Therapeutic effect of high-intensity focused ultrasound combined with transarterial chemoembolisation for hepatocellular carcinoma <5 cm: comparison with transarterial chemoembolisation monotherapy—preliminary observations

Abstract

Objective: To retrospectively compare the therapeutic effects of combined highintensity focused ultrasound (HIFU) and transarterial chemoembolisation (TACE) with TACE alone for the treatment of non-advanced hepatocellular carcinomas (HCCs) ,5 cm. Methods: We retrospectively reviewed the tumour responses of 32 HCCs of 25 patients who underwent combined HIFU and TACE, and 46 HCCs of 32 patients who underwent TACE only. The mean follow-up observation of the TACE+HIFU group was on average 31 months and that of the TACE group was 33 months. Those patients who had undergone any other treatment modality (including systemic chemotherapy) during the follow-up observation period were excluded. The therapeutic effects were classified according to the modified Response

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

“…Planned iatrogenic right hydrothorax with intra-pleural infusion of warm saline solution was reported in 272 cases, to enhance HIFU coupling in cases of liver dome tumor (26,35,36,38,41,45,52,55,75). Other studies reported on the use of artificial pleural infusion or artificial ascites in selected cases, without detailing the number of patients (42)(43)(44)49,51).…”

“…Other studies reported on the use of artificial pleural infusion or artificial ascites in selected cases, without detailing the number of patients (42)(43)(44)49,51). Intragastric water filling and colon irrigation have also been described to optimize acoustic coupling and consequently reduce the risks of burn injuries to air-filled viscera that might interpose between the HIFU transducer and the target (41). The placement of degassed waterfilled balloons on the application site, with slight pressure to displace bowel and clear gas, is an additional mean to enhance the coupling and reduce the risk of injuries to innocent organs.…”

“…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).…”

Intrapleural Fluid Infusion for MR-Guided High-Intensity Focused Ultrasound Ablation in the Liver Dome

“…Several authors have reported the use of IPI for ultrasoundguided HIFU ablation of liver tumors, although IPI was never the subject of these reports (11,12,18,19). Jung et al have described a delayed complication after IPI-assisted ultrasound-guided HIFU treatment of a liver tumor patient, a diaphragm rupture with herniation of the colon into the thoracic cavity (13).…”

Comparative Study on Transcatheter Arterial Chemoembolization, Portal Vein Embolization and High Intensity Focused Ultrasound Sequential Therapy for Patients

“…Transcarterial chemoembolization (TACE) is a recognized preferable non-surgical treatment in this setting of paitents (Kim et al, 2012). In fact, 20%~50% of tumor tissue necrosis completely after TACE; even after repeated RESEARCH ARTICLE TACE, there are still cancer cells remaining, and the 5-year survival rate is only 9%~16.2% ( Zhou et al, 2011).…”