Transcatheter and Ablative Therapeutic Approaches for Solid Malignancies

2007 ◽  
Vol 25 (8) ◽  
pp. 978-986 ◽  
Author(s):  
Eleni Liapi ◽  
Jean-Francois H. Geschwind
Keyword(s):  
Focused Ultrasound ◽  
Local Tumor Control ◽  
High Intensity Focused Ultrasound ◽  
Tumor Control ◽  
Curative Intent ◽  
Medline Search ◽  
Ablative Therapies ◽  
Technological Advances ◽  
Solid Malignancies ◽  
Bland Embolization

The purpose of this article is to present in a concise manner an overview of the most widely used locoregional transcatheter and ablative therapies for solid malignancies. An extensive MEDLINE search was performed for this review. Therapies used for liver cancer were emphasized because these therapies are used most commonly in the liver. Applications in pulmonary, renal, and bone tumors were also discussed. These approaches were divided into catheter-based therapies (such as transcatheter arterial chemoembolization, bland embolization, and the most recent transcatheter arterial approach with drug-eluting microspheres), ablative therapies (such as chemical [ethanol or acetic acid injection]), and thermal ablative therapies (such as radiofrequency ablation, laser induced thermotherapy, microwave ablation, cryoablation, and extracorporeal high-intensity focused ultrasound ablation). A brief description of each technique and analysis of available data was reported for all therapies. Locoregional transcatheter and ablative therapies continue to be used mostly for palliation, but have also been used with curative intent. A growing body of evidence suggests clear survival benefit, excellent results regarding local tumor control, and improved quality of life. Clinical trials are underway to validate these results. Image-guided transcatheter and ablative approaches currently play an important role in the management of patients with various types of cancer—a role that is likely to grow even more given the technological advances in imaging, image-guidance systems, catheters, ablative tools, and drug delivery systems. As a result, the outcomes of patients with cancer undoubtedly will improve.

scholarly journals HIFU for Bone Metastases and other Musculoskeletal Applications

2018 ◽  
Vol 35 (04) ◽  
pp. 261-267 ◽  
Author(s):  
Michele Anzidei ◽  
Alberto Bazzocchi ◽  
Cesare Gagliardo ◽  
Carlo Catalano ◽  
Alessandro Napoli ◽  
...  
Keyword(s):  
Bone Metastases ◽  
High Intensity ◽  
Focused Ultrasound ◽  
Facet Joint ◽  
Local Tumor Control ◽  
High Intensity Focused Ultrasound ◽  
Low Flow ◽  
Tumor Control ◽  
Ultrasound Waves ◽  
Tissue Heating

AbstractHigh-intensity focused ultrasound (HIFU) is a totally noninvasive procedure that has shown promising results in the management of numerous malignant and nonmalignant conditions. Under magnetic resonance or ultrasound guidance, high-intensity ultrasound waves are focused on a small, well-defined target region, inducing biologic tissue heating and coagulative necrosis, thus resulting in a precise and localized ablation. This treatment has shown both great safety and efficacy profiles, and may offer a multimodal approach to different diseases, providing pain palliation, potential local tumor control, and, in some cases, remineralization of trabecular bone. In musculoskeletal field, HIFU received FDA approval for treating bone metastasis, but its application has also been extended to other conditions, such as osteoid osteoma, desmoid tumor, low-flow vascular malformation, and facet joint osteoarthritis. This article illustrates the basic principles of HIFU and its main effects on biologic tissues with particular attention on bone, provides a step-by-step description of the HIFU procedure, and discusses the commonly treated conditions, in particular bone metastases.

scholarly journals Advanced Pancreatic Cancer: High-Intensity Focused Ultrasound (HIFU) and Other Local Ablative Therapies

2019 ◽  
Vol 191 (03) ◽  
pp. 216-227 ◽  
Author(s):  
Milka Marinova ◽  
Timo Wilhelm-Buchstab ◽  
Holger Strunk
Keyword(s):  
Pancreatic Cancer ◽  
Focused Ultrasound ◽  
Advanced Pancreatic Cancer ◽  
High Intensity Focused Ultrasound ◽  
Treatment Modalities ◽  
Mass Reduction ◽  
Local Tumor ◽  
Tumor Mass ◽  
Ablative Therapies

Background Locally advanced pancreatic cancer is a life-limiting tumor with a wide range of incapacitating symptoms such as cancer-associated pain. Several local ablative therapies with both thermal and non-thermal sources have recently received significant attention as modern treatment options for local tumor control and symptomatic improvement. The following review article provides an overview of currently available techniques and their outcomes including our own experience with high-intensity focused ultrasound (HIFU) being one of the most exciting and innovative modalities. Method Our experiences with HIFU treatment are based on 89 pancreatic cancer patients (UICC III-IV). Outcomes such as treatment-related changes in symptoms particularly in cancer pain and quality of life as well as local tumor response, safety and survival were compared to reported studies concerning HIFU, radiofrequency and microwave ablation, cryoablation, irreversible electroporation and stereotactic body radiation therapy. Results Even though all strategies appeared to be feasible, the unique feature of noninvasiveness represents a substantial advantage of the HIFU procedure. In 85 % of HIFU-treated patients, long-lasting pain relief was achieved. 50 % of patients did not require any analgesic treatment 6 weeks post-ablation. Unfortunately, pain palliation and quality-of-life outcomes are only rarely reported for other local treatment modalities. Tumor mass reduction could be achieved with all ablative therapies, with a mean tumor volume reduction of 60 % after 6 months in HIFU-treated pancreatic tumors. Differences in treatment-associated morbidity were reported. However, they are only partially comparable due to unbalanced study populations. Conclusion Various local ablative treatment modalities are available and feasible for tumor mass reduction of advanced pancreatic cancer but with different symptomatic benefit for patients. An effective and long-lasting reduction of cancer-related pain was observed following HIFU without insertion of needles or electrodes. Randomized controlled studies for head-to-head comparison of these modalities are warranted in the near future. Key points:  Citation Format

Tumor vessel destruction resulting from high-intensity focused ultrasound in patients with solid malignancies

2002 ◽  
Vol 28 (4) ◽  
pp. 535-542 ◽  
Author(s):  
Feng Wu ◽  
Wen-Zhi Chen ◽  
Jin Bai ◽  
Jian-Zhong Zou ◽  
Zhi-Long Wang ◽  
...  
Keyword(s):  
High Intensity ◽  
Focused Ultrasound ◽  
High Intensity Focused Ultrasound ◽  
Tumor Vessel ◽  
Solid Malignancies

scholarly journals Assessment of histopathological features of needle biopsy in recurrent prostate cancer following salvage high-intensity focused ultrasound

2016 ◽  
Vol 10 (11-12) ◽  
pp. 416 ◽  
Author(s):  
Michele Billia ◽  
Khurram M. Siddiqui ◽  
Susanne Chan ◽  
Fan Li ◽  
Ali Al-Zahrani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Focused Ultrasound ◽  
Clinical Decision Making ◽  
Morphological Changes ◽  
High Intensity Focused Ultrasound ◽  
Gleason Grade ◽  
Curative Intent ◽  
Histopathological Features ◽  
Biopsy Specimens ◽  
Daunting Task

Introduction: Local recurrence of prostate cancer (PCa) following radiotherapy may be treated with curative intent using salvage highintensity focused ultrasound (s-HIFU). The interpretation of needle core biopsy specimens following s-HIFU is a daunting task, even for experienced pathologists. We describe various histopathological features encountered in biopsy specimens following whole-gland s-HIFU in one of the largest descriptive studies to date.Methods: Fifty-five patients with biopsy-proven localized radiorecurrent PCa underwent s-HIFU and transrectal ultrasound (TRUS)- guided prostatic needle biopsies at 180 days post-treatment. All biopsies were reviewed by two genitourinary pathologists.Results: PCa was detected in 11 (24%) biopsies. Radiation therapyassociated changes were identified in all cases. Additional findings included extensive coagulative stromal necrosis (100%), smudgy chromatin of cancer nuclei (82%), and markedly enlarged bizarre nuclei in the residual cancer (55%). Gleason grade assignment was possible in 10 (91%) of these biopsies and concordance of Gleason grading between pre- and post-therapy specimens was observed in six (60%) cases.Conclusions: The histological interpretation of needle biopsies following salvage HIFU is challenging and requires an understanding of the histopathological changes associated with this procedure in both tumoural and non-tumoural prostatic tissue. Accurate interpretation of the morphological changes following s-HIFU is instrumental for optimization of clinical decision-making and treatment planning in recurrent PCa.

Primary Pain Palliation and Local Tumor Control in Bone Metastases Treated With Magnetic Resonance-Guided Focused Ultrasound

2013 ◽  
Vol 48 (6) ◽  
pp. 351-358 ◽  
Author(s):  
Alessandro Napoli ◽  
Michele Anzidei ◽  
Beatrice Cavallo Marincola ◽  
Giulia Brachetti ◽  
Federica Ciolina ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Bone Metastases ◽  
Focused Ultrasound ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Pain Palliation ◽  
Local Tumor

scholarly journals Targeted therapy in advanced desmoid tumors: Current perspectives

2020 ◽  
Vol 11 (3) ◽  
pp. 9-16
Author(s):  
Amrallah A. Mohammed ◽  
Hani EL-Tanni ◽  
Hani M. EL-Khatib
Keyword(s):  
Targeted Therapy ◽  
Treatment Options ◽  
Aggressive Fibromatosis ◽  
Local Tumor Control ◽  
The Body ◽  
Treatment Modalities ◽  
Tumor Control ◽  
Desmoid Tumors ◽  
Treatment Needs ◽  
Medline Search

Abstract Background Desmoid tumors/aggressive fibromatosis (DTs/AF) are cytological bland fibrous neoplasms originating from the musculoaponeurotic structures throughout the body. The exact cause still remains unknown, however, they may present sporadically or as a manifestation of a hereditary syndrome called familial adenomatous polyposis (FAP). Although they lack the capacity to establish metastases, DTs/AF may be devastated and occasionally fatal. As a result of the heterogeneity of DTs/AF, treatment needs to be individualized to improve local tumor control and maintain patients’ quality of life. Therefore, after a multidisciplinary approach, all treatment options should be discussed with patients. Where systemic chemotherapy has been shown to be unsuccessful with marked side effects in case of advanced DTs/AF, new therapeutic options are needed. Methods A Medline search was conducted and published articles in different studies from 2000 to the present were reviewed. Conclusion More research is needed to illustrate both the prognostic and predictive factors of the targeted therapy and the value of their combinations with or without other treatment modalities to get the best result for the treatment of advanced DTs/AF.

scholarly journals Electrochemotherapy: A Review of Current Status, Alternative IGP Approaches, and Future Perspectives

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Nazila Esmaeili ◽  
Michael Friebe
Keyword(s):  
Practical Method ◽  
Local Tumor Control ◽  
Current Status ◽  
Tumor Control ◽  
Future Perspectives ◽  
Curative Intent ◽  
Treatment Techniques ◽  
Electrical Pulses ◽  
Nonthermal Treatment ◽  
Pharmaceutical Agents

The efficiency of electroporation (EP) has made it a widely used therapeutic procedure to transfer cell killing substances effectively to the target site. A lot of researches are being done on EP-based cancer treatment techniques. Electrochemotherapy (ECT) is the first EP-based application in the field of drug administration. ECT is a local and nonthermal treatment of cancer that combines the use of a medical device with pharmaceutical agents to obtain local tumor control in solid cancers. It involves the application of eight, 100µs, pulses at 1 or 5000 Hz frequency and specified electric field (V/cm) with a median duration of 25 minutes. The efficacy of chemotherapeutic drugs increases by applying short and intense electrical pulses. Several clinical studies proposed ECT as a safe and complementary curative or palliative treatment option (curative intent of 50% to 63% in the treatment of Basal Cell Carcinoma (BCC)) to treat a number of solid tumors and skin malignancies, which are not suitable for conventional treatments. It is used currently for treatment of cutaneous and subcutaneous lesions, without consideration of their histology. On the contrary, it is also becoming a practical method for treatment of internal, deep-seated tumors and tissues. A review of this method, needed instruments, alternative image-guided procedures (IGP) approaches, and future perspectives and recommendations are discussed in this paper.

scholarly journals Magnetic resonance–guided, high-intensity focused ultrasound sonolysis: potential applications for stroke

2018 ◽  
Vol 44 (2) ◽  
pp. E12 ◽  
Author(s):  
Adeel Ilyas ◽  
Ching-Jen Chen ◽  
Dale Ding ◽  
Andrew Romeo ◽  
Thomas J. Buell ◽  
...  
Keyword(s):  
High Intensity ◽  
Focused Ultrasound ◽  
Therapeutic Option ◽  
High Intensity Focused Ultrasound ◽  
Clot Lysis ◽  
Vessel Occlusion ◽  
Technological Advances ◽  
Stroke Models

Stroke is one of the leading causes of death worldwide and a significant source of long-term morbidity. Unfortunately, a substantial number of stroke patients either are ineligible or do not significantly benefit from contemporary medical and interventional therapies. To address this void, investigators recently made technological advances to render transcranial MR-guided, high-intensity focused ultrasound (MRg-HIFU) sonolysis a potential therapeutic option for both acute ischemic stroke (AIS)—as an alternative for patients with emergent large-vessel occlusion (ELVO) who are ineligible for endovascular mechanical thrombectomy (EMT) or as salvage therapy for patients in whom EMT fails—and intracerebral hemorrhage (ICH)—as a neoadjuvant means of clot lysis prior to surgical evacuation. Herein, the authors review the technological principles behind MRg-HIFU sonolysis, its results in in vitro and in vivo stroke models, and its potential clinical applications. As a noninvasive transcranial technique that affords rapid clot lysis, MRg-HIFU thrombolysis may develop into a therapeutic option for patients with AIS or ICH. However, additional studies of transcranial MRg-HIFU are necessary to ascertain the merit of this treatment approach for thrombolysis in both AIS and ICH, as well as its technical limitations and risks.

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