High intensity focused ultrasound

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High-intensity focused ultrasound ( English high intensity focused ultrasound , HIFU ) is a medical application of ultrasound in the tissue is heated and destroyed by targeted bundling the sound waves. This therapeutic procedure is also known as ultrasound ablation , magnetic resonance guided focused ultrasound surgery (MRgFUS) or pyrotherapy . An important field of application is the treatment of prostate cancer . It is becoming increasingly important in the treatment of uterine fibroids and, since 2012, in the treatment of adenomyosis and the palliative treatment of bone metastases . Its use in a variety of other diseases (including breast cancer , brain tumors , Parkinson's disease , stroke , epilepsy ) has been tested in small studies.

development

The first studies on the non-invasive ablation of tissue by HIFU were published by John G. Lynn and colleagues in 1942. Other important work on this treatment method comes from the 1950s and 1960s by William and Francis Fry. Initially, HIFU was mainly used for brain tumors. Frank Fry later used it to treat patients with Parkinson's syndrome and other neurological diseases. HIFU use in neurosurgery was researched extensively in the 1950s and 1960s, however practical and technological limitations limited the possibilities. In 1956, Burov proposed using HIFU in cancer treatment.

functionality

In the HIFU method, sound waves with frequencies in the low megahertz (MHz) range are bundled in a focus by suitable curvature of the transducer (sounder) or by time-shifted control of several small sounders , similar to how a magnifying glass bundles the light. This focus is at a distance of 1–20 cm from the sounder. The temperature arising in the focus can reach up to 90 ° C. At this temperature the treated tissue is destroyed. Due to the pronounced concentration of the energy transmitted by the sound waves, however, the surrounding tissue remains intact. Computer control of the transducer position helps reduce the risk of side effects and complications. The treatment is usually carried out under partial anesthesia, but general anesthesia is also possible on request.

Treatment of prostate cancer with HIFU

Typically, HIFU is used in the treatment of prostate cancer in its early stages. A transducer is inserted into the rectum . The coupling of the sounder with the mucous membrane is achieved with the aid of a feed line made of water or gel. The water or gel is constantly cooled to 5 ° C so that the intestine cannot be injured by the heat generated. If water is used as the flow, it must be completely degassed, otherwise small air bubbles will scatter the sound. A computer determines the treatment area in three dimensions and marks it on the ultrasound image.

HIFU is usually combined with transurethral surgery . Indications for HIFU therapy are localized prostate cancer; Circumstances that speak against an operation (age, comorbidities, etc.); fundamental rejection of an operation / radiation therapy / hormone therapy ; PSA ≤ 20. HIFU can also be used if a tumor recurs in the prostate (local recurrence ), or as a palliative therapy for advanced tumor diseases.

Treatment attempts for enlarged prostate (BPH) with HIFU

Attempts to use HIFU from the intestine (transrectally) even with benign prostate enlargement (BPH) have not proven successful.

Recently (as of 2019), HIFU has also been offered directly from within the prostate via a urethral catheter . The previously defined target area of ​​the effect of HIFU is monitored by real-time MRI . However, the scientific basis for using this procedure for prostate enlargement (BPH) is still completely inadequate (as of 2019). There have been several publications on preclinical trials in this area since 2004, but not a single clinical study .

In the USA, unlike in Europe, not even the only technical device currently available has been approved for this method (as of 2019). In England, the National Institute for Health and Care Excellence (NICE) expressly classified the method as "not recommended" in a statement from August 2018.

history

HIFU therapy for prostate cancer was first carried out in France in 1993. The method has also been available in Germany since 1996. By July 2009, 20,000 therapies had been carried out in 218 HIFU centers worldwide and 6150 in Germany.

Manufacturer of HIFU devices

  • Ablatherm Robotic HIFU was developed in France in 1989 by Inserm (French National Institute of Medical Research), the Edouard Herriot Hospital in Lyon and EDAP TMS.
  • Sonablate 500 was developed for the treatment of benign prostatic hyperplasia (BPH) in the States by Focus Surgery in the early 1990s and was later modified to treat prostate cancer.
  • ExAblate One is the development of marketed since 2010 employed since 2004 ExAblate and has opposite him the benefit of the targeted achievement of difficult to access Gewebsarealen. The device was developed by InSightec and is used to treat myomas and bone metastases; For prostate treatment and for use in neurology / neurosurgery, a test phase is currently underway.
  • Ulthera , developed by Ulthera Inc. and sold by the Merz Pharma Group , is a device for performing non-invasive lifting procedures using ultrasound
  • Sonalleve MR-HIFU was developed by Philips in 2011 and is used for the treatment of uterine fibroids and pain therapy for bone metastases. Since June 2017, Philips' MR-HIFU business (including the Sonelleve system) has been managed by Profound Medical.
  • TULSA-PRO was developed by Profound Medical to enable an adaptable ablation of diseased prostate tissue and at the same time to actively protect the urethra and rectum and thus to preserve the natural functional capabilities of the prostate. The first TULSA-PRO treatment for prostate cancer was carried out in 2013.

literature

  • JE Kennedy, GR Ter Haar, D. Cranston: High intensity focused ultrasound: surgery of the future? In: The British journal of radiology. Volume 76, Number 909, September 2003, pp. 590-599, doi : 10.1259 / bjr / 17150274 , PMID 14500272 (review).

Individual evidence

  1. ↑ Treatment options with MRgFUS ( Memento of the original from May 7, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  @1@ 2Template: Webachiv / IABot / www.fus-bottrop.de
  2. ↑ CR Hill, GR ter Haar: Review article: high intensity focused ultrasound-potential for cancer treatment. In: The British journal of radiology Volume 68, Number 816, December 1995, pp. 1296-1303. PMID 8777589 . (Review).
  3. ↑ R. Yang, NT Sanghvi, FJ Rescorla, KK Kopecky, JL Grosfeld: Liver cancer ablation with extracorporeal high-intensity focused ultrasound. In: European Urology Volume 23 Suppl 1, 1993, pp. 17-22. PMID 8513829 . (Review).
  4. ↑ G. ter Haar: Focused ultrasound therapy. In: Curr Opin Urol Volume 4, 1994, pp. 89-92.
  5. ↑ F. Wu, ZB Wang, YD Cao, WZ Chen, J. Bai, JZ Zou, H. Zhu: A randomized clinical trial of high-intensity focused ultrasound ablation for the treatment of patients with localized breast cancer. In: British journal of cancer Volume 89, Number 12, December 2003, pp. 2227-2233. doi : 10.1038 / sj.bjc.6601411 . PMID 14676799 . PMC 2395272 (free full text).
  6. ↑ PE Huber, JW Jenne, R. Rastert, I. Simiantonakis, HP Sinn, HJ Strittmatter, D. von Fournier, MF Wannenmacher, J. Debus: A new noninvasive approach in breast cancer therapy using magnetic resonance imaging-guided focused ultrasound surgery . In: Cancer research Volume 61, Number 23, December 2001, pp. 8441-8447. PMID 11731425 .
  7. ↑ KU Köhrmann, MS Michel, J. Gaa, E. Marlinghaus, P. Alken: High intensity focused ultrasound as noninvasive therapy for multilocal renal cell carcinoma: case study and review of the literature. In: The Journal of Urology 167, 2002, pp. 2397-2403. PMID 11992045 . (Review).
  8. ↑ Elias WJ, Huss D: A pilot study of focused ultrasound thalamotomy for essential tremor. In: N Engl J Med 2013, Aug 15,369 (7): 640-8 doi : 10.1056 / NEJMoa1300962 , PMID 23944301
  9. ↑ JG Lynn, RL Zwemer, AJ Chick, AE Miller: A new method for the generation and use of focused ultrasound in experimental biology. In: The Journal of General Physiology Volume 26, Number 2, Nov. 1942, pp. 179-193. PMID 19873337 . PMC 2142058 (free full text).
  10. ^ WJ Fry, WH Mosberg, JW Barnard, FJ Fry: Production of focal destructive lesions in the central nervous system with ultrasound. In: Journal of Neurosurgery Volume 11, Number 5, September 1954, pp. 471-478. doi : 10.3171 / jns.1954.11.5.0471 . PMID 13201985 .
  11. ↑ FJ Fry: Precision high intensity focusing ultrasonic machines for surgery. In: American journal of physical medicine Volume 37, Number 3, June 1958, pp. 152-156. PMID 13545382 .
  12. ↑ HT Ballantine, E. Bell, J. Manlapaz: Progress and problems in the neurological applications of focused ultrasound. In: Journal of neurosurgery Volume 17, September 1960, pp. 858-876. doi : 10.3171 / jns.1960.17.5.0858 . PMID 13686380 .
  13. ^ R. Warwick, J. Pond: Trackless lesions in nervous tissues produced by high intensity focused ultrasound (high-frequency mechanical waves). In: Journal of Anatomy Volume 102, Pt 3 March 1968, pp. 387-405. PMID 4968493 . PMC 1231478 (free full text).
  14. ^ PP Lele: Concurrent detection of the production of ultrasonic lesions. In: Medical & biological engineering Volume 4, Number 5, September 1966, pp. 451-456. PMID 5975870 .
  15. ^ PP Lele: Production of deep focal lesions by focused ultrasound – current status. In: Ultrasonics Volume 5, April 1967, pp. 105-112. PMID 6039539 .
  16. ↑ AK Burov: High-intensity ultrasonic vibrations for action on animal and human malignant Tumors. In: Dokl Akad Nauk SSSR Volume 106, 1956, pp. 239-241.
  17. ↑ S. Madersbacher, G. Schatzl, B. Djavan, T. Stulnig, M. Marberger: Long-term outcome of transrectal high-intensity focused ultrasound therapy for benign prostatic hyperplasia. In: European urology. Volume 37, Number 6, June 2000, pp. 687-694, doi : 10.1159 / 000020219 , PMID 10828669 .
  18. ↑ G. Sommer, KB Pauly, A. Holbrook, J. Plata, B. Daniel, D. Bouley, H. Gill, P. Prakash, V. Salgaonkar, P. Jones, C. Diederich: Applicators for magnetic resonance-guided ultrasonic ablation of benign prostatic hyperplasia. In: Investigative radiology. Volume 48, number 6, June 2013, pp. 387-394, doi : 10.1097 / RLI.0b013e31827fe91e , PMID 23462673 , PMC 4045500 (free full text).
  19. ↑ VA Salgaonkar, CJ Diederich: Catheter-based ultrasound technology for image-guided thermal therapy: current technology and applications. In: International journal of hyperthermia: the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group. Volume 31, number 2, March 2015, pp. 203-215, doi : 10.3109 / 02656736.2015.1006269 , PMID 25799287 , PMC 4659534 (free full text) (review).
  20. ↑ Focused Ultrasound Foundation: Benign Prostatic Hyperplasia (BPH) , website of the industry lobby organization.
  21. ↑ National Institute for Health and Care Excellence (NICE): Current care pathway (for BPH) , August 2018.
  22. ↑ Exablate presented by marketer
  23. ↑ Philips Expands collaboration with Profound Medical Corp. in MR-guided ultrasound ablation therapies. Retrieved December 13, 2019 .
  24. ↑ Tulsa | Profound Medical. Retrieved December 13, 2019 .