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 neuroblastoma. This novel technology focuses beams of ultrasonic energy precisely and accurately on targets deep in the brain 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 the precise ablation (thermal destruction of tissue), which can be done to completely destroy the target or to partially treat it. Partial treatment is believed to stimulate the patient’s immune response, which may have a broader impact.
Another mechanism is to produce local hyperthermia of the targeted tissue, which can have a variety of beneficial effects including the release of chemotherapy drugs that are contained in temperature sensitive molecules. This allows delivery of a higher level of chemotherapy precisely to the targeted tissue, while limiting the effects for the rest of the body.
Advantages
The mainstay of treatment for neuroblastoma is surgical resection coupled with chemotherapy. However, many patients do not respond adequately to chemotherapy and commonly relapse. Furthermore, most long-term survivors suffer adverse effects from their treatment.
For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications at a lower cost.
Potential advantages as compared to current treatments:
- Focused ultrasound is non-invasive and radiation-free – no incisions, holes in the skull, electrodes in the brain – and therefore has reduced risk for infection and blood clots.
- Precise targeting minimizes damage to non-targeted healthy brain.
- Treatment can be conformed to a wide variety of shapes and sizes.
- Tissue temperature can be monitored in real-time using magnetic resonance imaging (MRI).
- Treatment can be a complement to drug therapy, enabling effective treatment with lower doses of drugs and minimal toxicity.
Clinical Trials
A clinical trial is using thermosenstitive doxorubicin in a variety of tumors, including neuroblastoma.
A second clinical trial using focused ultrasound to ablate recurrent or refractory solid tumors, including neuroblastoma, has been completed.
Regulatory Approval and Reimbursement
Focused ultrasound treatment for neuroblastoma is not yet approved by regulatory bodies or covered by medical insurance companies.
Preclinical Laboratory Studies
Early-stage preclinical studies suggest that focused ultrasound may play a beneficial role in the treatment of unresectable neuroblastoma. In one study, mice with neuroblastoma were treated with chemotherapy, focused ultrasound plus chemotherapy, or focused ultrasound alone. Following treatment, 53% of mice treated with focused ultrasound and 80% of mice treated with focused ultrasound plus chemotherapy were cured with no evidence of tumor at 200 days, versus 100% fatality at 45 days in the control group and in mice treated with just chemotherapy.
Additional Information
Children’s Neuroblastoma Cancer Foundation
Notable Papers
Bellary A, Villarreal A, Eslami R, Undseth QJ, Lec B, Defnet AM, Bagrodia N, Kandel JJ, Borden MA, Shaikh S, Chopra R, Laetsch TW, Delaney LJ, Shaw CM, Eisenbrey JR, Hernandez SL, Sirsi SR. Perfusion-guided sonopermeation of neuroblastoma: a novel strategy for monitoring and predicting liposomal doxorubicin uptake in vivo. Theranostics. 2020 Jul 9;10(18):8143-8161. doi: 10.7150/thno.45903. eCollection 2020.
Eranki A, Srinivasan P, Ries M, Kim A, Lazarski CA, Rossi CT, Khokhlova TD, Wilson E, Knoblach S, Sharma KV, Wood BJ, Moonen C, Sandler AD, Kim PCW. High Intensity Focused Ultrasound (HIFU) Triggers Immune Sensitization of Refractory Murine Neuroblastoma to Checkpoint Inhibitor Therapy. Clin Cancer Res. 2019 Oct 15. pii: clincanres.1604.2019. doi: 10.1158/1078-0432.CCR-19-1604.
Tung S, Fahy AS, Lamberti-Pasculli M, Waspe AC, Pichardo S, Gerstle JT. Magnetic Resonance-guided High-intensity Focused Ultrasound(MRgHIFU) Virtual Treatment Planning for Abdominal Neuroblastoma Utilizing Retrospective Diagnostic 3D CT Images. J Pediatr Hematol Oncol. 2019 Jul 26. doi: 10.1097/MPH.0000000000001563.
Shim J, Staruch RM, Koral K, Xie XJ, Chopra R, Laetsch TW. Pediatric Sarcomas Are Targetable by MR-Guided High Intensity Focused Ultrasound (MR-HIFU): Anatomical Distribution and Radiological Characteristics. Pediatr Blood Cancer. 2016 Oct;63(10):1753-60. doi: 10.1002/pbc.26079. Epub 2016 May 19.
S. Wang, V. Frenkel, and V. Zderic, “Optimization of pulsed focused ultrasound exposures for hyperthermia applications.,” J. Acoust. Soc. Am., vol. 130, no. 1, pp. 599–609, Jul. 2011.
H. Matsumoto, “Revisiting sensitization mechanisms in cancer thermochemotherapy.,” Fukuoka igaku zasshi = Hukuoka Acta medica, vol. 100, no. 4, pp. 95–103, Apr. 2009.
Yang R, Reilly CR, Rescorla FJ, Sanghvi NT, Fry FJ, Franklin TD Jr, Grosfeld JL. Effects of high-intensity focused ultrasound in the treatment of experimental neuroblastoma. J Pediatr Surg. 1992 Feb;27(2):246-50
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