高强度聚焦超声治疗晚期胰腺癌

目的寻求胰腺癌局部治疗新方法,探讨高强度聚焦超声(HIFU)治疗胰腺癌的安全性、有效性及可行性.方法应用高强度聚焦超声治疗胰腺癌25例,其中7例给予术后化疗.结果治疗后临床症状缓解,MRI和彩色超声检查示肿瘤内血供减少,甚至消失,近期生存时间延长.结论高强度聚焦超治疗胰腺癌是安全、有效、可行的.     

高强度聚焦超声治疗胰腺癌的研究现状

胰腺癌的诊治目前仍是医学界的难题。高强度聚焦超声（HIFU）是一种新兴的非侵入性肿瘤治疗技术,它通过热效应使靶组织发生凝固性坏死而不损伤周围正常组织。目前临床上已将HIFU技术用于治疗胰腺癌,并被认为是安全可行的,本文就近年来HIFU在胰腺癌治疗中的应用作一综述。     

高强度聚焦超声治疗晚期胰腺癌的临床观察

目的 探讨高强度聚焦超声（HIFU）治疗晚期胰腺癌的疗效和安全性。方法 对41 例晚期胰腺癌患者行HIFU 治疗,观察治疗前后的影像学变化及临床症状,评价HIFU 治疗的近期有效率（RR）、临床受益率（CBR）、生存期及不良反应。结果 全组RR 为29.3%, CBR 85.4%,中位生存期6.7 个月（3.5～10.8 个月）,未发生皮肤烧伤、胰腺炎、胃肠道损伤等并发症。结论 HIFU 是一种治疗胰腺癌的有效方法,具有无创和较高的安全性,应用范围广,适合病情较重、不能耐受其他方法治疗的患者。     

高强度体外聚焦超声热疗治疗晚期胰腺癌近期疗效观察

目的：初步探讨高强度体外聚焦超声（high intensity focused ultrasound,HIFU)热疗治疗晚期胰腺癌的疗效及安全性。方法：13例晚期胰腺癌共接受91次（平均7次）HIFU治疗、其中4例同时应用小剂量5－FU单药化疗。结果：CR2例、PR4例，有效率46．2％；临床受益反应率（clinical benefit response,CBR)高达92．3％；中位生存期7．0个月；除1例HIFU治疗后5个月出现阻塞性黄疸外，未见其他副作用。结论：HIFU治疗晚期胰腺癌能取得一定的疗效，治疗安全性高，值得临床进一步观察研究。     

高强度聚焦超声治疗胰腺癌、肝癌的研究进展

高强度聚焦超声(HIFU)技术历经近二十年的发展已日趋成熟,逐渐得到临床医师的认可,临床应用日益广泛.消化系统肿瘤的发病率、病死率一直居高不下,根治性手术仍是其首选治疗方案,其次是姑息性治疗,包括放疗、化疗、介入、靶向、免疫、中医中药治疗等,HIFU具有无创、安全、有效、可重复等特点,因此其在消化系统肿瘤治疗中日益受到...     

高强度聚焦超声治疗晚期胰腺癌的疗效分析

目的探讨高强度聚焦超声(HIFU)治疗晚期胰腺癌的疗效及安全性。方法对64例晚期胰腺癌进行HIFU治疗。结果 5例(7.8%)完全缓解(CR),20例(31.2%)部分缓解(PR),15例(23.4%)稳定(SD),有效率达62.4%;患者均未见明显不良反应。结论 HIFU治疗晚期胰腺癌有一定疗效,安全性高,患者无痛苦、并发症,值得临床进一步观察研究。     

胰腺癌高强度聚焦超声治疗对全身炎症反应的影响

目的:分析胰腺癌患者高强度聚焦超声（HIFU）治疗后全身炎症反应的情况。方法:筛选符合入组条件的患者34例,根据是否在HIFU治疗前2周内行化疗分为化疗组与未化疗组。统计患者HIFU治疗前后外周静脉血中白细胞（WBC）、中性粒细胞（NE）、淋巴细胞（LY）、C反应蛋白（CRP）及肿瘤坏死因子-α（TNF-α）数值;利用SPSS 20.0统计软件分析各项指标变化;Kaplan-Meier法绘制生存曲线;Cox回归法分析影响生存时间的独立预后因素。结果:34例患者外周静脉血中WBC、NE和TNF-α在HIFU 治疗前后的差异无统计学意义（P=0.146、P=0.053、 P=0.628）,LY和CRP在HIFU治疗前后差异显著（P=0.002、P=0.002）;多因素Cox回归分析结果示WBC、NE、LY、CRP和TNF-α各指标变化不是HIFU治疗后生存时间的独立预后因素（P=0.169、P=0.757、P=0.884、P=0.161、P=0.950）;分层分析显示,化疗组（P=0.038）及未化疗组（P=0.039）CRP在HIFU 治疗前后均有统计学差异,但治疗前后CRP的差值在化疗与未化疗组间并无差异（P=0.97）。结论:胰腺癌HIFU治疗会导致体内轻度炎症反应,不影响患者生存时间,是否行化疗对HIFU相关炎症反应无显著影响。     

高强度聚焦超声与伽玛刀治疗晚期胰腺癌的对比观察*

目的：本研究主要对比观察高强度聚焦超声（HIFU）与伽玛刀治疗伴有癌痛的晚期胰腺癌疗效和不良反应。方法：回顾性分析武警上海总队医院2006年3 月至2008年10月收治晚期胰腺癌患者80例,其中26例（A 组）为HIFU治疗,54例（B 组）为伽玛刀治疗。对比评价两组的近期有效率（CR+PR）、平均生存期、临床受益率（CBR ）及不良反应。CBR 评价标准：疼痛程度减轻≥50% ,持续4 周以上;止痛药用量减少≥50% ,持续4 周以上;Karnofsky 评分增加≥20% ,持续4 周以上,体重增加7% 。结果：两组的平均生存期分别为（5.6 ± 4.1）个月及（5.4 ± 3.6）个月。A 组近期有效率26.9% ,B 组24.1% ,两组无显著性差异。A 组CBR 为84.6% ,B 组为57.4% 。两组比较差异有统计学意义（P=0.022）。 主要不良反应为：骨髓抑制,恶心,呕吐。A 组的不良反应明显小于B 组（P=0.040）。 结论：高强度聚焦超声与伽玛刀均是治疗晚期胰腺癌的安全、有效的治疗方法。HIFU与伽玛刀治疗的近期疗效与远期疗效相似,但在改善患者疼痛、体力状态等方面优于伽玛刀。在两者的不良反应上,HIFU治疗的骨髓抑制、消化道反应等方面均明显低于伽玛刀。提示HIFU可以应用于一般状况更差的患者。     

高强度聚焦超声消融在胰腺癌治疗中的现状与展望

胰腺癌具有早期侵袭性生长和远处转移的特性,起病隐匿,发现时多属于中晚期,手术切除是胰腺癌唯一可以根治的方法。如何提高手术切除率和生存率一直是胰腺癌临床治疗     

调强放疗联合高强度超声聚焦刀治疗中晚期胰腺癌的疗效观察

目的探讨调强放疗联合高强度超声聚焦刀（HIFU）治疗中晚期胰腺癌的治疗效果。方法 30例中晚期胰腺癌患者接受调强放疗联合HIFU,观察其疗效。结果疼痛减轻18例,黄疸、厌食减轻16例,CA199水平均有下降,其中8例恢复正常。中位生存期10.2个月。结论调强放疗联合HIFU治疗中晚期胰腺癌能有效缓解症状,延长生存期,是无法手术中晚期胰腺癌患者较好的治疗方式。     

The Efficacy of High-Intensity Focused Ultrasound （HIFU） in Advanced Pancreatic Cancer

OBJECTIVE To observe the efficacy of high-intensity focused ultrasound (HIFU) in the treatment of late-stage pancreatic cancer. METHODS Sixteen patients with advanced pancreatic cancer received HIFU therapy.Evaluation of efficacy was made on the basis of changes in clinical symptoms and variations in the tumor echo and size. RESULTS Clinical symptoms such as pain were significantly alleviated,echo of the tumor was enhanced with B-US and the quality of life such as eating,sleeping and mental status was markedly improved;no serious complications were observed. CONCLUSION The use of HIFU in the treatment of advanced pancreatic cancer is feasible and safe.It is effective in killing the carcinoma cells and alleviating pain.This technique may offer non-invasive therapy for the treatment of patients with late-stage pancreatic cancer.     

Advances of high intensity focused ultrasound (HIFU) for pancreatic cancer

Abstract

High intensity focused ultrasound (HIFU) is a novel therapeutic modality. Several preclinical and clinical studies have investigated the safety and efficacy of HIFU for treating solid tumours, including pancreatic cancer. Preliminary studies suggest that HIFU may be useful for the palliative therapy of cancer-related pain in patients with unresectable pancreatic cancer. This review provides a brief overview of HIFU, describes current clinical applications of HIFU for pancreatic cancer, and discusses future applications and challenges.     

Extracorporeal High-Intensity Focused Ultrasound Treatment for Breast Cancer

OBJECTIVE To evaluate the clinical safety and efficacy of using highintensity focused ultrasound (HIFU) therapy, for breast cancer, and to select the appropriate methods in evaluating the therapeutic effects.METHODS A total of 24 patients with breast cancer underwent HIFU treatment 1-2 weeks before receiving modified radical mastectomy. During and after HIFU therapy, changes in blood pressure, breath, pulse and peripheral blood oxygen saturation were monitored. At the same time, the damage of the skin and tissue produced by HIFU at the target region was evaluated as well. Surgically excised samples were used for pathological examinations to evaluate the HIFU-induced destruction of the targeted tissue. Three patients received Tc-ECT and 1 MRI examinations before and after HIFU.RESULTS HIFU treatment had no apparent influence on either the tissue nearby the target or on vital signs of the patients. Pathological, tc-ECT and MRI examinations demonstrated that targeted tissue showed complete coagulative necrosis.CONCLUSION Under the guidance of real-time ultrasonic imaging, HIFU can effectively and safely destroy the breast cancer mass and ^99MTc-ECT and MRI examination can be utilized to evaluate the therapeutic effects.HIFU may become one of the options for breast cancer therapy in the future.     

高强度聚焦超声与替吉奥联合治疗晚期胰腺癌的临床观察

目的:探讨高强度聚焦超声肿瘤消融与口服替吉奥联合治疗晚期胰腺癌的疗效。方法:将43例晚期胰腺癌患者随机分为高强度聚焦超声治疗组和高强度聚焦超声＋替吉奥治疗组,观察不良反应和疗效。结果:高强度聚焦超声、高强度聚焦超声＋替吉奥的近期有效率分别为: 22.73％（5/22）和52.38%（11/21）,联合治疗的效果明显优于单纯治疗（P<0.05）;临床获益反应率分别为81.82％（18/22）和76.19%（16/21）,两组无明显差异（P>0.05）;不良反应方面,接受高强度聚焦超声治疗的患者明显少于联合使用替吉奥的患者（P<0.05）;中位生存期分别为7.6和13.6个月,接受联合使用替吉奥治疗的患者生存期明显优于仅接受高强度聚焦超声治疗的患者（P<0.05）。结论:在高强度聚焦超声治疗的基础上,联合口服替吉奥治疗晚期胰腺癌患者治疗效果更好。     

A randomised clinical trial of high-intensity focused ultrasound ablation for the treatment of patients with localised breast cancer

High-intensity focused ultrasound (HIFU) is a noninvasive treatment that induces complete coagulative necrosis of a tumour at depth through the intact skin. This study was to explore the possibility of using HIFU for the treatment of patients with localised breast cancer in a controlled clinical trial. A total of 48 women with biopsy-proven breast cancer (T(1-2), N(0-2), M0) were randomised to the control group in which modified radical mastectomy was performed, and the HIFU group in which an extracorporeal HIFU ablation of breast cancer was followed by modified radical mastectomy. Short-term follow-up, pathologic and immunohistochemical stains were performed to assess the therapeutic effects on tumour and complications of HIFU. The results showed that no severe side effect was observed in the HIFU-treated patients. Pathologic findings revealed that HIFU-treated tumour cells underwent complete coagulative necrosis, and tumour vascular vessels were severely damaged. Immunohistochemical staining showed that no expression of PCNA, MMP-9, and CD44v6 was detected within the treated tumour cells in the HIFU group, indicating that the treated tumour cells lost the abilities of proliferation, invasion, and metastasis. It is concluded that, as a noninvasive therapy, HIFU could be effective, safe, and feasible in the extracorporeal treatment of localised breast cancer.     

The clinical efficacy of percutaneous ethanol-lipiodol injection (PEI) combined with high-intensity focused ultrasound (HIFU) for small hepatocellularcarcinoma in special or high-risk locations

Objective The objective of this study was to explore the short-term effects and postoperative complications of ultrasound-guided percutaneous ethanol-lipiodol injection (PEI) combined with high-intensity focused ultrasound (HIFU) for the treatment of small hepatocellular carcinoma in a special or high-risk location. Methods Forty patients with small liver cancer in a special or high-risk location were randomly divided into two groups: 20 patients were treated with PEI combined with HIFU (P + H group), and 20 patients were treated with HIFU alone (H group). There were no significant differences in average age, liver function, tumor location, tumor number, or tumor size between the two groups (P > 0.05). Results Significant differences were observed in ablation parameters between the two groups (P < 0.05). Under the same power, ablation rates of the P + H group were significantly higher than those in the H group, and postoperative complications in the P + H group were significantly lower than those in the H group (P < 0.05). Conclusion The combination of PEI and HIFU has better clinical value than HIFU alone for small-cell liver cancer in special or high-risk locations.     

Novel Therapeutic Method for Unresectable Pancreatic Cancer—The Impact of the Long-Term Research in Therapeutic Effect of High-Intensity Focused Ultrasound (HIFU) Therapy

High-intensity focused ultrasound (HIFU) is a novel advanced therapy for unresectable pancreatic cancer (PC). HIFU therapy with chemotherapy is being promoted as a novel method to control local advancement by tumor ablation. We evaluated the therapeutic effects of HIFU therapy in locally advanced and metastatic PC. PC patients were treated with HIFU as an optional local therapy and systemic chemotherapy. The FEP-BY02 (Yuande Bio-Medical Engineering) HIFU device was used under ultrasound guidance. Of 176 PC patients, 89 cases were Stage III and 87 were Stage IV. The rate of complete tumor ablation was 90.3%, while that of symptom relief was 66.7%. The effectiveness on the primary lesions were as follows: complete response (CR): n = 0, partial response (PR): n = 21, stable disease (SD): n = 106, and progressive disease (PD): n = 49; the primary disease control rate was 72.2%. Eight patients underwent surgery. The median survival time (MST) after diagnosis for HIFU with chemotherapy compared to chemotherapy alone (100 patients in our hospital) was 648 vs. 288 days (p < 0.001). Compared with chemotherapy alone, the combination of HIFU therapy and chemotherapy demonstrated significant prolongation of prognosis. This study suggests that HIFU therapy has the potential to be a novel combination therapy for unresectable PC.     

Simulation of non-linear acoustic field and thermal pattern of phased-array high-intensity focused ultrasound (HIFU)

Purpose: HIFU becomes an effective and non-invasive modality of solid tumour/cancer ablation. Simulation of the non-linear acoustic wave propagation using a phased-array transducer in multiple layered media using different focusing strategies and the consequent lesion formation are essential in HIFU planning in order to enhance the efficacy and efficiency of treatment.

Materials and methods: An angular spectrum approach with marching fractional steps was applied in the wave propagation from phased-array HIFU transducer, and diffraction, attenuation, and non-linearity effects were accounted for by a second-order operator splitting scheme. The simulated distributions of the first three harmonics along and transverse to the transducer axis were compared to the hydrophone measurements. The bioheat equation was used to simulate the subsequent temperature elevation using the deposited acoustic energy, and lesion formation was determined by the thermal dose.

Results: Better agreement was found between the measured harmonics distribution and simulation using the proposed algorithm than the Khokhlov–Zabozotskaya–Kuznetsov equation. Variable focusing of the phased-array transducer (geometric focusing, transverse shifting and the generation of multiple foci) can be simulated successfully. The shifting and splitting of focus was found to result in significantly less temperature elevation at the focus and the subsequently, the smaller lesion size, but the larger grating lobe grating lobe in the pre-focal region.

Conclusions: The proposed algorithm could simulate the non-linear wave propagation from the source with arbitrary shape and distribution of excitation through multiple tissue layers in high computation accuracy. The performance of phased-array HIFU can be optimised in the treatment planning.