Image-Guided High-Intensity Focused Ultrasound in the Treatment of Cancer
High-intensity focused ultrasound (HIFU) is a noninvasive technique delivering acoustic energy for localized thermal ablation of tumors. The targeted volume reaches temperatures above 70 °C within a fraction of a second resulting in coagulative necrosis a
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Image-Guided High-Intensity Focused Ultrasound in the Treatment of Cancer M. Raphael Pfeffer, Tatiana Rabin, Yael Inbar, Arik Hananel, and Raphael Catane
Abstract
High-intensity focused ultrasound (HIFU) is a noninvasive technique delivering acoustic energy for localized thermal ablation of tumors. The targeted volume reaches temperatures above 70 C within a fraction of a second resulting in coagulative necrosis and ablation of the target and minimal side effects to nontargeted tissues. Available systems use either ultrasound or magnetic resonance imaging (MRI) to define the target and guide the treatment. MR-guided HIFU has the additional advantage of real-time thermometry which allows measurement and adjustment of the deposited energy during therapy. Several HIFU devices are commercially available, and the clinical use of HIFU is approved in many countries for the treatment of benign uterine fibroids and for the treatment of adenomyosis and painful bone metastases. Clinical studies are investigating the use of MR-guided HIFU for the treatment of painful bone metastases, primary breast cancer, and primary prostate cancer. Ultrasound-guided transrectal HIFU devices are in use in several countries to treat benign prostatic hypertrophy as well as primary and locally recurrent prostate cancer. The use of HIFU in cancer treatment is expanding due to advances in technology and accumulating clinical experience. In this chapter, we will review the technology and clinical experience of HIFU in cancer treatment.
M.R. Pfeffer (*) T. Rabin R. Catane Oncology Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel e-mail: [email protected]; tatiana. [email protected]; [email protected]. gov.il Y. Inbar Imaging Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel e-mail: [email protected] A. Hananel Insightec Ltd., Tirat Carmel, Haifa, Israel e-mail: [email protected]
Introduction High-intensity focused ultrasound (HIFU) is a noninvasive technique that focuses acoustic energy precisely at a targeted tumor volume, thereby heating the target and destroying it by localized thermal ablation (similar to using a magnifying glass to focus energy from the sun) (Fig. 5.1). HIFU causes tissue damage through conversion of mechanical energy to heat and through acoustic cavitation of the
D.E. Dupuy et al. (eds.), Image-Guided Cancer Therapy, DOI 10.1007/978-1-4419-0751-6_7, # Springer Science+Business Media New York 2013
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Fig. 5.1 Focusing thermal ultrasonic energy waves can be compared to using a magnifying glass to focus solar energy on a small target (With permission from Insightec Ltd)
targeted tissue. The temperature elevation in the targeted volume (>70 C) results in irreversible coagulative necrosis and ablation of the targeted structure within a fraction of a second. The thermal energy decreases sharply outside the focal zone; thus, the overlying and surrounding tissues are minimally affected. This creates a sharp demarcation
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