HIFU治疗原发性肝癌的临床运用

原发性肝癌（肝癌）是常见的恶性肿瘤之一,我国发病人数约占全球的55％,在肿瘤相关死亡中居第2位[1]。目前,首选治疗方法仍为手术切除。然而大多肝癌在确诊时已进展为中晚期,其手术切除率低于25％,而术后3年复发率高于70％。肝癌对放化疗不敏感,对于无法行手术的患者现多应用局部治疗。高强度聚焦超声（High intensity focused ultrasound,HIFU）以其非侵入性、适形、可重复性等特点,近十年来在肝癌的局部治疗中迅速发展。本文就HIFU近年来在肝癌中的应用作一探讨。     

高强度聚焦超声治疗原发性肝癌相关并发症分析及处理

目的 对高强度聚焦超声（HIFU）治疗原发性肝癌的并发症进行分析,提高HIFU治疗的安全性.方法 回顾性分析郑州大学第一附属医院自2009年12月-2014年9月收治的165例经高强度聚焦超声治疗的原发性肝癌患者的资料,统计其发生的并发症并分析相关处理措施.结果 HIFU治疗原发性肝癌常见的并发症包括治疗区皮肤软组织损伤（118/165）、肝功能一过性损伤（83/165）、术后低热（81/165）、自限性胸腔积液（42/165）及术区疼痛麻木（33/165）;比较严重的并发症主要包括肋骨骨折（2例）、脏器穿孔损伤（1例）、癌灶破裂出血（1例）及皮肤Ⅱ（5例）、Ⅲ（1例）度烧伤;所有并发症积极治疗后均未引起严重后果.结论 高强度聚焦超声治疗原发性肝癌严重并发症少,安全性高.     

高强度聚焦超声体外治疗人恶性实体肿瘤的病理学变化

目的 研究高强度聚焦超声（HIFU）体外治疗人恶性实体肿瘤的病理学变化。方法 HIFU治疗164例恶性实体肿瘤病人,其中30例治疗后常规外科手术,观察治疗区组织的病理学变化。结果 HIFU治疗区与非治疗区边界清楚,治疗区内组织出现凝固性坏死。组织学检查显示治疗区内全部肿瘤细胞出现不可逆性损伤征象,其边缘有新生肉芽组织形成和淋巴细胞浸润。结论 HIFU体外治疗恶性实体肿瘤是安全、有效和可行的,该技术将为临床无创性治疗肿瘤提供一种全新的治疗手段。     

高强度聚焦超声与穿刺化疗药物注射治疗门静脉癌栓的对比研究

2006年1月至2008年12月对我院收治的晚期肝癌合并门静脉癌栓患者采用高强度聚焦超声(HIFU)或超声引导肝穿刺化疗药物注射治疗门静脉癌栓93例,取得满意效果,现报告如下.     

高强度聚焦超声治疗原发性肝癌的疗效

目的探讨高强度聚焦超声（HIFU）对原发性肝癌的治疗效果。方法对我科自2005年5月至2006年8月使用高强度聚焦超声治疗的35例原发性肝癌进行回顾性分析。结果本组术后疼痛症状缓解率为69.6%,术后3月生存率94.29%,6月生存率65.59%,1年生存率57.39%;术后生存期较其自然病程延长。结论高强度聚焦超声治疗原发性肝癌可在一定程度上减轻患者症状、改善患者生存质量、延长患者生存时间。     

高强度聚焦超声治疗中晚期原发性肝癌对患者免疫状态的影响

目的 观察高强度聚焦超声（HIFU）治疗中晚期原发性肝癌对患者免疫状态的影响。方法 对2003年3月至2003年12月我院收治的40例原发性肝癌患者行HIFU治疗,对其治疗前后进行自身比较并与射频治疗组进行比较,观察分析原发性肝癌患者在接受HIFU治疗后的免疫指标（cD3、cD4、CD8、CD4／CD8、NK、IL-2、TNF）变化。结果 HIFU治疗组与射频治疗组3、6、9个月及1年生存率比较,差异无统计学意义;患者上述各项免疫指标于HIFU治疗前后相比较差异无统计学意义,与射频治疗组比较,差异亦无统计学意义。结论 HIFU治疗中晚期原发性肝癌对患者早期免疫状态的影响不明显。     

聚焦超声消融治疗胰腺癌的临床观察

目的探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)消融治疗胰腺癌的疗效和安全性.方法采用JC型高强度聚焦超声治疗系统,消融治疗44例胰腺癌患者.观察治疗前后的影像学变化及临床症状,评价HIFU治疗的疼痛缓解程度、生存期及不良反应.结果44例患者经HIFU治疗后,疼痛缓解率为94.74%,1、3、5年生存率分别为15.91%、6.82%、2.27%,中位生存时间为8个月(3～71个月).无上消化道出血或胃肠穿孔等严重并发症.增强CT或MRI显示HIFU治疗区内组织消融.结论HIFU是一种治疗胰腺癌的有效方法.该法无创、安全性较高、止痛效果明显,适合病情较重、不能耐受其他方法治疗的患者.     

高强度聚焦超声治疗55例原发性肝癌后的早期影像学变化

目的：研究高强度聚焦超声（HIFU）治疗原发性肝癌（PLC）的早期影像学变化，为建立HIFU治疗肝癌的评价标准提供依据。方法：HIFU治疗本组55例PLC病人，观察治疗前后彩色多普勒超声、DSA、CT或MRI的变化。结果：与治疗前比较，经HIFU治疗后1-2周内肝癌出现治疗有效的影像学变化。其中，MRI是评价疗效的最佳检查方法，主要表现为T1和T2加权相信号的变化，以及动态增强相癌灶血液供应消失，边缘出现环状薄层的强化带。结论：MRI能及时判断HIFU是否完全灭活肝癌，治疗区有无残存癌组织和确定治疗范围。     

高强度聚焦超声治疗前列腺增生和前列腺癌的研究

微创外科是21世纪外科的发展趋势,高强度聚焦超声(HIFU)作为新兴的微创治疗技术,近年来在国内外发展迅速。1994年Bihrle等报道美国应用HIFU治疗前列腺增生(BPH)初步临床经验,1996年Gelet等报道HIFU治疗前列腺癌(PCa)患者早期临床疗效观察。越来越多的临床实践证明,HIFU在治疗BPH和PCa具有很高的安全性和较好的临床效果,并显示出其独特的优势。     

高强度聚焦超声在中晚期肝癌中的临床应用进展

肝癌发病率高,起病隐匿,确诊时多为中晚期,手术切除率低,术后复发率高,预后较差,目前缺乏有效治疗手段。高强度聚焦超声（high-intensity focused ultrasound,HIFU）技术具有无创、精准、无辐射、可重复和适形治疗等优势,近年来在中晚期肝癌中应用的安全性和有效性获得了肯定性结果,与经动脉化疗栓塞术（trans arterial chemoembolization,TACE）、放疗、中医药联合治疗可提高中晚期肝癌患者的生存时间,改善患者的生活质量且不增加不良反应。现结合本中心的经验就HIFU的发展与原理及其在中晚期肝癌中治疗安全性与有效性、联合治疗情况进行综述。     

高强度聚焦超声对21例中晚期原发性肝癌病人免疫状态的影响

目的　探讨高强度聚焦超声 (highintensityfocusedultrasound ,HIFU)对原发性肝癌(hepatocellularcarcinoma,HCC)病人机体免疫状态的影响。 方法　采用重庆海扶技术有限公司研制的HIFU系统 ,治疗中晚期HCC病人 2 1例。分别在治疗前和治疗后 3、7、14、2 1d抽取病人外周静脉血 ,检测细胞免疫和体液免疫的相关指标。HIFU治疗后又行癌灶切除的病例 ,对标本进行光学显微镜、电子显微镜观察。结果　光学显微镜、电子显微镜观察结果显示 ,HIFU治疗区内癌组织发生了不可逆性损伤。CD4治疗前 (34± 13)后 (3、7、14及 2 1d分别为 4 0± 7,37± 7,39± 9,37± 7)差异无显著意义 (F =0 89,P >0 0 5 ) ;其他细胞免疫指标 (CD3 ,CD8,CD4/CD8,CD16)以及体液免疫指标(IgG ,IgA ,IgM ,C3 )治疗前后间的差异亦均无显著意义。结论　HIFU能有效地破坏HCC组织。HIFU治疗中晚期HCC病人难以明显改善机体的免疫状态 ,此时若配合免疫治疗等手段 ,有望使病人获得更好的预后。     

Role of high-intensity focused ultrasound in treatment of hepatocellular carcinoma

About 70 per cent of patients with hepatocellular carcinoma are diagnosed at intermediate or advanced stages, and most of them are technically unresectable. As a novel, emerging therapeutic modality, high intensity focused ultrasound (HIFU) has a great potential for tumor treatment. In this review, principle of HIFU technique is introduced, and an overview of clinical applications and limitations of HIFU for HCC treatment, as well as prospects for future development, is provided. Consequently, HIFU has been considered a safe and feasible procedure for HCC treatment.     

Tolerance of High-Intensity Focused Ultrasound Ablation in Patients with Hepatocellular Carcinoma

Background

High-intensity focused ultrasound (HIFU) ablation is a relatively new, noninvasive way of ablation for treating hepatocellular carcinoma (HCC). Emerging evidence has shown that it is effective for the treatment of HCC, even in patients with poor liver function. There is currently no data on the safety limit of HIFU ablation in patients with cirrhosis. However, this information is vital for the selection of appropriate patients for the procedure. We analyzed HCC patients who had undergone HIFU ablation and determined the lower limit of liver function and other patient factors with which HCC patients can tolerate this treatment modality.

Methods

Preoperative variables of 100 patients who underwent HIFU ablation for HCC were analyzed to identify the risk factors in HIFU intolerance in terms of stress-induced complications. Factors that may contribute to postablation complications were compared.

Results

Thirteen (13?%) patients developed a total of 18 complications. Morbidity was mainly due to skin and subcutaneous tissue injuries (n?=?9). Five patients had first-degree skin burn, one had second-degree skin burn, and three had third-degree skin burn. Four complications were grade 3a in the Clavien classification and 14 were below this grade. Univariate analysis showed that age (p?=?0.022) was the only independent factor in HIFU intolerance.

Conclusions

HIFU ablation is generally well tolerated in HCC patients with cirrhosis. It is safe for Child-Pugh A and B patients and selected Child-Pugh C patients. With this new modality, HCC patients who were deemed unsalvageable by other surgical means in the past because of simultaneous Child-Pugh B or C disease now have a new hope.     

Extracorporeal High Intensity Focused Ultrasound Ablation in the Treatment of Patients with Large Hepatocellular Carcinoma

Background: High intensity focused ultrasound (HIFU) is a noninvasive treatment modality that induces complete coagulative necrosis of a deep tumor through the intact skin. The current study was conducted to determine the safety, efficacy, and feasibility of extracorporeal HIFU in the treatment of patients with hepatocellular carcinoma (HCC).Methods: A total of 55 patients with HCC with cirrhosis were enrolled in this prospective, nonrandomized clinical trial. Among them, 51 patients had unresectable HCC. Tumor size ranged from 4 to 14 cm in diameter with mean diameter of 8.14 cm. According to tumor, node, metastasis (TNM) classification, 15 patients corresponded to stage II, 16 to stage IIIA, and 24 to IIIC. All patients had HIFU, and the median number of HIFU session was 1.69. Safety and efficacy of HIFU were assessed in this trial.Results: No severe side effect was observed in the patients treated with HIFU. Follow-up imaging showed an absence of tumor vascular supply and the shrinkage of treated lesions. Serum -fetoprotein returned to normal level in 34% of patients. The overall survival rates at 6, 12, and 18 months were 86.1%, 61.5%, and 35.3%, respectively. The survival rates were significantly higher in patients in stage II than those in stage IIIA (P = .0132) and in stage IIIC (P = .0265).Conclusion: As a noninvasive therapy, HIFU appears to be effective, safe, and feasible in the treatment of patients with HCC. It may play an important role in the ablation of large tumors.     

高强度聚焦超声在肝癌临床治疗中的应用现状及发展

高强度聚焦超声是一种肝癌局部治疗新技术.与手术治疗和其他局部治疗(如射频消融、肝动脉栓塞化疗、酒精注射等)方法相比,因其具有无创伤、精确度高、肿瘤组织坏死确切及术后并发症少等诸多优势,故得到临床广泛认可.作为一种重要的肝癌治疗手段,该法正逐步普及于临床.本文对高强度聚焦超声治疗肝癌的机制、现状进行综述,并对其临床应用前景和发展方向加以探讨.     

Transrectal high-intensity focused ultrasound for local treatment of prostate cancer: current role

Attractivity of robotic high intensity focused ultrasound (HIFU) is based largely on the non-invasive, extremely precise nature of this high-tech robotic therapy as well as its clean, radiation free, surgical, but nevertheless, bloodless character. Today, in urological oncology, HIFU is used clinically as a therapeutic tool for the treatment of prostate cancer. Experimentally it is investigated for therapeutic use in kidney and breast cancer. Transrectal treatment of localized prostate cancer with HIFU has been under investigation since the 1990s and it is meanwhile an actively used therapy for the disease in many urological departments worldwide. Since 2000 HIFU is mostly used in combination with transurethral resection of the prostate in order to reduce prostate gland size, to facilitate effective tissue destruction and to avoid side effects. Palliative and salvage indications as well as focal therapy of prostate cancer are under investigation to extend the spectrum of HIFU indications for non invasive prostate cancer therapy.     

High-intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after external beam radiation, brachytherapy or proton therapy

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment. This study showed a long‐term follow up of salvage HIFU in men with recurrence of localized prostate cancer following not only external beam radiation therapy but also brachytherapy or proton therapy.

OBJECTIVE

To investigate the use of high‐intensity focused ultrasound (HIFU) as a salvage therapy in patients with recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy.

PATIENTS AND METHODS

We retrospectively reviewed the charts of all patients who had undergone salvage HIFU for biopsy‐proven prostate cancer after primary radiation therapy. Patient characteristics and oncological outcomes were assessed.

RESULTS

Records of 22 patients with a median (range) follow‐up of 24 (5–80) months were reviewed. Patients were men with presumed organ‐confined disease who had been treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high‐dose brachytherapy using In¹⁹²; and one with low‐dose brachytherapy using Au⁹⁸) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52–80) years, with a median (range) prostate‐specific antigen (PSA) level before radiation therapy of 14.3 (5.7–118) ng/mL and a median (range) PSA level of 4.0 (1.2–30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4–96) months. The biochemical disease‐free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low‐, intermediate‐ and high‐risk groups were 100%, 86%, and 14%, respectively. One of the twelve patients who received post‐HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient.

CONCLUSION

Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment.     

高强度聚焦超声治疗VX2骨肿瘤的免疫变化

目的　探讨高强度聚焦超声 (HIFU )治疗骨肿瘤前后的免疫学变化。方法　将新西兰大白兔分为HIFU治疗组 (2 3只 )及正常对照组 (10只 ) ,对HIFU治疗组兔建立VX2移植性骨肿瘤模型 ,2周后接受HIFU治疗 ,于不同时间处死 ,免疫组织化学染色观察HSP70表达的变化 ,并在治疗前后抽血检测CD2 5变化。结果　治疗前肿瘤组织HSP70阳性表达细胞数量少 ,治疗后即刻直到 2 1d一直呈强阳性表达且阳性表达的细胞数明显增加。治疗前CD2 5为 7.83± 2 .0 3与正常兔 13 .18± 3 .47比较差异有显著性 (P <0 .0 5 ) ;治疗后增高为 15 .5 5± 2 .69,与治疗前比较差异有非常显著性 (P <0 .0 1)。结论　HIFU治疗后骨恶性肿瘤组织HSP70、CD2 5的数量增多 ,可递呈特异性抗原给T细胞 ,刺激T细胞增殖 ,提高机体抗肿瘤的免疫作用     

La thérapie par ultrasons focalisés : état actuel et applications potentielles en neurochirurgie

High Intensity Focused Ultrasound (HIFU) therapy is an innovative approach for tissue ablation, based on high intensity focused ultrasound beams. At the focus, HIFU induces a temperature elevation and the tissue can be thermally destroyed. In fact, this approach has been tested in a number of clinical studies for the treatment of several tumors, primarily the prostate, uterine, breast, bone, liver, kidney and pancreas. For transcranial brain therapy, the skull bone is a major limitation, however, new adaptive techniques of phase correction for focusing ultrasound through the skull have recently been implemented by research systems, paving the way for HIFU therapy to become an interesting alternative to brain surgery and radiotherapy.