Biomedical Engineering Reference
In-Depth Information
15
Extracorporeal Ultrasound-Guided
High-Intensity Focused Ultrasound
Ablation for Cancer Patients
15.1 Clinical History of High-Intensity Focused Ultrasound Tumor Ablation .....................255
15.2 Physical Principles of HIFU Ablation ................................................................................. 256
15.3 Biological Effects of Thermal Ablation on Tumor ............................................................ 257
Direct Thermal and Nonthermal Effects on Tumor • Thermal Effects on Tumor
Vasculature • Secondary Effects on Tumor • Antitumor Immune Response after HIFU
Treatment
15.4 HIFU Therapeutic Plan ......................................................................................................... 259
Pre-HIFU Planning • Imaging for HIFU Planning • Tumor Volume
Localization • Acoustic Path for Ultrasound Energy Entry • Ultrasonic Properties of
Overlying Tissues • Therapeutic Planning Using US-Guided HIFU Device
15.5 HIFU 3-D Conformal Therapy ............................................................................................. 262
15.6 Medical Imaging in HIFU Ablation .................................................................................... 263
Medical Images Used in HIFU • Medical Imaging for HIFU Planning • Ultrasound Imaging
for HIFU Procedure • Follow-Up Imaging for Assessment of HIFU Ablation
15.7 Clinical Applications of Extracorporeal US-Guided HIFU for Solid Malignancies ... 266
Purposes of HIFU Therapy • Anesthesia Selection for HIFU Therapy • HIFU
Therapy for Liver Cancer • HIFU Therapy for Breast Cancer • HIFU Therapy for
Bone Malignancy • HIFU Therapy for Renal Cancer • HIFU Therapy for Pancreatic
Cancer • HIFU Therapy for Soft Tissue Sarcoma
15.8 Conclusions...............................................................................................................................271
References ............................................................................................................................................ 272
Feng Wu
Chongqing Medical University
and University of Oxford
15.1 Clinical History of High-Intensity
Focused Ultrasound tumor ablation
Using thermal energy to treat human neoplasms in clinics has
a long history. It was reported that approximately five thou-
sand years ago, physicians in Egypt used cautery with heated
implements to destroy tumors [1]. In the past two decades,
high-intensity focused ultrasound (HIFU) has been developed
noninvasively to treat patients with solid tumors. It provides
a thermal ablation for the precise and complete destruction of
entire tumors in a three-dimension conformal fashion, with
almost no limitation of tumor size and shape. This thermal
therapy is attractive to both patients and physicians due to being
less invasive with no incision, less scarring, cheap, less pain, and
short recovery time. These technological advances result in an
associated reduction in mortality, morbidity, hospital stay, and
cost, and improved quality of life for cancer patients, initiating a
change from open surgery toward less invasive techniques in the
treatment of tumors [2-5].
The concept of using HIFU as a noninvasive therapy for
destroying diseased tissues dates back about 70 years. In 1942,
Lynn and colleagues reported for the first time that HIFU could
cause tissue destruction with no damage to overlying and sur-
rounding tissues [6]. In the 1950s and 1960s, William and Frank
Fry at the University of Illinois in Champaign-Urbana, Illinois,
did most of the early HIFU research work. They found that the
lesion induced with HIFU exposure was well circumscribed.
HIFU could successfully produce lesions deep in the brain of
animals such as cat and monkey [7,8], and subsequently treated
patients with Parkinson's disease and other neurological condi-
tions after removing a piece of skull to create an “acoustic win-
dow” [9]. Early reports were encouraging in the treatment of
Parkinson's disease. In the 1970s, Fred Lizzi and colleagues at
the Riverside Research Institute in New York put considerable
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