恶性骨肿瘤的高强度聚焦超声无创治疗

目的 探讨以高强度聚焦超声为主无创治疗恶性骨肿瘤的疗效、可能并发症和禁忌证。方法 以HIFU为主无创治疗20例恶性骨肿瘤患者，观察治疗前后临床表现、生化指标、影像学、组织病理学、肢体功能评价等方面变化及并发症。结果 临床表现、肢体功能评价等改善，生化指标、影像学、组织病理学明显地显示为HIFU治疗后的改变，效果满意，且并发症轻微。结论 HIFU治疗恶性骨肿瘤是安全有效、便捷可行的，慎重选择适合的病例可避免或减少并发症的发生。     

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。     

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。     

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.     

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。     

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。     

Primary malignant tumours of the bony pelvis: US-guided high intensity focused ultrasound ablation

Abstract

Purpose: The aim of this review is to evaluate the value of ultrasound (US)-guided high intensity focused ultrasound (HIFU) ablation in the treatment of primary malignant tumours of the bony pelvis. Materials and methods: Eleven patients with primary malignant tumours of the bony pelvis received US-guided HIFU ablation. The maximum tumour size ranged from 5.6 to 25.0?cm (median 10.5?cm). Treatment was curative in four patients and palliative in seven patients. During follow-up, the effectiveness of HIFU ablation was assessed by contrast-enhanced magnetic resonance (MR). Results: Significant coagulative necrosis was obtained in all patients after scheduled HIFU ablations; the volume ablation ratio was 86.7%?±?12.5% (range 65–100%). Complete tumour necrosis was achieved in all patients receiving curative HIFU ablation. No major complications were encountered. No patients died of local tumour progression during follow-up. Conclusions: US-guided HIFU ablation may be a safe and effective minimally invasive technique for the local treatment of primary malignant tumours of the bony pelvis.     

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。     

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.     

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.     

"Wide local ablation" of localized breast cancer using high intensity focused ultrasound

BACKGROUND AND OBJECTIVE: High intensity focused ultrasound (HIFU) is a non-invasive technique for tumor ablation. The goal of this study was to investigate the feasibility of performing wide local ablation using ultrasound-guided HIFU in the treatment of patients with localized breast cancer. METHODS: Twenty-three patients with histologically proven breast cancer were enrolled in this prospective clinical trial. They underwent HIFU treatment for breast cancer including the tumor and 1.5-2.0 cm normal breast tissue surrounding the tumor, followed by modified mastectomy 1-2 weeks after HIFU. Radiological examination, histological, and terminal deoxynucleotidyl transferase-mediated nick end labeling (TUNEL) methods were performed to evaluate therapeutic effects in the treated region. RESULTS: Thermal ablation was confirmed in all 23 patients. It included tumor and normal breast tissue surrounding the tumor. Mean values of the largest parallel and perpendicular dimensions, and volume of HIFU lesions in excised breasts were significantly larger than those of the targeted tumors respectively (P < 0.001). Hematoxylin and eosin (H & E) staining showed clear evidence of complete coagulation necrosis in the treated regions. However, no apoptotic cells were detected in either treated tumor or normal breast tissue. CONCLUSION: As a non-invasive therapy, ultrasound-guided HIFU can induce wide local ablation in the treatment of patients with localized breast cancer.     

高强度聚焦超声和射频消融治疗子宫腺肌瘤的临床对比研究

目的:对比分析高强度聚焦超声（HIFU）和射频消融（RFA）两种方法治疗子宫腺肌瘤患者的临床疗效。方法:回顾性分析2014年3月至2016年3月于我院就诊的250例子宫腺肌瘤患者临床资料,其中接受HIFU治疗患者136例、RFA 治疗患者114例。根据子宫腺肌瘤直径将患者分为3组（2~4 cm组、＞4~6 cm组、＞6~8 cm组）,对比两种治疗方法的疗效及并发症。结果:HIFU及RFA组间患者一般情况比较及2~4 cm、＞4~6 cm、＞6~8 cm腺肌瘤组内两组间病例数分布、年龄、不同位置肌瘤构成比比较无统计学差异（P>0.05）,两种治疗组总有效率分别为83.09%、93.86%,两组比较差异有统计学意义（P＜0.05）。对于2~4 cm的子宫腺肌瘤患者,HIFU及RFA治疗组总有效率比较差异无统计学意义（P>0.05）。对于＞4~6 cm、＞6~8 cm的子宫腺肌瘤患者,HIFU及RFA治疗组总有效率比较差异均有统计学意义（P＜0.05）,RFA治疗组总有效率明显高于HIFU治疗组。HIFU治疗组并发症发生率显著低于RFA治疗组,差异具有统计学意义（P＜0.05）。结论:对于直径小于4 cm的子宫腺肌瘤患者建议选择HIFU,因其疗效与RFA相当,但并发症发生率低;而对于大于4 cm的子宫腺肌瘤,建议选择RFA治疗。两种治疗方法对于子宫腺肌瘤患者来说均是有效的治疗方法,值得临床推广。     

High intensity focused ultrasound: Physical principles and devices

High intensity focused ultrasound (HIFU) is gaining rapid clinical acceptance as a treatment modality enabling non-invasive tissue heating and ablation for numerous applications. HIFU treatments are usually carried out in a single session, often as a day case procedure, with the patient either fully conscious, lightly sedated or under light general anaesthesia. A major advantage of HIFU over other thermal ablation techniques is that there is no necessity for the transcutaneous insertion of probes into the target tissue. The high powered focused beams employed are generated from sources placed either outside the body (for treatment of tumours of the liver, kidney, breast, uterus, pancreas and bone) or in the rectum (for treatment of the prostate), and are designed to enable rapid heating of a target tissue volume, while leaving tissue in the ultrasound propagation path relatively unaffected. Given the wide-ranging applicability of HIFU, numerous extra-corporeal, transrectal and interstitial devices have been designed to optimise application-specific treatment delivery. Their principle of operation is described here, alongside an overview of the physical mechanisms governing HIFU propagation and HIFU-induced heating. Present methods of characterising HIFU fields and of quantifying HIFU exposure and its associated effects are also addressed.     

High intensity focused ultrasound treatment for patients with advanced pancreatic cancer: A preliminary dosimetric analysis

Objective: To analyse the clinical dosimetry of high intensity focused ultrasound (HIFU) for the treatment of inoperable pancreatic cancer in humans.

Methods: 136 patients with advanced pancreatic cancer were treated with HIFU, including 89 male and 47 female patients. The median targeted volume (V_t) was 31.1?cm³ (range: 9.8–102.1). The median of the average ultrasound power (P_avg) was 225?W (range: 117–399), and the median energy of the ultrasound (E_total) was 278.3?kJ (range: 70.5–1195.2). Spearman rank correlation analysis for HIFU dosimetric analysis was conducted.

Results: There was a significant correlation between greyscale changes after HIFU ablation and HIFU dose intensity (DI), P_avg, and unit time (T_u). However, no correlation was found between greyscale changes after HIFU ablation and gender, age, pancreatic cancer position, or depth of tumour.

Conclusions: We preliminarily deem that dose intensity and sound power can act as good reference points for HIFU dosimetry in the treatment of pancreatic tumours using the Chongqing system. If there was no obvious change in the ultrasound-monitored image following HIFU treatment for pancreatic cancer, the P_avg and DI should be no less than 260?W and 11?kJ/cm³, respectively.     

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.     

高能聚焦超声刀联合化疗治疗不能手术的结直肠癌肝转移的近期疗效

目的:探讨高能聚焦超声刀联合化疗治疗不能手术的结直肠癌肝转移的近期疗效及不良反应。方法:96例结直肠癌肝转移的患者,分为实验组和对照组。实验组48例,给予FOLFOX方案、FOLFIRI方案或单药卡培他滨口服方案,同时给予病灶局部高能聚焦超声刀,对照组的化疗方案与实验组相同。比较两组患者的疗效及不良反应。结果:实验组有效率为45.83%,而对照组治疗有效率为20.83%,差异有统计学意义（P=0.03）,不良反应分为血液学和非血液学不良反应,两组患者的不良反应无统计学差异（P>0.05）。结论:高能聚焦超声刀联合化疗可以提高结直肠癌肝转移治疗的有效率,且不增加患者不良反应。     

High intensity focused ultrasound in clinical tumor ablation

Recent advances in high intensity focused ultrasound (HIFU), which was developed in the 1940s as a viable thermal tissue ablation approach, have increased its popularity. In clinics, HIFU has been applied to treat a variety of solid malignant tumors in a well-defined volume, including the pancreas, liver, prostate, breast, uterine fibroids, and soft-tissue sarcomas. In comparison to conventional tumor/cancer treatment modalities, such as open surgery, radio- and chemo-therapy, HIFU has the advantages of non-invasion, non-ionization, and fewer complications after treatment. Over 100 000 cases have been treated throughout the world with great success. The fundamental principles of HIFU ablation are coagulative thermal necrosis due to the absorption of ultrasound energy during transmission in tissue and the induced cavitation damage. This paper reviews the clinical outcomes of HIFU ablation for applicable cancers, and then summarizes the recommendations for a satisfactory HIFU treatment according to clinical experience. In addition, the current challenges in HIFU for engineers and physicians are also included. More recent horizons have broadened the application of HIFU in tumor treatment, such as HIFU-mediated drug delivery, vessel occlusion, and soft tissue erosion (“histotripsy”). In summary, HIFU is likely to play a significant role in the future oncology practice.     

Quantitative measurement and real-time tracking of high intensity focused ultrasound using phase-sensitive optical coherence tomography: Feasibility study

Purpose: Phase-sensitive optical coherence tomography (PhS-OCT) is proposed, as a new high intensity focused ultrasound (HIFU) imaging guidance to detect and track HIFU focus inside 1% agar samples in this work. The experiments studied the effect of varying HIFU power on the induction of shear wave, which can be implemented as a new technique to monitor focused ultrasound surgery (FUS).

Method: A miniature HIFU transducer (1.02?MHz, 20?mm aperture diameter, 15?mm radius of curvature) was produced in-house, pressure-field mapped, and calibrated. The transducer was then embedded inside a 1% agar phantom, which was placed under PhS-OCT for observation, under various HIFU power settings (acoustic power, and number of cycles per pulse). Shear wave was induced on the sample surface by HIFU and was captured in full under PhS-OCT. The lowest HIFU acoustic power output for the detection of shear wave was found to be 0.36 W (1.02?MHz, 100 cycles/pulse), or with the number of cycles/pulse as low as 20 (1.02?MHz, 0.98 W acoustic power output).

Results: A linear relationship between acoustic power output and the maximum shear wave displacement was found in the first study. The second study explores a non-linear correlation between the (HIFU) numbers of cycles per pulse, and the maximum shear wave displacement.

Conclusion: PhS-OCT demonstrates excellent tracking and detection of HIFU-induced shear wave. The results could benefit other imaging techniques in tracking and guiding HIFU focus. Further studies will explore the relationship between the physical transducer characteristics and the HIFU-induced shear wave.     

Clinical applications for magnetic resonance guided high intensity focused ultrasound (MRgHIFU): Present and future

It has been well known for decades that high intensity focused ultrasound (HIFU) generates heat in tissues resulting in coagulative necrosis. Implementation, however, has been slow, due to difficulties with finding an appropriate imaging modality that could not only guide treatment, but also provide real‐time thermal feedback. These problems have been overcome with the newest magnetic resonance‐guided high intensity focused ultrasound systems (MRgHIFU). With its superior spatial resolution enabling accurate image guidance coupled with its ability to provide real‐time thermography during treatments, MRI is moving further into the realm of therapeutics for oncologic patient care. This article will discuss the implementation of an MR‐guided HIFU system, current clinical indications and touch on future directions.