High intensity focused ultrasound (HIFU), is a promising, non-invasive modality for treatment of tumours in conjunction with magnetic resonance imaging or diagnostic ultrasound guidance. HIFU is being used increasingly for treatment of prostate cancer and uterine fibroids. Over the last 10 years a growing number of clinical trials have examined HIFU treatment of both benign and malignant tumours of the liver, breast, pancreas, bone, connective tissue, thyroid, parathyroid, kidney and brain. For some of these emerging indications, HIFU is poised to become a serious alternative or adjunct to current standard treatments--including surgery, radiation, gene therapy, immunotherapy, and chemotherapy. Current commercially available HIFU devices are marketed for their thermal ablation applications. In the future, lower energy treatments may play a significant role in mediating targeted drug and gene delivery for cancer treatment. In this article we introduce currently available HIFU systems, provide an overview of clinical trials in emerging oncological targets, and briefly discuss selected pre-clinical research that is relevant to future oncological HIFU applications.

https://www.tandfonline.com/doi/pdf/10.3109/02656736.2014.969789

Emerging HIFU applications in cancer therapy.

OBJECTIVE. This article reviews the physical principles of MRI-guided focused ultra-sound and discusses current and potential applications of this exciting technology. CONCLUSION. MRI-guided focused ultrasound is a new minimally invasive method of targeted tissue thermal ablation that may be of use to treat central neuropathic pain, essential tremor, Parkinson tremor, and brain tumors. The system has also been used to temporarily disrupt the blood-brain barrier to allow targeted drug delivery to brain tumors.

/pdf/transcranial-mri-guided-focused-ultrasound-a-review-of-the-45ctwpwkt1.pdf

Transcranial MRI-Guided Focused Ultrasound: A Review of the Technologic and Neurologic Applications

The therapeutic application of heat is very effective in cancer treatment Both hyperthermia, ie, heating to 39-45 °C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 °C destroy tumor cells directly are frequently applied in the clinic Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, eg, by infrared radiation This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy Proven and experimental clinical applications of thermal ablation and hyperthermia are listed Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors

https://biblio.ugent.be/publication/8672203/file/8672204.pdf

Heating technology for malignant tumors: a review

Every year the Breast Committee of the Arbeitsgemeinschaft Gynakologische Onkologie (German Gynecological Oncology Group, AGO), a group of gynecological oncologists specialized in breast cancer and interdisciplinary members specialized in pathology, radiologic diagnostics, medical oncology, and radiation oncology, prepares and updates evidence-based recommendations for the diagnosis and treatment of patients with early and metastatic breast cancer. Every update is performed according to a documented rule-fixed algorithm, by thoroughly reviewing and scoring the recent publications for their scientific validity and clinical relevance. This current publication presents the 2019 update on the recommendations for metastatic breast cancer.

https://epub.ub.uni-muenchen.de/21810/1/10_1159_000353590.pdf

AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2020.

Cytoreduction for Colorectal Metastases: Liver, Lung, Peritoneum, Lymph Nodes, Bone, Brain. When Does it Palliate, Prolong Survival, and Potentially Cure?

Bone metastases are common in patients with advanced cancer and are the greatest contributor to cancer-related pain, often severely affecting quality of life (1,2). Many patients with advanced cancer are undertreated for pain (3,4). Radiation therapy (RT), together with systemic therapies and analgesics, is the standard of care for localized metastatic bone pain, although up to two-thirds of patients have residual pain after RT (5,6), leaving them with limited treatment options. These include reirradiation, which results in temporary pain reduction in some patients (7), surgical intervention (8), and percutaneous cryoablation (9). More effective systemic therapies are prolonging survival of cancer patients with metastatic disease, resulting in an increased need for alternative therapies for painful bone metastases.

Focused ultrasound is a noninvasive technique that delivers acoustic energy to heat lesions focally to ablative temperatures of more than 65°C. The combination of focused ultrasound with magnetic resonance (MR) imaging enables physicians to perform precise localized tumor tissue ablation, while using MR thermometry for real-time temperature monitoring (10,11). Preliminary clinical studies on the use of MR-guided focused ultrasound surgery (MRgFUS) for palliation of painful bone metastases demonstrated excellent response rates and safety (12–14).

We report here results of a randomized controlled trial to evaluate safety and efficacy of MRgFUS for treating bone metastases in patients with persistent or recurrent pain after RT, or who were otherwise not candidates for RT, or who declined RT. The primary objective was to evaluate pain reduction after MRgFUS. The secondary objectives of the study included assessment of the treatment’s impact on pain-related interference with patient functioning and treatment-related toxicity.

/pdf/magnetic-resonance-guided-focused-ultrasound-for-patients-43qx94v2zw.pdf

Ann Roberts

Papers

Magnetic resonance-guided focused ultrasound for patients with painful bone metastases: phase III trial results