High Intensity Focused Ultrasound (HIFU) in Hepatology
HIFU is a new type of cancer treatment using a machine that gives off high frequency sound waves, which deliver a strong beam to a specific part of a cancer.Some cells die when this high intensity ultrasound beam is focused directly onto them, without harming surrounding structures.
It is commercially available only for a few applications, namely uterine fibroid treatment (the sole FDA approved device) and prostate treatment. A lot of work is currently done for developing this technique to treat other organs, especially the liver.
Small tumours can generally be destroyed in one session, but large tumours may require more than one session. There are advantages in some cases to combine HIFU with other medical treatments. It is normal to follow up the HIFU treatment with one or more MRI scans to confirm the destruction of the tumour.There is no evidence of side effects of diagnostic ultrasound. With HIFU there have been occasions when the skin has been affected by the equivalent of a mild sunburn, which clears up in a matter of days.
HIFU treatment can stimulate the immune system. In some treated patients, tumours that were not directly targeted have become smaller, and even disappeared. There is also evidence from Europe, where HIFU is being used to treat prostate cancer, of a similar immune response.
To be treatable with HIFU a tumour must be "lumpy" and in a position where it is visible using imaging ultrasound. There must be a clear path for the HIFU through to the tumour. Cancers near the surface of the skin are not treated, owing to the danger of skin damage. A decision on whether or not a tumour is treatable will be made before treatment commences.
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Studies and publications regarding HIFU
- Hiroyuki Fukuda, Taketo Yamaguchi, Seigo Yukisawa, et al. US-guided high intensity focused ultrasound for the treatment for liver tumours. ISTU 2007
- Feng Wu. Extracorporeal high intensity focused ultrasound in the treatment of patients with solid malignancy. Minimally Invasive Therapy. 2006; 15:1; 26–35.
- RO Illing, JE Kennedy, F Wu, et al. The safety and feasibility of extracorporeal high-intensity focused ultrasound (HIFU) for the treatment of liver and kidney tumours in a Western population. British Journal of Cancer (2005) 93, 890 – 895.
- Kennedy JE. High intensity focused ultrasound in the treatment of solid tumours. Nature Reviews Cancer 2005; 5(4): 321-327.
- Wu F, Wang ZB, Chen WZ, et al. Extracorporeal high intensity focused ultrasound ablation in the treatment of patients with large hepatocellular carcinoma. Ann Surg Oncology 2004; 11 (12): 1061-1069.
- Li CX, Xu GL, Jiang ZY, et al. Analysis of clinical effect of high-intensity focused ultrasound on liver cancer. World J Gastroenterol 2004;10:2201-2204.
- Wu F, Wang ZB, Chen WZ, et al. Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview. Ultrasonics Sonochemistry 2004;11:149–154.
- Abdalla EK, Vauthey JN. Focus on treatment of large hepatocellular carcinoma. Ann Surg Oncology 2004; 11(12): 1035-1036.
- Kennedy JE, Wu F, ter Haar GR, et al. High-intensity focused ultrasound for the treatment of liver tumours. Ultrasonics 2004;42:931-935.
- Wu F, Wang ZB, Chen WZ, et al. Extracorporeal focused ultrasound surgery for treatment of human solid carcinomas: Early Chinese clinical experience. Ultrasound Med Biol 2004;30:245-260.
- Kennedy JE, ter Haar G, Cranston D. High intensity focused ultrasound: Surgery of the future? Br J Radiology 2003; 76:590-599.
- Wu F, Chen WZ, Bai J, et al. Tumor vessel destruction resulting from high-intensity focused ultrasound in patients with solid malignancies. Ultrasound Med Biol 2002; 28:535-542.
- Wu F, Chen WZ, Bai J, et al. Pathological changes in human malignant carcinoma treated with high-intensity focused ultrasound. Ultrasound Med Biol 2001;27: 1099-1106.
- Noninvasive Evaluation of Hepatic Fibrosis Using Serum Fibrotic Markers, Transient Elastography (FibroScan) and Real-Time Tissue Elastography. Tatsumi C, Kudo M, Ueshima K, Kitai S, Takahashi S, Inoue T, Minami Y, Chung H, Maekawa K, Fujimoto K, Akiko T, Takeshi M Intervirology 2008;51(Suppl.1):27-33 (DOI: 10.1159/000122602)