Focused Ultrasound Therapy
Focused ultrasound is a rapidly evolving, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with biliary tract tumors. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the body without damaging surrounding normal tissue.
There is also a page dedicated to Biliary Tract Obstruction, which includes a disease outside of the biliary pathway that can cause obstructive symptoms.
How it Works
Where the beams converge, focused ultrasound produces several therapeutic effects that are being evaluated. One mechanism is the production of precise ablation, or thermal destruction of tissue, with the goal of complete or partial ablation of the cancer. Partial ablation may allow better placement of a biliary stent. A second mechanism is the use of focused ultrasound to activate sonosensitizer therapeutics, such as epirubicin. The combination of focused ultrasound and epirubicin results in the formation of a cytotoxic reactive oxygen molecules in the region of the tumor.
Advantages
The primary options for treatment for malignancies of the biliary tract include chemotherapy, but radiation therapy or surgery can also be used.
For certain patients, focused ultrasound could provide an enhanced method of chemotherapy treatment or a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing, surgical complications, or anesthesia – at a lower cost. The sonodynamic approach can enhance the chemotherapy levels in the desired region, while minimizing the exposure of the rest of the body. Furthermore, the approach can be repeated, if necessary.
Clinical Trials
Researchers in Japan are using sonodynamic therapy to activate chemotherapeutic agents in patients with biliary tract cancer.
At the present time, there are no other clinical trials recruiting patients for biliary duct tumors treatments.
Regulatory Approval and Reimbursement
Focused ultrasound treatment for biliary duct tumors is not yet approved by regulatory bodies or covered by medical insurance companies.
Notable Papers
Zhang FQ, Li L, Huang PC, Xia FF, Zhu L, Cao C. Stent Insertion With High Intensity-Focused Ultrasound Ablation for Biliary Obstruction Caused by Pancreatic Carcinoma: A Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech. 2021 Feb 17. doi: 10.1097/SLE.0000000000000918.
Cai PF, Gu H, Zhu LJ, Xu YS, Deng HY. Stent insertion with high-intensity focused ultrasound ablation for malignant biliary obstruction: A protocol of systematic review and meta-analysis. Medicine (Baltimore). 2021 Jan 22;100(3):e23922. doi: 10.1097/MD.0000000000023922.
Cao Q, Li JJ, Feng T, Shi YB, Wang G, Xia FF. Unilateral Stent Insertion With High-intensity Focused Ultrasound Ablation for Hilar Cholangiocarcinoma. Surg Laparosc Endosc Percutan Tech. 2020 Mar 11. doi: 10.1097/SLE.0000000000000780.
Masanori Maeda, Yoshihiro Muragaki, Jun Okamoto, Shin Yoshizawa, Nobutaka Abe, Hidekazu Nakamoto, Hiroshi Ishii, Kenichi Kawabata, Shinichiro Umemura, Nobuhiro Nishiyama, Azunori Kataoka, and Hiroshi Iseki. Sonodynamic Therapy Based on Combined Use of Low Dose Administration of Epirubicin-Incorporating Drug Delivery System and Focused Ultrasound. Ultrasound in Med. & Biol., Vol. 43, No. 10, pp. 2295–2301, 2017. http://dx.doi.org/10.1016/j.ultrasmedbio.2017.06.003
Takahashi A, Yamamoto Y, Yasunaga M, Koga Y, Kuroda J, Takigahira M, Harada M, Saito H, Hayashi T, Kato Y, Kinoshita T, Ohkohchi N, Hyodo I, Matsumura Y. NC-6300, an epirubicinincorporatingmicelle, extends the antitumor effect and reduces thecardiotoxicity of epirubicin.micelle, extends the antitumor effect and reduces thecardiotoxicity of epirubicin. Cancer Sci 2013;104:920–925.
Niu S, Cheng L, Qiao Y, Fu YF, Cao C. Combined Stent Insertion and High-intensity Focused Ultrasound Ablation for Patients With Malignant Obstructive Jaundice. Surg Laparosc Endosc Percutan Tech. 2016 Dec;26(6):488-492.
Reid MH. Visualization of the bile ducts using focused ultrasound. Radiology. 1976 Jan;118(1):155-8.
Click here for additional references from PubMed.
