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

Sofuni, Atsushi; Asai, Yasufumi; Tsuchiya, Takayoshi; Ishii, Kentaro; Tanaka, Reina; Tonozuka, Ryosuke; Honjo, Megumi; Mukai, Shuntaro; Nagai, Kazumasa; Yamamoto, Kenjiro; Matsunami, Yukitoshi; Kitaoka, Takashi; Kojima, Hiroyuki; Homma, Toshihiro; Minami, Hideki; Nakatsubo, Ryosuke; Hirakawa, Noriyuki; Miyazawa, Hironari; Nagakawa, Yuichi; Tsuchida, Akihiko; Itoi, Takao

doi:10.3390/curroncol28060409

Cited by 18 publications

(10 citation statements)

References 64 publications

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“…Radiological tumor responses were commonly seen in these studies, and pain reduction was frequently reported in patients following treatment. Survival was reported in 56 of the studies, and 11 of these demonstrated statistically significant improvements in OS ( 12 , 25 , 31 – 33 ), median survival time ( 34 , 35 ), and disease specific survival ( 33 ). However, the RCTs for RFA did not show this survival benefit ( 18 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…In a study that built on the retrospective evidence, Sofuni et al. (2021) performed a prospective clinical safety trial to evaluate the effects of HIFU for unresectable PC ( 34 ). 176 patients received HIFU and CHT, and 89 patients received CHT only.…”

Section: Discussionmentioning

confidence: 99%

“…The CHT regimens in this trial included gemcitabine monotherapy, S-1 monotherapy, Gemcitabine plus S-1 therapy, Gemcitabine plus Nab-paclitaxel, and FOLFIRINOX. The median survival time after diagnosis was 21.3 months in the HIFU and CHT group compared to 9.5 months in the CHT only group (P<0.001) ( 34 ). Although this was a prospective study, there was a possible selection bias based on the timing of HIFU, prior therapy, and CHT regimen of the patients.…”

Section: Discussionmentioning

confidence: 99%

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Thermal ablation in pancreatic cancer: A scoping review of clinical studies

et al. 2022

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BackgroundPancreatic cancer is a deadly cancer with a 5-year survival rate less than 10%. Only 20% of patients are eligible to receive surgery at diagnosis. Hence, new therapies are needed to improve outcomes for non-surgical candidates. Thermal ablation techniques can offer a non-invasive alternative to surgery.AimThe aim of this review is to map the literature for the use of thermal ablative techniques: Radiofrequency ablation (RFA), High-intensity focused ultrasound (HIFU), Microwave ablation (MWA), and Laser ablation (LA) in the management of patients with PC.MethodsA search strategy was applied to PUBMED and EMBASE using keywords concerning pancreatic cancer, radiofrequency ablation, ultrasound ablation, laser ablation, and microwave ablation. The studies that fit this inclusion criteria were summarized in table format and results reviewed for interpretation.Results72 clinical studies were included. Most of the included studies related to RFA (n=35) and HIFU (n=27). The most common study design was retrospective (n=33). Only 3 randomized control trials (RCT) were included, all of which related to RFA. Safety outcomes were reported in 53 of the 72 studies, and survival outcomes were reported in 39. Statistically significant survival benefits were demonstrated in 11 studies.ConclusionThe evidence for the benefit of MWA and LA in PC patients is limited. RFA and HIFU are safe and feasible therapies to be used in PC patients. Further RCTs where thermal techniques are standardized and reported are necessary in the future to elucidate thermal ablation’s clinical utility, and before an evidence-based decision on its routine use in PC management can be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Thermal ablation in pancreatic cancer: A scoping review of clinical studies

et al. 2022

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“…Fergadi et al conducted a meta-analysis study involving 939 patients with PC, revealing that HIFU when paired with subsequent chemotherapy is a safe intervention, inducing an overall survival rate and less discomfort compared to chemotherapy alone [ 162 ]. Similarly, in another study conducted on 176 patients with stage III and IV PC receiving HIFU paired with traditional chemotherapy, an increased survival time and more than 60% pain relief were obtained [ 163 ]. Zhao et al investigated the effects of patients receiving two types of HIFU, traditional or low-power cumulative HIFU, and the former offered significantly higher pain response and overall survival [ 164 ].…”

Section: Locoregional Therapiesmentioning

confidence: 99%

Pancreatic Cancer: Challenges and Opportunities in Locoregional Therapies

Bazeed

Day

Garg

2022

Cancers

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Pancreatic cancer (PC) remains the seventh leading cause of cancer-related deaths worldwide and the third in the United States, making it one of the most lethal solid malignancies. Unfortunately, the symptoms of this disease are not very apparent despite an increasing incidence rate. Therefore, at the time of diagnosis, 45% of patients have already developed metastatic tumours. Due to the aggressive nature of the pancreatic tumours, local interventions are required in addition to first-line treatments. Locoregional interventions affect a specific area of the pancreas to minimize local tumour recurrence and reduce the side effects on surrounding healthy tissues. However, compared to the number of new studies on systemic therapy, very little research has been conducted on localised interventions for PC. To address this unbalanced focus and to shed light on the tremendous potentials of locoregional therapies, this work will provide a detailed discussion of various localised treatment strategies. Most importantly, to the best of our knowledge, the aspect of localised drug delivery systems used in PC was unprecedentedly discussed in this work. This review is meant for researchers and clinicians considering utilizing local therapy for the effective treatment of PC, providing a thorough guide on recent advancements in research and clinical trials toward locoregional interventions, together with the authors’ insight into their potential improvements.

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“…As non-invasive, non-ionizing radiation, non-invasive treatment, high-intensity focused ultrasound (HIFU) has been widely used to treat solid tumors such as uterine fibroids [1], liver cancer [2], bone tumors [3], breast cancer [4] and pancreatic cancer [5] and is an effective complement to traditional surgery. The primary goal of HIFU treatment is to cause instantaneous coagulation and necrosis in the target tissue, which is then absorbed or scarred.…”

Section: Introductionmentioning

confidence: 99%

Formation process of thermal damage in a target area of high intensity focused ultrasound and effectiveness analysis of B-ultrasound real-time monitoring

Zhao

Wang²,

Wu³

et al. 2022

Acta Acust.

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High intensity of focused ultrasound (HIFU) is an effective tumor therapy, taking advantage of the thermal effect and cavitation effect to generate thermal damage to the target tissue. However, inaccurate ultrasonic dose control may result in ineffective or excessive treatment. Thus, real-time monitoring of the thermal damage formation process is critical. To evaluate the effectiveness of real-time monitoring of B-ultrasound, ex-vivo bovine livers were irradiated by 1.155 MHz focused ultrasound with emission time T1 of 200 ms and interval time T2 of 200 ms. For orthogonal experiments, ultrasound was irradiated at sound power of 100 W, 125 W, and 150 W for 10 s, 20 s, and 40 s, respectively. B-ultrasound image sequences are collected using a 7.5 MHz linear array and compared with backscattered echo signals and thermal damage slices, respectively, to build relationships between B-mode ultrasound monitoring and thermal effect or cavitation effect. The experimental results demonstrated that the tissue ablation process caused by thermal effect cannot be effectively monitored using B-ultrasound, but the process caused by the cavitation effect can. The analysis revealed a strong temporal correlation between the appearance of bright spots in B-ultrasound images and the sudden increase of the scattered echo power spectrum, which were caused by a large number of micro-bubbles from cavitation. The damaged cavity structure of the slices and the development trend of micro-bubbles showed a strong spatial correlation. Furthermore, the sudden increase in the scattered echo signal shows the potential of early warning of cavitation, as it is 1.2–2.0 s ahead of the bright spot in the B-ultrasound image, laying the experimental basis for improving the effectiveness of B-ultrasound monitoring in clinical HIFU surgery.

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

Cited by 18 publications

References 64 publications

Thermal ablation in pancreatic cancer: A scoping review of clinical studies

Thermal ablation in pancreatic cancer: A scoping review of clinical studies

Pancreatic Cancer: Challenges and Opportunities in Locoregional Therapies

Formation process of thermal damage in a target area of high intensity focused ultrasound and effectiveness analysis of B-ultrasound real-time monitoring

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