The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional c...The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional conformal radiotherapy（3-DCRT） and high-intensity focused ultrasound（HIFU）.From October,2005 to September,2010,120 patients with unresectable HCC received the sequential treatments of several courses of TACE followed in 2-4 weeks by 3-DCRT and then a single session of HIFU with a curative intent.The median tumor irradiation dose was 40 Gy.Tumor response,toxicity and overall survival rate were analyzed.Clinicopathologic factors affecting the primary technique effectiveness and overall survival rates were investigated by univariate analysis or multivariate analysis.All 120 HCC patients were followed up by the last follow-up time.Among these patients,hepatic toxicities due to treatment were notable in 9 cases.Gastrointestinal bleeding after the overall treatment occurred in 2 cases,leukopenia of grade III was detected in 1 case,radiation-induced liver disease（RILD） was observed in 2 patients,and first-and second-degree skin burn around the HIFU treatment zone were observed in 2 patients and 1 patient,respectively.Among 120 patients,23,83 and 14 cases achieved partial response,stable disease and progressive disease,respectively.The overall survival rates at 1 year,3 years and 5 years were 70%,35% and 15%,respectively,with a median survival time of 26 months.Both Child-Pugh liver function grading and radiation dose were determined to be independent predictors for overall survival revealed by the multivariate analysis.It is concluded that the sequential therapy of TACE,3-DCRT and HIFU is a promising therapeutic regimen for unresectable HCC.展开更多
Importance:Hepatocellular carcinoma(HCC)is usually accompanied by liver cirrhosis,which makes treatment of this disease challenging.Liver transplantation theoretically provides an ultimate solution to the disease,but ...Importance:Hepatocellular carcinoma(HCC)is usually accompanied by liver cirrhosis,which makes treatment of this disease challenging.Liver transplantation theoretically provides an ultimate solution to the disease,but the maximal surgical stress and the scarcity of liver graft make this treatment option impossible for some patients.In an ideal situation,a treatment that is safe and effective should provide a better outcome for patients with the dilemma.Objective:This article aims to give a comprehensive review of various types of loco-ablative treatment for HCC.Evidence Review:Loco-ablative treatment bridges the gap between surgical resection and transarterial chemotherapy.Various types of ablative therapy have their unique ability,and evidence-based outcome analysis is the most important key to assisting clinicians to choose the most suitable treatment modality for their patients.Findings:Radiofrequency ablation(RFA)has a relatively longer history and more evidence to support its effectiveness.Microwave ablation(MWA)is gaining momentum because of its shorter ablation time and consistent ablation zone.High-intensity focused ultrasound(HIFU)ablation is a relatively new technology that provides non-invasive treatment for patients with HCC.It has been carried out at centers of excellence and it is a safe and effective treatment option for selected patients with HCC and liver cirrhosis.Conclusion and Relevance:Selective use of different loco-ablative therapies will enhance clinicians’treatment options for treatment of HCC.展开更多
High-intensity focused ultrasound(HIFU)is a technique to destroy tissue at depth within the body,selectively and without harming overlying and adjacent structures within the path of the beam because the ultrasonic int...High-intensity focused ultrasound(HIFU)is a technique to destroy tissue at depth within the body,selectively and without harming overlying and adjacent structures within the path of the beam because the ultrasonic intensity at the beam focus is much higher than that outside of the focus.Diagnostic ultrasound is the first imaging modality used for guiding HIFU ablation.In 1997,a patient with osteosarcoma was first successfully treated with ultrasound imaging-guided HIFU in Chongqing,China.Over the last decade,thousands of patients with uterine fibroids,liver cancer,breast cancer,pancreatic cancer,bone tumors,and renal cancer have been treated with ultrasound imaging-guided HIFU.Based on several research groups’reports,as well as our ten-year clinical experience,we conclude that this technique is safe and effective in treating human solid tumors.HIFU is a promising technique.Most importantly,HIFU offers patients another alternative when those patients have no other treatment available.展开更多
The article“US-guided high-intensity focused ultrasound in pancreatic cancer treatment:a consensus initiative between Chinese and European HIFU centers”by Zhou et al.provides a valuable overview of the application o...The article“US-guided high-intensity focused ultrasound in pancreatic cancer treatment:a consensus initiative between Chinese and European HIFU centers”by Zhou et al.provides a valuable overview of the application of ultrasound-guided high-intensity focused ultrasound(USgHIFU)in treating pancreatic cancer(1).展开更多
When large tumors are treated,ablation of the entire volume of tumors requires multiple treatment spots formed by high intensity-focused ultrasound(HIFU)scanning therapy.The heating effect of HIFU on biological tissue...When large tumors are treated,ablation of the entire volume of tumors requires multiple treatment spots formed by high intensity-focused ultrasound(HIFU)scanning therapy.The heating effect of HIFU on biological tissue is mainly reflected in temperature elevation and tissue lesions.Tissue property parameters vary with temperature and,in turn,the distribution of temperature as well as the heating effects change accordingly.In this study,an HIFU scanning therapy model considering dynamic tissue properties is provided.The acoustic fields and temperature fields are solved combining the Helmholtz wave equation with Pennes bio-heat transfer equation based on the finite element method(FEM)to investigate the effects of various tissue properties(i.e.,the attenuation coefficient,acoustic velocity,thermal conductivity,specific heat capacity,density,and blood perfusion rate)on heating performance.Comparisons of the temperature distribution and thermal lesions under static and dynamic properties are made based on the data of tissue property parameters varying with temperature.The results show that the dynamic changes of thermal conductivity,specific heat capacity,and acoustic velocity may account for the decrease of temperature elevation in HIFU treatment,while the dynamic changes of attenuation coefficient,density,and blood perfusion rate aggravate the increase of temperature on treatment spots.Compared with other properties,the dynamic change of attenuation coefficient has a greater impact on tissue temperature elevation.During HIFU scanning therapy,the temperature elevation and tissue lesions of the first treatment spot are smaller than those of the subsequent treatment spots,but the temperature on the last treatment spot drops faster during the cooling period.The ellipsoidal tissue lesion is not symmetrical;specifically,the part facing toward the previous treatment spot tends to be larger.Under the condition of the same doses,the temperature elevation and the size of tissue lesions under dynamic properties present signific展开更多
Objective The objective of this study was to explore the short-term effects and postoperative complications of ultrasound-guided percutaneous ethanol-lipiodol injection(PEI)combined with high-intensity focused ultraso...Objective The objective of this study was to explore the short-term effects and postoperative complications of ultrasound-guided percutaneous ethanol-lipiodol injection(PEI)combined with high-intensity focused ultrasound(HIFU)for the treatment of small hepatocellular carcinoma in a special or high-risk location.Methods Forty patients with small liver cancer in a special or high-risk location were randomly divided into two groups:20 patients were treated with PEI combined with HIFU(P+H group),and 20 patients were treated with HIFU alone(H group).There were no significant differences in average age,liver function,tumor location,tumor number,or tumor size between the two groups(P>0.05).Results Significant differences were observed in ablation parameters between the two groups(P<0.05).Under the same power,ablation rates of the P+H group were significantly higher than those in the H group,and postoperative complications in the P+H group were significantly lower than those in the H group(P<0.05).Conclusion The combination of PEI and HIFU has better clinical value than HIFU alone for small-cell liver cancer in special or high-risk locations.展开更多
The feasibility of a new full bridge high intensity focused ultrasound(HIFU) amplifier system with harmonic cancellation is evaluated in this study. Harmonic cancellation technique is applied to these power amplifiers...The feasibility of a new full bridge high intensity focused ultrasound(HIFU) amplifier system with harmonic cancellation is evaluated in this study. Harmonic cancellation technique is applied to these power amplifiers, which can eliminate the 3rd harmonic and all even harmonics. Since this technique requires two channels of phase signal to control one channel of power amplifier, the signal generator is required to double its output. The transducer array proposed in this study has 100 elements. So we choose an FPGA chip to generate 200 driving signals, and each channel has a phase resolution of 2ns, less than 1°. The phase signal from the FPGA meets the requirement of driving the power amplifiers. The output waveform of one channel of power amplifier(voltage across the transducer) is evaluated, and shows fewer harmonic components.展开更多
Hepatocellular carcinoma(HCC)accounts for the vast majority of primary hepatic malignancies.The overall incidence of this disease has always been significant,but in recent years it has continued to rise,now making HCC...Hepatocellular carcinoma(HCC)accounts for the vast majority of primary hepatic malignancies.The overall incidence of this disease has always been significant,but in recent years it has continued to rise,now making HCC one of the leading causes of cancer deaths worldwide.Fortunately,research into the mechanisms of carcinogenesis and treatment options for this disease has also been progressing rapidly.Although the future for new insights and therapies appears more promising than ever,it also remains important to understand both the nature of HCC and the current state-of-the-art for treating affected patients.Although surgery is often considered to be a first choice,many patients present with extensive disease and are therefore not operative candidates.Fortunately,significant clinical advances over the last decade have contributed a number of new or improved treatment options.Many of these treatments require expertise from a variety of different clinical subspecialties.Indeed,managing patients with HCC has rapidly become a multi-modality,multi-disciplinary endeavor in which the details of each in-dividual’s circumstance can greatly impact outcomes,and strategies can be quite nuanced.The purpose of this review is to provide a perspective on the disease itself,the patients who become afflicted,the spectrum of currently available treatment options,and the strategies for their optimal implementation.Such knowledge can be critically important as new data become available on the research front.展开更多
文摘The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional conformal radiotherapy（3-DCRT） and high-intensity focused ultrasound（HIFU）.From October,2005 to September,2010,120 patients with unresectable HCC received the sequential treatments of several courses of TACE followed in 2-4 weeks by 3-DCRT and then a single session of HIFU with a curative intent.The median tumor irradiation dose was 40 Gy.Tumor response,toxicity and overall survival rate were analyzed.Clinicopathologic factors affecting the primary technique effectiveness and overall survival rates were investigated by univariate analysis or multivariate analysis.All 120 HCC patients were followed up by the last follow-up time.Among these patients,hepatic toxicities due to treatment were notable in 9 cases.Gastrointestinal bleeding after the overall treatment occurred in 2 cases,leukopenia of grade III was detected in 1 case,radiation-induced liver disease（RILD） was observed in 2 patients,and first-and second-degree skin burn around the HIFU treatment zone were observed in 2 patients and 1 patient,respectively.Among 120 patients,23,83 and 14 cases achieved partial response,stable disease and progressive disease,respectively.The overall survival rates at 1 year,3 years and 5 years were 70%,35% and 15%,respectively,with a median survival time of 26 months.Both Child-Pugh liver function grading and radiation dose were determined to be independent predictors for overall survival revealed by the multivariate analysis.It is concluded that the sequential therapy of TACE,3-DCRT and HIFU is a promising therapeutic regimen for unresectable HCC.
文摘Importance:Hepatocellular carcinoma(HCC)is usually accompanied by liver cirrhosis,which makes treatment of this disease challenging.Liver transplantation theoretically provides an ultimate solution to the disease,but the maximal surgical stress and the scarcity of liver graft make this treatment option impossible for some patients.In an ideal situation,a treatment that is safe and effective should provide a better outcome for patients with the dilemma.Objective:This article aims to give a comprehensive review of various types of loco-ablative treatment for HCC.Evidence Review:Loco-ablative treatment bridges the gap between surgical resection and transarterial chemotherapy.Various types of ablative therapy have their unique ability,and evidence-based outcome analysis is the most important key to assisting clinicians to choose the most suitable treatment modality for their patients.Findings:Radiofrequency ablation(RFA)has a relatively longer history and more evidence to support its effectiveness.Microwave ablation(MWA)is gaining momentum because of its shorter ablation time and consistent ablation zone.High-intensity focused ultrasound(HIFU)ablation is a relatively new technology that provides non-invasive treatment for patients with HCC.It has been carried out at centers of excellence and it is a safe and effective treatment option for selected patients with HCC and liver cirrhosis.Conclusion and Relevance:Selective use of different loco-ablative therapies will enhance clinicians’treatment options for treatment of HCC.
文摘High-intensity focused ultrasound(HIFU)is a technique to destroy tissue at depth within the body,selectively and without harming overlying and adjacent structures within the path of the beam because the ultrasonic intensity at the beam focus is much higher than that outside of the focus.Diagnostic ultrasound is the first imaging modality used for guiding HIFU ablation.In 1997,a patient with osteosarcoma was first successfully treated with ultrasound imaging-guided HIFU in Chongqing,China.Over the last decade,thousands of patients with uterine fibroids,liver cancer,breast cancer,pancreatic cancer,bone tumors,and renal cancer have been treated with ultrasound imaging-guided HIFU.Based on several research groups’reports,as well as our ten-year clinical experience,we conclude that this technique is safe and effective in treating human solid tumors.HIFU is a promising technique.Most importantly,HIFU offers patients another alternative when those patients have no other treatment available.
文摘The article“US-guided high-intensity focused ultrasound in pancreatic cancer treatment:a consensus initiative between Chinese and European HIFU centers”by Zhou et al.provides a valuable overview of the application of ultrasound-guided high-intensity focused ultrasound(USgHIFU)in treating pancreatic cancer(1).
基金Project partially supported by the National Natural Science Foundation of China(Grant Nos.11774088 and 11474090)the Natural Science Foundation of Hunan Province,China(Grant Nos.2016JJ3090 and 2018JJ3557)the Scientific Research Fund of Hunan Provincial Education Department,China(Grant Nos.16B155 and 17B025)。
文摘When large tumors are treated,ablation of the entire volume of tumors requires multiple treatment spots formed by high intensity-focused ultrasound(HIFU)scanning therapy.The heating effect of HIFU on biological tissue is mainly reflected in temperature elevation and tissue lesions.Tissue property parameters vary with temperature and,in turn,the distribution of temperature as well as the heating effects change accordingly.In this study,an HIFU scanning therapy model considering dynamic tissue properties is provided.The acoustic fields and temperature fields are solved combining the Helmholtz wave equation with Pennes bio-heat transfer equation based on the finite element method(FEM)to investigate the effects of various tissue properties(i.e.,the attenuation coefficient,acoustic velocity,thermal conductivity,specific heat capacity,density,and blood perfusion rate)on heating performance.Comparisons of the temperature distribution and thermal lesions under static and dynamic properties are made based on the data of tissue property parameters varying with temperature.The results show that the dynamic changes of thermal conductivity,specific heat capacity,and acoustic velocity may account for the decrease of temperature elevation in HIFU treatment,while the dynamic changes of attenuation coefficient,density,and blood perfusion rate aggravate the increase of temperature on treatment spots.Compared with other properties,the dynamic change of attenuation coefficient has a greater impact on tissue temperature elevation.During HIFU scanning therapy,the temperature elevation and tissue lesions of the first treatment spot are smaller than those of the subsequent treatment spots,but the temperature on the last treatment spot drops faster during the cooling period.The ellipsoidal tissue lesion is not symmetrical;specifically,the part facing toward the previous treatment spot tends to be larger.Under the condition of the same doses,the temperature elevation and the size of tissue lesions under dynamic properties present signific
基金Supported by the research grant from Dalian Health and Family Planning Commission of China(No.1611020).
文摘Objective The objective of this study was to explore the short-term effects and postoperative complications of ultrasound-guided percutaneous ethanol-lipiodol injection(PEI)combined with high-intensity focused ultrasound(HIFU)for the treatment of small hepatocellular carcinoma in a special or high-risk location.Methods Forty patients with small liver cancer in a special or high-risk location were randomly divided into two groups:20 patients were treated with PEI combined with HIFU(P+H group),and 20 patients were treated with HIFU alone(H group).There were no significant differences in average age,liver function,tumor location,tumor number,or tumor size between the two groups(P>0.05).Results Significant differences were observed in ablation parameters between the two groups(P<0.05).Under the same power,ablation rates of the P+H group were significantly higher than those in the H group,and postoperative complications in the P+H group were significantly lower than those in the H group(P<0.05).Conclusion The combination of PEI and HIFU has better clinical value than HIFU alone for small-cell liver cancer in special or high-risk locations.
基金the National Natural Science Foundation of China(No.30800246)the Shanghai Key Technologies R&D Program of China(No.09441900500)the Research Program of Shanghai Education Commission(No.14CXY05)
文摘The feasibility of a new full bridge high intensity focused ultrasound(HIFU) amplifier system with harmonic cancellation is evaluated in this study. Harmonic cancellation technique is applied to these power amplifiers, which can eliminate the 3rd harmonic and all even harmonics. Since this technique requires two channels of phase signal to control one channel of power amplifier, the signal generator is required to double its output. The transducer array proposed in this study has 100 elements. So we choose an FPGA chip to generate 200 driving signals, and each channel has a phase resolution of 2ns, less than 1°. The phase signal from the FPGA meets the requirement of driving the power amplifiers. The output waveform of one channel of power amplifier(voltage across the transducer) is evaluated, and shows fewer harmonic components.
文摘Hepatocellular carcinoma(HCC)accounts for the vast majority of primary hepatic malignancies.The overall incidence of this disease has always been significant,but in recent years it has continued to rise,now making HCC one of the leading causes of cancer deaths worldwide.Fortunately,research into the mechanisms of carcinogenesis and treatment options for this disease has also been progressing rapidly.Although the future for new insights and therapies appears more promising than ever,it also remains important to understand both the nature of HCC and the current state-of-the-art for treating affected patients.Although surgery is often considered to be a first choice,many patients present with extensive disease and are therefore not operative candidates.Fortunately,significant clinical advances over the last decade have contributed a number of new or improved treatment options.Many of these treatments require expertise from a variety of different clinical subspecialties.Indeed,managing patients with HCC has rapidly become a multi-modality,multi-disciplinary endeavor in which the details of each in-dividual’s circumstance can greatly impact outcomes,and strategies can be quite nuanced.The purpose of this review is to provide a perspective on the disease itself,the patients who become afflicted,the spectrum of currently available treatment options,and the strategies for their optimal implementation.Such knowledge can be critically important as new data become available on the research front.
