Focused Ultrasound Therapy
Focused ultrasound is an early stage, noninvasive therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with pancreatic tumors. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the body without damaging surrounding normal tissue. Where the beams converge, the ultrasound produces a variety of therapeutic effects enabling the patient to be treated without incisions or radiation.
Current treatment options are focused on pancreatic cancer, and include combinations of surgery, radiation, chemotherapy, embolization or other ablative methods, yet these still not very effective for many patients.
Focused ultrasound – used alone and in combination with other therapies – is being investigated to treat pancreatic cancer and the pain associated with the disease. Focused ultrasound has the potential to achieve symptomatic relief by improving the resection of the tumor prior to surgery, by reducing tumor size and spread, and by reduction in overall tumor pain.
- Focused ultrasound is non-invasive and therefore has reduced risk for infection and blood clots, and shorter recovery time.
- Precise targeting minimizes damage to non-targeted healthy tissue.
- No ionizing radiation, enabling repeat treatment if necessary.
- Treatment can be a complement to drug therapy, enabling enhanced delivery of chemotherapy or immunotherapy to tumors.
- May potentially induce an anti-tumor immune response.
The University of Roma La Sapienza is leading a study to assess the feasibility and clinical performance of focused ultrasound ablation of unresectable pancreatic cancer in pain palliation and tumor control.
The Focused Ultrasound Foundation is working with leading sites to implement the ARRAY registry to capture data from pancreatic cancer patients to help guide future decisions about optimal clinical care, safety and regulatory factors, and reimbursement concerns. The goal of this registry is to capture early data to expedite the availability of focused ultrasound improvements for patient care as soon as possible.
Researchers in Japan are using sonodynamic therapy to release chemotherapeutic agents in patients with pancreatic cancer.
Regulatory Approval and Reimbursement
The Model JC system manufactured by Chongqing Haifu has been approved in Europe for palliative treatment in patients with pancreatic cancer.
Focused ultrasound treatment for patients with pancreatic cancer is not universally reimbursed by medical insurers.
Preclinical Laboratory Studies
Preclinical studies are underway to investigate the use of non-ablation mechanisms of focused ultrasound in the treatment of pancreatic cancer. Examples of these studies include:
- Focused ultrasound to induce an immune response that could be combined with immunotherapeutics to treat both local and systemic disease.
- Focused ultrasound to enable targeted delivery and/or activation of drugs via carrier vehicles (e.g. microbubbles, nanoparticles, liposomes) to enable delivery of high concentrations in the tumor with minimal systemic side effects.
Suggested Reading: Focused Ultrasound for Pancreatic Cancer (PDF), July 2019.
Focused Ultrasound Foundation Workshop. The Role of Focused Ultrasound in Pancreatic Cancer, 2019.
Zhu B, Li J, Diao L, Ma K, Fan Y, Yang W. High-intensity focused ultrasound ablation for advanced pancreatic cancer. J Cancer Res Ther. 2019;15(4):831-835. doi: 10.4103/jcrt.JCRT_408_18.
Ning Z, Zhu Z, Wang H, Zhang C, Xu L, Zhuang L, Yan X, Wang D, Wang P, Meng Z. High-intensity focused ultrasound enhances the effect of bufalin by inducing apoptosis in pancreatic cancer cells. Onco Targets Ther. 2019 Feb 12;12:1161-1170. doi: 10.2147/OTT.S185953. eCollection 2019.
Saccomandi P, Lapergola A, Longo F, Schena E, Quero G. Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies. Int J Hyperthermia. 2018 Nov 14:1-21. doi: 10.1080/02656736.2018.1506165.
Nabavizadeh A, Payen T, Saharkhiz N, McGarry M, Olive KP, Konofagou EE. Technical Note: Feasibility of the In vivo Young's modulus visualization of pancreatic ductal adenocarcinoma during HIFU ablation Using Harmonic Motion Elastography (HME) in vivo. Med Phys. 2018 Sep 4. doi: 10.1002/mp.13170.
Marinova M, Huxold HC, Henseler J, Mücke M, Conrad R, Rolke R, Ahmadzadehfar H, Rauch M, Fimmers R, Luechters G, Cuhls H, Radbruch L, Schild HH, Strunk H. Clinical Effectiveness and Potential Survival Benefit of US-Guided High-Intensity Focused Ultrasound Therapy in Patients with Advanced-Stage Pancreatic Cancer. Ultraschall Med. 2018 Apr 17. doi: 10.1055/a-0591-3386.
Park EJ, Ahn YD, Lee JY. In vivo study of enhanced chemotherapy combined with ultrasound image-guided focused ultrasound (USgFUS) treatment for pancreatic cancer in a xenograft mouse model. Eur Radiol. 2018 Mar 29. doi: 10.1007/s00330-018-5355-9.
Strunk HM, Lützow C, Henseler J, Mücke M, Rauch M, Marx C, Schild HH, Marinova M. Mesenteric Vessel Patency Following HIFU Therapy in Patients with Locally Invasive Pancreatic Cancer. Panc ca Ultraschall Med. 2018 Jan 18. doi: 10.1055/s-0043-125391.
Masanori Maeda, Yoshihiro Muragaki, Jun Okamoto, Shin Yoshizawa, Nobutaka Abe, Hidekazu Nakamoto, Hiroshi Ishii, Kenichi Kawabata, Shinichiro Umemura, Nobuhiro Nishiyama, Kazunori 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
Maloney E, Khokhlova T, Pillarisetty VG, Schade GR, Repasky EA, Wang YN, Giuliani L, Spring M, Hwang JH. Focused ultrasound for immuno-adjuvant treatment of pancreatic cancer: An emerging clinical paradigm in the era of personalized oncotherapy. Int Rev Immunol. 2017 Sep 29:1-14. doi: 10.1080/08830185.2017.1363199.
Farr N, Wang YN, D'Andrea S, Starr F, Partanen A, Gravelle KM, McCune JS, Risler LJ, Whang SG, Chang A, Hingorani SR, Lee D, Hwang JH. Hyperthermia-enhanced targeted drug delivery using magnetic resonance-guided focussed ultrasound: a pre-clinical study in a genetic model of pancreatic cancer. Int J Hyperthermia. 2017 Jul 17:1-8. doi: 10.1080/02656736.2017.1336675.
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.
Shi Y, Ying X, Hu X, Shen H. Pain management of pancreatic cancer patients with high-intensity focused ultrasound therapy. Pak J Pharm Sci. 2017 Jan;30(1 Suppl):303-307.
Zhao J, Zhao F, Shi Y, Deng Y, Hu X, Shen H. The efficacy of a new high intensity focused ultrasound therapy for locally advanced pancreatic cancer. J Cancer Res Clin Oncol. 2017 Jun 15. doi: 10.1007/s00432-017-2459-6.
Dababou S, Marrocchio C, Rosenberg J, Bitton R, Pauly KB, Napoli A, Hwang JH, Ghanouni P. A meta-analysis of palliative treatment of pancreatic cancer with high intensity focused ultrasound. J Ther Ultrasound. 2017 Apr 1;5:9. doi: 10.1186/s40349-017-0080-4.
Scott SJ, Adams MS, Salgaonkar V, Sommer FG, Diederich CJ. Theoretical investigation of transgastric and intraductal approaches for ultrasound-based thermal therapy of the pancreas. J Ther Ultrasound. 2017 May 3;5:10. doi: 10.1186/s40349-017-0090-2. eCollection 2017.
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