Key Points
- HIFU ablation palliates pain, destroys early-stage tumors, and debulks unresectable cancers.
- Clinical research applications include cancers of the breast, prostate, pancreas, liver, kidney, and bone, as well as non-cancerous tumors like uterine fibroids.
Image-guided HIFU ablation is increasingly used as an alternative approach to surgery, interventional radiologic approaches, and radiation therapy to treat benign and malignant tumors. Published studies report the ability of HIFU to palliate pain, completely ablate early-stage tumors, and debulk late-stage cancers that are unresectable. It is also being investigated to treat a variety of other oncology indications at various stages of disease, including cancers of the breast, prostate, pancreas, liver, kidney, and bone.
A collaborative group of international researchers led by Alessandro Napoli, MD, PhD, at Sapienza University of Rome, reviewed and outlined all current applications for HIFU ablation for cancer.
High-Intensity Focused Ultrasound Surgery for Tumor Ablation: A Review of Current Applications
As the most common and widely explored application of HIFU, thermal ablation destroys tissue within seconds by heating it to 55 degrees Celsius or higher while creating sharp treatment margins. HIFU ablation is a repeatable procedure that has achieved regulatory approval for 32 indications, and it is commercially available for each of these indications. Many different transducers, systems, monitoring, and guidance are being used. There are many advantages in using HIFU to treat tumors, as it is incisionless, does not involve radiation, and has no dose-limiting toxicity.
After providing an overview of how HIFU ablation is administered (e.g., team members, settings), this comprehensive review article outlines the state of the field for the following indications:
- Painful bone metastases
- Bone tumors (e.g., osteoid osteoma)
- Liver tumors
- Pancreatic cancer
- Kidney/renal cancer
- Prostate cancer
- Breast cancer
- Uterine fibroids
- Soft-tissue tumors (e.g., desmoids)
- Brain tumors
“When HIFU ablation is used to treat uterine fibroids, the data show that symptom reduction and quality of life at 12 months are comparable with surgery,” said Suzanne LeBlang, MD, the Foundation’s director of clinical relationships. “Therefore, this noninvasive option should be available to women who are most commonly offered surgery as the only option.”
“This review points out several important characteristics of HIFU ablation as compared with other treatment options,” said Dr. Napoli. “For example, HIFU provides more rapid pain relief than radiation therapy in the palliative treatment of bone metastases.”
Tim Meakem, MD, a managing director at the Foundation and its co-director of research and education, added, “Patients who are dealing with painful bone metastases from cancer really do not control their options in terms of HIFU versus radiation therapy. Physicians truly need this evidence on the efficacy, safety, and durability of HIFU as compared with other treatment options.”
See Radiology: Imaging Cancer (Open Source)