High-Intensity Focused Ultrasound Treatment of Late-Stage Pancreatic Body Carcinoma: Optimal Tumor Depth for Safe Ablation

Ge, Huiyu; Miao, Lei; Xiong, Liu‐Lin; Yan, Fang; Zheng, Chuansheng; Wang, Jinrui; Jia, Jianwen; Cui, Ligang; Chen, Wen

doi:10.1016/j.ultrasmedbio.2013.11.020

Cited by 29 publications

(26 citation statements)

References 12 publications

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“…Seventeen articles on pancreatic HIFU ablation have been included, for a total of 581 patients [75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91]. In most cases (515 out of 581-88.6%) the ablative treatment was reserved to unresectable lesion (stage III-IV), while 38 lesions were classified as borderline.…”

Section: Clinical Applicationmentioning

confidence: 99%

Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies

Saccomandi

Lapergola

Longo

et al. 2018

International Journal of Hyperthermia

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Purpose: Pancreatic cancer is a challenging malignancy with low treatment option and poor life expectancy. Thermal ablation techniques were proposed as alternative treatment options, especially in advanced stages and for unfit-for-surgery patients. This systematic review describes the thermal ablative techniques-i.e., Laser (LA), Radiofrequency (RFA), Microwave (MWA) Ablation, High-Intensity Focused Ultrasound (HIFU) and cryoablation-available for pancreatic cancer treatment. Additionally, an analysis of the efficacy, complication rate and overall survival for each technique is conducted. Material and methods: This review collects the ex vivo, preclinical and clinical studies presenting the use of thermal techniques in the pancreatic cancer treatment, searched up to March 2018 in PubMed and Medline. Abstracts, letters-to-the-editor, expert opinions, reviews and non-English language manuscripts were excluded. Results: Sixty-five papers were included. For the ex vivo and preclinical studies, there are: 12 records for LA, 8 for RFA, 0 for MWA, 6 for HIFU, 1 for cryoablation and 3 for hybrid techniques. For clinical studies, 1 paper for LA, 14 for RFA, 1 for MWA, 17 for HIFU, 1 for cryoablation and 1 for hybrid techniques. Conclusions: Important technological advances are presented in ex vivo and preclinical studies, as the real-time thermometry, nanotechnology and hybrid techniques to enhance the thermal outcome. Conversely, a lack of standardization in the clinical employment of the procedures emerged, leading to contrasting results on the safety and feasibility of some analyzed techniques. Uniform conclusions on the safety and feasibility of these techniques for pancreatic cancer will require further structured investigation.

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Section: Clinical Applicationmentioning

confidence: 99%

Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies

Saccomandi

Lapergola

Longo

et al. 2018

International Journal of Hyperthermia

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“…Forty-four studies reported on the clinical use of HIFU (7,(10)(11)(12)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) to treat liver lesions , while 19 series were found on HIFU treatment for pancreatic cancers (6,(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73) and 4 studies included patients suffering from both liver and pancreatic cancers (74)(75)(76)(77), reporting on a total of 1,682 and 823 cases for the liver and pancreas, respectively. However, the real number of patients who benefited from HIFU treatment is much larger, since a recent review article from Zhou reported on over 3,000 cases of advanced pancreatic cancer treated with HIFU alone or in combination with chemotherapy (CHT) or radiotherapy (RT) (78).…”

Section: Study Selection and Level Of Evidencementioning

confidence: 99%

“…No clinical MRI or CT-guided procedures were reported. One study reported the use of pre-HIFU CT to determine the optimal depth of treatment ensuring safe ablation (71). In case of liver treatment, the HIFU ablation procedure is more frequently performed under general or epidural anesthesia, while in pancreatic procedures, it is often performed without anesthesia but only under analgesia and/or sedation.…”

Section: Records Included For Qualitative Synthesis N=67mentioning

confidence: 99%

“…The most frequent complications were skin burns at the application sites and osteonecrosis of ribs or vertebra along the US pathway ( Tables 5,6). Post-HIFU pain was not assessed systematically and was reported in 17 studies (384 patients undergoing liver HIFU procedures) (7,12,(19)(20)(21)(22)24,26,28,29,32,39,41,45,49,54,75) and 6 studies (62 patients receiving HIFU for pancreatic malignancies) (56,59,62,70,71,75). In only a few of those trials, a semi-quantitative evaluation tool was used to report pain level, based on the analgesic requirements (mild = no analgesic; moderate = non-steroidal anti-inflammatory drugs; severe = required morphine) (7,19,20,24,39).…”

Section: Complicationsmentioning

confidence: 99%

“…Pancreatitis (biological or clinical symptoms) (n=34) (6,56,62,(70)(71)(72)75) Post-HIFU reactive pleural effusion in absence of artificial pleural infusion (n=15) (21,24,45) Cholecystitis (n=4) (24,75) Biliary tract obstructions (n=2) (26,75) Renal impairement and hematuria (n=9) (24,38) Supraventricular tachycardia (n=5), hypertension (n=8) (24) Liver abscess (n=2) (34,38) HIFU, high intensity focused ultrasound.…”

Section: Table 6 Miscellaneous (Most Significant) Complicationsmentioning

confidence: 99%

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High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system—current state of the art and future perspectives

Diana¹,

Schiraldi²,

Liu³

et al. 2016

Hepatobiliary Surg. Nutr.

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Background: High intensity focused ultrasound (HIFU) is emerging as a valid minimally-invasive imageguided treatment of malignancies. We aimed to review to current state of the art of HIFU therapy applied to the digestive system and discuss some promising avenues of the technology.Methods: Pertinent studies were identified through PubMed and Embase search engines using the following keywords, combined in different ways: HIFU, esophagus, stomach, liver, pancreas, gallbladder, colon, rectum, and cancer. Experimental proof of the concept of endoluminal HIFU mucosa/submucosa ablation using a custom-made transducer has been obtained in vivo in the porcine model. Results:Forty-four studies reported on the clinical use of HIFU to treat liver lesions, while 19 series were found on HIFU treatment of pancreatic cancers and four studies included patients suffering from both liver and pancreatic cancers, reporting on a total of 1,682 and 823 cases for liver and pancreas, respectively. Only very limited comparative prospective studies have been reported. Conclusions:Digestive system clinical applications of HIFU are limited to pancreatic and liver cancer. It is safe and well tolerated. The exact place in the hepatocellular carcinoma (HCC) management algorithm remains to be defined. HIFU seems to add clear survival advantages over trans arterial chemo embolization (TACE) alone and similar results when compared to radio frequency (RF). For pancreatic cancer, HIFU achieves consistent cancer-related pain relief. Further research is warranted to improve targeting accuracy and efficacy monitoring. Furthermore, additional work is required to transfer this technology on appealing treatments such as endoscopic HIFU-based therapies.Keywords: High intensity focused ultrasound (HIFU); liver cancer; pancreatic cancer; miniature HIFU delivery system; endoluminal applications of HIFU; mucosa and submucosal ablations using HIFU

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Multimodal Therapies against Pancreatic Ductal Adenocarcinoma: A Review on Synergistic Approaches toward Ultimate Nanomedicine Treatments

Conte

Cauda

2022

Advanced Therapeutics

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In the last decades, extensive research has been carried out on the understanding and treatment of pancreatic cancer. Despite the significant advances in medicine and nanotechnology, there is an increasing concern about the lack of a standardized therapy with favorable outcomes for patients affected by this malignant disease, whose survival rates are nowadays far alarmingly low. The aim of this review is to offer a comprehensive view on the topic, by drawing upon two strands of research into pancreatic cancer. First, a detailed overview on the tumor genesis, progression, and resulting intricate microenvironment is presented. Thereafter, an extensive insight into the current treatments and their evolution throughout time, with a major focus on nanomedicine approaches, are offered to the reader. With respect to previous studies, a particular emphasis is given here to innovative theranostic approaches. In the light of what is now well established by recent evidence, the focus is given to multimodal treatments involving the combination of different therapies and, in particular, of nanoparticle‐based medicine. The challenging purpose is finally of shedding light on future ultimate treatments out of the currently followed well‐worn paths.

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High-Intensity Focused Ultrasound Treatment of Late-Stage Pancreatic Body Carcinoma: Optimal Tumor Depth for Safe Ablation

Cited by 29 publications

References 12 publications

Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies

Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies

High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system—current state of the art and future perspectives

Multimodal Therapies against Pancreatic Ductal Adenocarcinoma: A Review on Synergistic Approaches toward Ultimate Nanomedicine Treatments

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