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 colorectal cancer. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the body without damaging surrounding normal tissue.
How it Works
Where the beams converge, focused ultrasound produces several therapeutic effects that are being evaluated. One mechanism is to produce precise ablation (thermal destruction of tissue), enabling colorectal cancer to be fully or partially treated. Partial treatments may stimulate the patient’s immune response, which can have a broader effect. Another mechanism is to combine focused ultrasound with sonosensitizer therapeutics, such as epirubicin. This method results in cytotoxic reactive oxygen molecules in the region of the tumor. A third mechanism is to use focused ultrasound to cause local hyperthermia, which may enhance chemotherapy absorption. While significant preclinical work has been performed, there is still much to be done before this technology will be widely available.
Advantages
The primary options for treatment of colorectal cancer include medication or invasive surgery.
For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing or infection – at a lower cost. Focused ultrasound can reach the desired target without damaging surrounding tissue, and enhance chemotherapy dose for the target, with less impact to the rest of the patient. It can also be repeated, if necessary.
Clinical Trials
A clinical trial in the UK is recruiting patients with colorectal cancer and metastasis to the liver. It is using focused ultrasound to activate a microbubble preparation designed to improve the penetration of chemotherapy to the liver.
A clinical trial is recruiting patients with colorectal cancer with metastatic lesions and a high degree of microsatellite instability (MSI-H) at the University of Virginia.
A clinical trial in London, England, is using endoluminal focused ultrasound to treat rectal cancers and some additional cancers.
A clinical trial in Norway is using focused ultrasound to enhance chemotherapy penetration in patients with liver metastasis from colorectal and breast cancers.
A clinical trial in China is using focused ultrasound to enhance chemotherapy in patients with drug resistant colorectal cancer.
See a full list of colorectal cancer clinical trials >
See a list of treatment sites >
See a list of clinical trials sites >
See a list of laboratory research sites >
Regulatory Approval and Reimbursement
Focused ultrasound treatment for colorectal tumor is not yet approved by regulatory bodies or covered by medical insurance companies.
Notable Papers
Zhang L, Qiao L, Zhang M, Xue Y, Zhang X, Gao X. Comparison of prognosis among patients with colorectal cancer liver metastases treated by surgical resection, radiofrequency ablation and HIFU: A protocol for network meta-analysis. Medicine (Baltimore). 2022 Aug 19;101(33):e27915. doi: 10.1097/MD.0000000000027915.
Kim D, Lee SS, Moon H, Park SY, Lee HJ. PD-L1 Targeting Immune-Microbubble Complex Enhances Therapeutic Index in Murine Colon Cancer Models. Pharmaceuticals (Basel). 2020 Dec 23;14(1):6. doi: 10.3390/ph14010006.
Li M, Wan G, Yu H, Xiong W. High-intensity focused ultrasound inhibits invasion and metastasis of colon cancer cells by enhancing microRNA-124-mediated suppression of STAT3. FEBS Open Bio. 2019 Jun;9(6):1128-1136. doi: 10.1002/2211-5463.12642. Epub 2019 May 4.
Ma B, Liu X, Yu Z. The effect of high intensity focused ultrasound on the treatment of liver cancer and patients’ immunity. Cancer Biomark. 2019;24(1):85-90. doi: 10.3233/CBM-181822.
Ektate K, Munteanu MC, Ashar H, Malayer J, Ranjan A. Chemo-immunotherapy of colon cancer with focused ultrasound and Salmonella-laden temperature sensitive liposomes (thermobots). Sci Rep. 2018 Aug 30;8(1):13062. doi: 10.1038/s41598-018-30106-4.
VanOsdol J, Ektate K, Ramasamy S, Maples D, Collins W, Malayer J, Ranjan A. Sequential HIFU heating and nanobubble encapsulation provide efficient drug penetration from stealth and temperature sensitive liposomes in colon cancer. J Control Release. 2017 Feb 10;247:55-63. doi: 10.1016/j.jconrel.2016.12.033. Epub 2016 Dec 30.
Boissenot T, Bordat A, Larrat B, Varna M, Chacun H, Paci A, Poinsignon V, Fattal E, Tsapis N. Ultrasound-induced mild hyperthermia improves the anticancer efficacy of both Taxol® and paclitaxel-loaded nanocapsules. J Control Release. 2017 Oct 28;264:219-227. doi: 10.1016/j.jconrel.2017.08.041. Epub 2017 Sep 1.
Maeda M, Muragaki Y, Okamoto J, Yoshizawa S, Abe N, Nakamoto H, Ishii H, Kawabata K, Umemura S, Nishiyama N, Kataoka K, Iseki H. Sonodynamic Therapy Based on Combined Use of Low Dose Administration of Epirubicin-Incorporating Drug Delivery System and Focused Ultrasound. Ultrasound Med Biol. 2017 Oct;43(10):2295-2301. doi: 10.1016/j.ultrasmedbio.2017.06.003. Epub 2017 Jul 10.
VanOsdol J, Ektate K, Ramasamy S, Maples D, Collins W, Malayer J, Ranjan A. Sequential HIFU heating and nanobubble encapsulation provide efficient drug penetration from stealth and temperature sensitive liposomes in colon cancer. J Control Release. 2017 Feb 10;247:55-63. doi: 10.1016/j.jconrel.2016.12.033. Epub 2016 Dec 30.
Chu W, Staruch RM, Pichardo S, Tillander M, Köhler MO, Huang Y, Ylihautala M, McGuffin M, Czarnota G, Hynynen K. Magnetic Resonance-Guided High-Intensity Focused Ultrasound Hyperthermia for Recurrent Rectal Cancer: MR Thermometry Evaluation and Preclinical Validation. Int J Radiat Oncol Biol Phys. 2016 Jul 15;95(4):1259-67. doi: 10.1016/j.ijrobp.2016.03.019. Epub 2016 Mar 24.
PLOS ONE Staff. Correction: First clinical experience of intra-operative high intensity focused ultrasound in patients with colorectal liver metastases: a phase I-IIa study. PLoS One. 2015 Mar 30;10(3):e0123751. doi: 10.1371/journal.pone.0123751. eCollection 2015.
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