused ultrasound (HIFU) or focused ultrasound (FUS) is a promising modality to treat tumors in a complete, non invasive fashion where online image guidance and therapy control can be achieved by magnetic resonance imaging (MRI) or diagnostic ultrasound (US). In the last 10 years, the feasibility and the safety of HIFU have been tested in a growing number of clinical studies on several benign and malignant tumors of the prostate, breast, uterine, liver, kidney, pancreas, bone, and brain. For certain indications this new treatment principle is on its verge to become a serious alternative or adjunct to the standard treatment options of surgery, radiotherapy, gene therapy and chemotherapy in oncology. In addition to the now clinically available thermal ablation, in the future, focused ultrasound at much lower intensities may have the potential to become a major instrument to mediate drug and gene delivery for localized cancer treatment. We introduce the technology of MRI guided and ultrasound guided HIFU and present a critical overview of the clinical applications and results along with a discussion of future HIFU developments.     

高强度聚焦超声治疗乳腺癌骨转移的疗效

目的:研究高强度聚焦超声（high intensity focused ultrasound,HIFU）治疗乳腺癌骨转移的疗效。方法:选取乳腺癌骨转移患者50例,随机将患者分为观察组与对照组,每组各25名。观察组采用HIFU治疗,对照组采用放疗。观察2组患者治疗前后的疼痛缓解率及骨显像浓集影区别。结果:观察组与对照组疼痛缓解显效分别为15例（60%）、5例（20%）（P＜0.01）,观察组与对照组治疗前后骨显像CR分别为19例（76%）、1例（4%）（P＜0.01）。结论:HIFU是一种从体外无创治疗骨转移瘤的有效手段。与传统治疗方法相比,治疗时间短,一般需2~3小时,治疗即可完成。局部复发后可再次应用HIFU治疗。HIFU治疗将成为骨转移的又一有效治疗手段。     

Extracorporeal high intensity focused ultrasound treatment for patients with breast cancer

Purpose. To investigate the safety, efficacy and feasibility of using high-intensity focused ultrasound (HIFU) as a non-invasive treatment for patients with breast cancer.Patients and Methods. Twenty-two patients with breast cancer were enrolled into this non-randomized prospective trial. Disease TNM stage was classified as stage I in 4 patients, stage II_A in 9 patients, stage II_B in 8 patients, and stage IV in 1 patient. Tumor size ranged from 2 to 4.8 cm in diameter (mean 3.4 cm). All patients received chemotherapy, radiation and tamoxifen, following HIFU for the primary lesions. Outcome measures included radiological and pathologic assessment of the treated tumor, cosmesis, and local recurrence. A cumulative survival rate is calculated by using the Kaplan–Meier method.Results. No severe complications were encountered after HIFU. Post-operative imaging demonstrated positive response and regression of all treated lesions. Follow-up biopsy revealed coagulation necrosis of target tumor and subsequent replacement by fibroblastic tissue. After a median follow-up of 54.8 months, 1 patient died, 1 was lost to follow-up, and 20 were still alive. Two of 22 patients developed local recurrence. Five-year disease-free survival and recurrence-free survival were 95% and 89%, respectively. Cosmetic result was judged as good to excellent in 94% of patients.Conclusions. HIFU treatment is safe, effective, and feasible for patients with breast cancer. But, large-scale, multiple-center clinical trials will be needed to determine the future role of this novel modality.     

Use of High Intensity Focused Ultrasound for Treating Malignant Tumors

OBJECTIVE To investigate the efficacy and side effects of high intensity focused ultrasound(HIFU) in the treatment of malignant solid tumors. METHODS Thirty patients who refused surgery and/or were refractory to chemotherapy were treated by HIFU alone, with the efficacy and side effects monitored as follows: observation of vital organ signs; functional assay of important organs; imaging examinations including: digital subtraction angiography (DSA), CT, MRI, single photon emission computed tomography (SPECT), large core needle biopsy, complications and metastasis. RESULTS After HIFU therapy, the vital signs remained stable and the functions of the heart, lung, kidney and liver were also normal. DSA images showed that small or larger arteries were not damaged. After a follow-up of 10-38 months(mean 23.1 months), 26 patients(87%) were alive. The volume of the tumor underwent complete regression in 10 patients. Shrinkage of the tumor volume ≥50% was observed in 13 patients. Eight of 13 patients were examined by large core needle biopsy, all showing necrosis and/or fibrosis though 3 patients(10%) had local recurrence. Two of these were retreated again by HIFU and the locally recurrent tumors were controlled. New metastases developed in 5 patients after H IFU. Two patients suffered from peripheral nerve injuriy and they have recovered during the follow-up. One patient developed skin injury. CONCLUSION High intensity focused ultrasound is effective and safe in the treatment of malignant solid tumors.