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Review
. 2018 Feb;91(1083):20170641.
doi: 10.1259/bjr.20170641. Epub 2018 Jan 17.

Focused ultrasound: tumour ablation and its potential to enhance immunological therapy to cancer

Giovanni Mauri  1 , Luca Nicosia  2 , Zhen Xu  3 , Salvatore Di Pietro  2 , Lorenzo Monfardini  4 , Guido Bonomo  1 , Gianluca Maria Varano  1 , Francesco Prada  5   6   7 , Paolo Della Vigna  1 , Franco Orsi  1
Affiliations
Review

Focused ultrasound: tumour ablation and its potential to enhance immunological therapy to cancer

Giovanni Mauri et al. Br J Radiol. 2018 Feb.

Abstract

Various kinds of image-guided techniques have been successfully applied in the last years for the treatment of tumours, as alternative to surgical resection. High intensity focused ultrasound (HIFU) is a novel, totally non-invasive, image-guided technique that allows for achieving tissue destruction with the application of focused ultrasound at high intensity. This technique has been successfully applied for the treatment of a large variety of diseases, including oncological and non-oncological diseases. One of the most fascinating aspects of image-guided ablations, and particularly of HIFU, is the reported possibility of determining a sort of stimulation of the immune system, with an unexpected "systemic" response to treatments designed to be "local". In the present article the mechanisms of action of HIFU are described, and the main clinical applications of this technique are reported, with a particular focus on the immune-stimulation process that might originate from tumour ablations.

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Figures

Figure 1.
Figure 1.
Case of a patient with colorectal liver metastases in a difficult location close to the inferior vena cava succesfully treated with HIFU. (a) A contrast-enhanced CT showing a lesion (arrow) located very close to the inferior vena cava. (b) Treatment with HIFU and fusion of real-time ultrasound images. (c) Treatment with HIFU and fusion of real-time CT images. (d) A contrast-enhanced CT showing large area of ablation without residual vital tissue 3 months after the treatment. HIFU, high intensity focused ultrasound.
Figure 2.
Figure 2.
Case of a patient with a pancreatic adenocarcinoma treated with HIFU ablation with abscopal response of distant lymph-node metastases. (a) A contrast-enhanced CT showing a 7 cm mass at the level of pancreatic body (arrow). The lesion was considered to be not suitable for surgical resection and was fast growing under chemotherapy. (b) The same CT scan demonstrated the presence of lymph-node metastases in the paraortic space (arrow). The patient underwent treatment with USg (Ultrasound guided)-HIFU for pain palliation. (c) A contrast-enhanced CT scan performed 1 year after the procedure demonstrated large avascular area in correspondence of the treated tumour (arrow). (d) The same CT scan demonstrated the complete disappearance of the pathological lymph nodes (arrow). HIFU, High intensity focused ultrasound.
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References

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