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Key Points Researchers at The Israel Institute of Technology investigated whether focused ultrasound could be used to alleviate chronic pain occurring after limb amputation.Physicians applied focused ultrasound to six stump neuromas in five participants.The team struggled to reach ablative temperatures, but the treatment temporarily decreased pain intensity for up to three months. Feasibility of Magnetic Resonance-Guided High-Intensity-Focused Ultrasound (MRgHIFU) Ablation of Stump Neuromas for the Relief of Chronic Postamputation Neuropathic PainThe results from a Foundation-funded clinical trial conducted in Israel have recently been published. Researchers at The Technion, Israel Institute of Technology, in Haifa, sought to determine whether focused ultrasound could be used to alleviate chronic pain that occurs after limb amputation, because a high percentage (70%) of amputees experience phantom pain and neuropathic pain after limb loss. These patients often develop neuromas in the affected limb. A neuroma is a benign growth of nerve tissue that is often called a “nerve tumor.” It causes burning, tingling, shooting pain, or numbness.Instead of the current invasive surgeries to ablate neuromas, physicians used the Insightec Exablate body system to apply magnetic resonance–guided high-intensity focused ultrasound (MRgHIFU) to six stump neuromas in five participants.In this feasibility study, the team was only able to reach an ablative temperature (> 65°C) at the neuroma in one participant, but the treatments did temporarily decrease the intensity of the pain (from 5.7 to 4.3, which increased back to 5.6 at 3- and 6-months of follow-up). One participant experienced bone necrosis. The team determined that further studies are warranted for this application and suggested the creation of a modified device with a dome-shaped transducer that can be placed around the amputated limb. Solving these technical challenges may allow for a more effective treatment.See Journal of Ultrasound in Medicine >Related StoriesDiseases and Conditions: Painful Amputation Neuromas and Neuropathic PainFocus Feature: Focused Ultrasound and Chronic Pain July 2019Stump Neuroma Trial Begins August 2017

Key Points Matthew Gallitto, MD, a postdoctoral clinical fellow at Columbia University, has received an ASCO Young Investigator Award.He is researching focused ultrasound—induced blood-brain barrier disruption to address diffuse intrinsic pontine gliomas (DIPG). Matthew Gallitto, MD, a postdoctoral clinical fellow in radiation oncology at Columbia University was one of five oncology trainees at the Herbert Irving Comprehensive Cancer Center to be recognized with a Young Investigator Award. The awards were given by the American Society of Clinical Oncology (ASCO) and the Conquer Cancer Foundation.Dr. Gallitto’s research, entitled “Focused ultrasound-enhanced STAT3 inhibition and radiosensitization for diffuse midline glioma,” involves using focused ultrasound to disrupt the blood-brain barrier to address a devastating pediatric brain tumor – diffuse intrinsic pontine gliomas (DIPG). The goal is to introduce a new approach to treating this disease and also address barriers that prevent optimal drug delivery.He is the first combined radiation oncology resident and PhD doctoral candidate at Columbia and is being mentored by Cheng-Chia Wu, MD, Elisa Konofagou, PhD, and Zhiguo Zhang, PhD. This fall, he will also begin his PhD studies in Cellular, Molecular, and Biomedical Studies at Columbia’s Graduate School of Arts and Sciences.“ASCO’s Young Investigator Award will provide me with the support and resources to prepare me for a successful career in clinical oncology and help me establish the use focused ultrasound in the treatment of pediatric cancers,” said Dr. Gallitto. “It is a true honor to work alongside ASCO and the Focused Ultrasound Foundation to usher in this new era of ‘acoustic oncology.'”

Key Points The 2022 American Urological Association (AUA) Annual Meeting was held in New Orleans from May 13–16.There were two educational offerings and 13 abstracts that involved high-intensity focused ultrasound (HIFU).Three of the HIFU manufacturers in the prostate space participated in the meeting. The 2022 American Urological Association (AUA) Annual Meeting was held in New Orleans from May 13–16.According to the AUA Daily News Online, “Focal ablation is one of the hottest topics in urology today, driven in large part by direct-to-consumer marketing.” As one form of focal ablation, high-intensity focused ultrasound (HIFU) was an active part of many conversations, papers, and poster presentations. During the plenary session entitled, “Second Opinion: Focal Therapy for Prostate Cancer: Should it Replace Standard of Care,” with Drs. Michael Koch, Kelly Stratton, and Scott Eggener, the speakers concluded that although focal therapy does not have the long-term data of greater than eight years found with radiation therapy and surgery, the results to date suggest that it should be considered in the mix of standard-of-care treatments.In addition, there were two educational offerings that included HIFU: Introduction to Prostate Tissue Ablation: High Intensity Focused Ultrasound and Cryotherapy.This workshop is the first time the AUA offered hands-on training for focal therapy with HIFU. EDAP and SonaBlate trained approximately 25 urologists on the use of their equipment.Complications and Recurrence after Focal Therapy for Prostate Cancer “Sonablate, Profound Medical, and EDAP all made a big impact at this year’s AUA meeting,” said Mark Carol, MD, a senior consultant at the Focused Ultrasound Foundation. “The urology community is beginning to make strides toward more aggressively addressing focal disease, and this is the area where HIFU offers the triple advantages of effectiveness, low cost, and fewer side effects.”In a company press release, Sonablate Corporation described its participation in the meeting, including mention in a best poster presentation. The poster described the publication titled “Cancer Control Outcomes Following Focal Therapy Using High-Intensity Focused Ultrasound in 1379 Men with Nonmetastatic Prostate Cancer: A Multi-institute 15-year Experience,” was authored by Deepika Reddy, MD, Prof. Hashim Ahmed, and Prof. Mark Emberton from Imperial College London. The data supported the use of Sonablate HIFU for focal prostate ablation and showed favorable medium-term disease control.Another therapeutic ultrasound company, Profound Medical, shared in its press release that its platform, TULSA-PRO, was highlighted in multiple clinical presentations and product demonstrations at AUA 2022. TULSA-PRO is used to treat patients with prostate cancer and benign prostatic hyperplasia (BPH). One plenary session featured Kenneth A. Goldberg, MD, an assistant professor of urology at UT Southwestern Medical Center, performing a semi-live TULSA procedure.There were 13 abstracts that included HIFU data, as listed below. All abstracts can be searched and accessed on the AUA website. MP22-08: Less is More in the Management of Proximal Stricture Disease after Prostate Cancer TreatmentMP22-09: Urethral Stricture/Stenosis as a Complication of High Intensity Focused Ultrasound of the Prostate: What is the Overall Patient Experience?MP55-01: Cancer Control Outcomes Following Focal Therapy using HIFU in 1,379 Men with Non-Metastatic Prostate Cancer: A Multi-Institute 15-Year ExperienceMP55-02: Repeat Focal Therapy of Prostate CancerMP55-04: The Predictive Value of Tissue Change during Ultrasound Guided High Intensity Focused Ultrasound (USgHIFU) Focal Therapy on Treatment SuccessMP55-06: Focal Ablative Salvage Therapy for Radio-Recurrent Prostate Cancer: 6 Year Oncological and Safety OutcomesMP55-07: Partial Ablation and Total Ablation with High Intensity Focused Ultrasound (HIFU) Compared to Radical Prostatectomy (RP): a Propensity Score-Matched Study (Abstract Withdrawn)MP55-08: High Intensity Focused Ultrasound and Cryoablation Focal Therapy for Intermediate Risk Prostate Cancer: Oncologic and Functional OutcomesMP55-11: Prostate Cancer Focal Therapy – Locations of Post-Ablation DiseaseMP55-14: Salvage Robotic Radical Prostatectomy after Focal Therapy versus Radiation: A 10-Year ExperienceMP55-18: A National Cohort Study of Cancer Outcomes Following High-Intensity Focused Ultrasound Treatment of Clinically Localised Prostate CancerPD54-07: Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High Intensity Focused Ultrasound (HIFU), Cryotherapy or Electroporation) for Localised Prostate CancerV07-09: Robotic-Assisted Laparoscopic Prostatectomy and Urethral Pull Through of Membranous Urethra to Bladder AUA offers the latest technology and urologic education for urologists, oncologists, osteopaths, urology residents, researchers, advanced practice professionals, educators, technicians, nurses, medical assistants, medical students, and other health care professionals.

Key Points Researchers at The University of Texas MD Anderson Cancer Center have developed and tested a new therapeutic ultrasound treatment platform that improves two types of cancer immunotherapy.They named the system “MUSIC,” or Microbubble-assisted, UltraSound-guided Immunotherapy of Cancer.MUSIC can be used to image and burst microbubbles that have accumulated on tumors. Researchers at The University of Texas MD Anderson Cancer Center have developed and tested a new therapeutic ultrasound treatment platform that improves two types of cancer immunotherapy: the antitumor immune response and the response to checkpoint inhibitors.They named the platform “MUSIC,” which is derived from Microbubble-assisted, UltraSound-guided Immunotherapy of Cancer. With its integrated ultrasound capabilities, the MUSIC platform can first be used to image the accumulation of microbubbles on tumors – and then used to oscillate and burst the accumulated microbubbles. Loosely translated as “sound pores,” sonoporation uses ultrasound energy to open “pores” in cellular membranes that allow the transfer of new molecules (or genes) into a cell.The marriage of sonoporation with cancer immunotherapy is novel in the way that the MD Anderson team, led by Wen Jiang, MD, PhD, assistant professor of radiation oncology, designed MUSIC to deliver molecules that activate the immune system. During preclinical testing of the system, Dr. Jiang and his team observed a 60% complete tumor eradication rate in breast cancer models, significantly improved antitumor responses (primary tumor control with decreased systemic progression) and minimal toxicity effects in other experiments, and superior survival in a combination therapy group.“Our findings show that the MUSIC strategy is capable of paving the way toward novel image-guided strategies for targeted cancer immunotherapy,” said Dr. Jiang “Although the majority of cancer immunotherapies have focused on boosting the adaptive branch of the body’s immune system, there has been a growing realization that both the innate and adaptive branches of the body’s immune system need to be engaged to generate optimal antitumoral immunity. This understanding has led to the development of new immunotherapies that target the regulators of innate immune systems…”The highly technical aspects of this project have been published in Nature Nanotechnology. The article is titled, “Cancer Immunotherapy Based on Image-Guided STING Activation by Nucleotide Nanocomplex-Decorated Ultrasound Microbubbles.”See the MD Anderson Press Release >See Nature Nanotechnology >