High-intensity Focused Ultrasound in the Solid Tumor Treatment

Seong Tae Hahn

doi:10.5124/jkma.2006.49.8.707

J Korean Med Assoc > Volume 49(8); 2006 > Article

Hahn: High-intensity Focused Ultrasound in the Solid Tumor Treatment

Continuing Education Column

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2006; 49(8): 707-716.

Published online: August 31, 2006

DOI: http://dx.doi.org/10.5124/jkma.2006.49.8.707

High-intensity Focused Ultrasound in the Solid Tumor Treatment

Seong Tae Hahn, MD

Department of Diagnostic Radiology/HIFU Cancer Therapy Center, The Catholic University of Korea College of Medicine, Korea. sthahn@catholic.ac.kr

Abstract

High intensity focused ultrasound (HIFU) is a technique that was first introduced in the 1940s as a potential method of destroying selective regions within the brain to aid neurobehavioral studies. A beam of ultrasound can be delivered to a targeted focus at a distance from its source, and if a sufficient amount of energy is concentrated in the focus, the cells lying within this focal volume are selectively killed. This is, therefore, a non-invasive method of producing selective and "trackless" tissue destruction in deep-seated targets in the body without damage to the overlying tissues. Although it had not been in clinical use for a long time, HIFU is now widely used as a non-invasive treatment method for malignant tumors of the liver, kidney, breast, bone, uterus and pancreas, as well as for the relief of chronic pain of malignant origin. Further improvement of technology and imaging of HIFU in the near future will make it one of the most important tools in the treatment of solid tumors, further expanding its clinical applications.

Therapeutic ultrasound; Thermal ablation; Malignant tumor

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Figure 1

Schematic showing the principle of high-intensity focused ultrasound

A) An extracorporeal source generates an ultrasound beam, which forms a cigar-shaped focus deep within the target tissue(liver). The volume of ablation('lesion') following a single high-intensity focused ultrasound exposure is small and will vary according to transducer characteristics, but is typically in the order of 1~3mm wide by 8~15mm in length along the beam axis.

B) Schematic illustrating application of sequential "single lesions" to achieve tumour volume ablation. The lesions must be placed side by side systematically to "paint out" the target tumour and some of the surrounding normal tissue margin.

Figure 2

The principle of inertial cavitation

A mechanical ultrasound wave progresses through tissues(top), causing alternating cycles of increased and reduced pressure (compression and rarefaction respectively-middle). Gas is drawn out of solution during rarefaction, creating bubbles. These can oscillate in size in a stable fashion with the chaging tissue pressure, but ultimately might collapse, causing local energy release and temperature rises at the microscopic level (bottom).

Figure 3

A case of high-intensity focused ultrasound for hepatocelluar carcinoma

A) Before HIFU: Abdominal CT shows a large, 9cm-diameter, hepatocelluar carcinoma(arrows) at right hepatic lobe in 67-year-old man.

B) After HIFU: MR obtained 2 months later shows the lesion(arrows) has markedly decreased without contrast enhancement.