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Ultraschall Med 2016; 37(01): 46-55
DOI: 10.1055/s-0035-1553318
Review
© Georg Thieme Verlag KG Stuttgart · New York

Novel Non-invasive Treatment With High-intensity Focused Ultrasound (HIFU)

What you need to know about HIFU for gynaecological tumors Innovative nichtinvasive Behandlung mit hochintensivem fokussierten Ultraschall (HIFU)Was Sie über die HIFU-Behandlung gynäkologischer Tumoren wissen müssen
M. Marinova
,
M. Rauch
,
H. H. Schild
,
H. M. Strunk
Further Information

Publication History

21 September 2014

21 May 2015

Publication Date:
07 August 2015 (online)

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Abstract

Ultrasound is not only used for diagnostic purposes but it also can be applied therapeutically so far that nowadays high-intensity focused ultrasound (HIFU) even represents a novel non-invasive treatment modality for various solid tumors. HIFU works by causing selectively deep tissue destruction of target lesions within the body without harming adjacent and overlying structures. In this article, we present an overview on both the mode of action and requirements for a HIFU treatment as well as on the safety and the current status of indications and possible applications with regard to benign and malignant gynecological diseases. Based on numerous studies and original articles, HIFU proved to be an effective and low-risk treatment option particularly for uterine fibroids and adenomyosis, but it also seems to be effective for breast fibroadenomas or even for breast cancer in special cases and other rare entities.

Zusammenfassung

Ultraschall kann nicht nur zu diagnostischen Zwecken eingesetzt werden. Durch hochintensiven fokussierten Ultraschall (HIFU) wird das Einsatzspektrum deutlich erweitert, sodass dieser als neuartige nichtinvasive therapeutische Modalität für die Behandlung verschiedenartiger solider Tumoren erfolgreich angewendet werden kann. Hierbei werden selektiv im menschlichen Körper befindliche Zielregionen zerstört, ohne eine Schädigung benachbarter Strukturen zu verursachen. Dieser Artikel gibt einen Überblick sowohl über die Wirkungsweise und Voraussetzungen für eine HIFU-Behandlung, als auch über die Sicherheit und den aktuellen Stand der Einsatzmöglichkeiten dieses innovativen Verfahrens bei gutartigen und bösartigen gynäkologischen Erkrankungen. Anhand zahlreicher Studien und Originalarbeiten wird aufgezeigt, dass mittels HIFU eine wirksame und risikoarme Behandlung von Uterusmyomen und Adenomyose, aber auch von Fibroadenomen der Brust sowie Mammakarzinomen und anderen eher selteneren Entitäten erzielt werden kann.

Key words

HIFU - gynecological tumors - high-intensity focused ultrasound - uterine fibroids - adenomyosis
 

  • References

  • 1 Jenne JW, Preusser T, Gunther M. High-intensity focused ultrasound: principles, therapy guidance, simulations and applications. Z Med Phys 2012; 22: 311-322
    CrossrefPubMedGoogle Scholar
  • 2 Kennedy JE. High-intensity focused ultrasound in the treatment of solid tumours. Nat Rev Cancer 2005; 5: 321-327
    CrossrefPubMedGoogle Scholar
  • 3 Wu F, Wang ZB, Chen WZ et al. Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview. Ultrasonics sonochemistry 2004; 11: 149-154
    CrossrefPubMedGoogle Scholar
  • 4 Griffiths A, terHaar G, Rivens I et al. High-intensity focused ultrasound in obstetrics and gynecology: the birth of a new era of noninvasive surgery?. Ultraschall in Med 2012; 33: E8-E15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Zhang L, Wang ZB. High-intensity focused ultrasound tumor ablation: review of ten years of clinical experience. Frontiers of medicine in China 2010; 4: 294-302
    CrossrefPubMedGoogle Scholar
  • 6 Jenne J. Cavitations in biological tissues. Ultraschall in Med 2001; 22: 200-207
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Wu F, Chen WZ, Bai J et al. Tumor vessel destruction resulting from high-intensity focused ultrasound in patients with solid malignancies. Ultrasound in medicine & biology 2002; 28: 535-542
    CrossrefPubMedGoogle Scholar
  • 8 Zhao WP, Chen JY, Zhang L et al. Feasibility of ultrasound-guided high intensity focused ultrasound ablating uterine fibroids with hyperintense on T2-weighted MR imaging. European journal of radiology 2013; 82: e43-e49
    CrossrefPubMedGoogle Scholar
  • 9 Wang W, Wang Y, Tang J. Safety and efficacy of high intensity focused ultrasound ablation therapy for adenomyosis. Academic radiology 2009; 16: 1416-1423
    CrossrefPubMedGoogle Scholar
  • 10 Lumsden MA. Modern management of fibroids. Obstetrics, gynaecology and reproductive medicine 2013; 23: 65-70
    PubMedGoogle Scholar
  • 11 Bouwsma EV, Hesley GK, Woodrum DA et al. Comparing focused ultrasound and uterine artery embolization for uterine fibroids-rationale and design of the Fibroid Interventions: reducing symptoms today and tomorrow (FIRSTT) trial. Fertility and sterility 2011; 96: 704-710
    CrossrefPubMedGoogle Scholar
  • 12 Vaezy S, Fujimoto VY, Walker C et al. Treatment of uterine fibroid tumors in a nude mouse model using high-intensity focused ultrasound. American journal of obstetrics and gynecology 2000; 183: 6-11
    PubMedGoogle Scholar
  • 13 Keshavarzi A, Vaezy S, Noble ML et al. Treatment of uterine fibroid tumors in an in situ rat model using high-intensity focused ultrasound. Fertility and sterility 2003; 80 (Suppl. 02) 761-767
    CrossrefPubMedGoogle Scholar
  • 14 Kohrmann KU, Michel MS, Fruhauf J et al. High intensity focused ultrasound for non-invasive tissue ablation in the kidney, prostate and uterus. The Journal of urology 2000; 163: 156
    PubMedGoogle Scholar
  • 15 Zhou CY, Nie Y, Li Y. A preliminary study of high-intensity focused ultrasound ablation for patients with uterine leiomyoma. Proceedings of 3rd International Symposium on Therapeutic Ultrasound 2003; 157-160
    PubMedGoogle Scholar
  • 16 Stewart EA, Gedroyc WM, Tempany CM et al. Focused ultrasound treatment of uterine fibroid tumors: safety and feasibility of a noninvasive thermoablative technique. American journal of obstetrics and gynecology 2003; 189: 48-54
    CrossrefPubMedGoogle Scholar
  • 17 Hindley J, Gedroyc WM, Regan L et al. MRI guidance of focused ultrasound therapy of uterine fibroids: early results. Am J Roentgenol American journal of roentgenology 2004; 183: 1713-1719
    PubMedGoogle Scholar
  • 18 Stewart EA, Rabinovici J, Tempany CM et al. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertility and sterility 2006; 85: 22-29
    CrossrefPubMedGoogle Scholar
  • 19 Funaki K, Fukunishi H, Sawada K. Clinical outcomes of magnetic resonance-guided focused ultrasound surgery for uterine myomas: 24-month follow-up. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2009; 34: 584-589
    CrossrefPubMedGoogle Scholar
  • 20 Dobrotwir A, Pun E. Clinical 24 month experience of the first MRgFUS unit for treatment of uterine fibroids in Australia. Journal of medical imaging and radiation oncology 2012; 56: 409-416
    CrossrefPubMedGoogle Scholar
  • 21 Kim YS, Bae DS, Kim BG et al. A faster nonsurgical solution very large fibroid tumors yielded to a new ablation strategy. American journal of obstetrics and gynecology 2011; 205: 292 e1-292 e5
    CrossrefPubMedGoogle Scholar
  • 22 Wang W, Wang Y, Wang T et al. Safety and efficacy of US-guided high-intensity focused ultrasound for treatment of submucosal fibroids. European radiology 2012; 22: 2553-2558
    CrossrefPubMedGoogle Scholar
  • 23 Peng S, Xiong Y, Li K et al. Clinical utility of a microbubble-enhancing contrast ("SonoVue") in treatment of uterine fibroids with high intensity focused ultrasound: a retrospective study. European journal of radiology 2012; 81: 3832-3838
    CrossrefPubMedGoogle Scholar
  • 24 Qin J, Chen JY, Zhao WP et al. Outcome of unintended pregnancy after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2012; 117: 273-277
    CrossrefPubMedGoogle Scholar
  • 25 Wang F, Tang L, Wang L et al. Ultrasound-Guided High-Intensity Focused Ultrasound vs Laparoscopic Myomectomy for Symptomatic Uterine Myomas. 2014; 21: 279-284
    PubMedGoogle Scholar
  • 26 Froling V, Kroncke TJ, Schreiter NF et al. Technical eligibility for treatment of magnetic resonance-guided focused ultrasound surgery. Cardiovascular and interventional radiology 2014; 37: 445-450
    CrossrefPubMedGoogle Scholar
  • 27 Froeling V, Meckelburg K, Schreiter NF et al. Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: long-term results. European journal of radiology 2013; 82: 2265-2269
    CrossrefPubMedGoogle Scholar
  • 28 Froling V, Kroncke TJ, Schreiter NF et al. Technical eligibility for treatment of magnetic resonance-guided focused ultrasound surgery. Cardiovascular and interventional radiology 2014; 37: 445-450
    CrossrefPubMedGoogle Scholar
  • 29 Rabinovici J, Inbar Y, Revel A et al. Clinical improvement and shrinkage of uterine fibroids after thermal ablation by magnetic resonance-guided focused ultrasound surgery. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2007; 30: 771-777
    CrossrefPubMedGoogle Scholar
  • 30 Yu T, Luo J. Adverse events of extracorporeal ultrasound-guided high intensity focused ultrasound therapy. PloS one 2011; 6
    PubMedGoogle Scholar
  • 31 Ren XL, Zhou XD, Yan RL et al. Sonographically guided extracorporeal ablation of uterine fibroids with high-intensity focused ultrasound: midterm results. Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 2009; 28: 100-103
    PubMedGoogle Scholar
  • 32 Radeleff B, Eiers M, Bellemann N et al. Expulsion of dominant submucosal fibroids after uterine artery embolization. European journal of radiology 2010; 75: e57-e63
    CrossrefPubMedGoogle Scholar
  • 33 Yeniel O, Cirpan T, Ulukus M et al. Adenomyosis: prevalence, risk factors, symptoms and clinical findings. Clinical and experimental obstetrics & gynecology 2007; 34: 163-167
    PubMedGoogle Scholar
  • 34 Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertility and sterility 2014; 101: 472-487
    CrossrefPubMedGoogle Scholar
  • 35 Bergeron C, Amant F, Ferenczy A. Pathology and physiopathology of adenomyosis. Best practice & research Clinical obstetrics & gynaecology 2006; 20: 511-521
    CrossrefPubMedGoogle Scholar
  • 36 Zhang X, Li K, Xie B et al. Effective ablation therapy of adenomyosis with ultrasound-guided high-intensity focused ultrasound. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2014; 124: 207-211
    CrossrefPubMedGoogle Scholar
  • 37 Yang Z, Cao YD, Hu LN et al. Feasibility of laparoscopic high-intensity focused ultrasound treatment for patients with uterine localized adenomyosis. Fertility and sterility 2009; 91: 2338-2343
    CrossrefPubMedGoogle Scholar
  • 38 Zhang X, Li K, Xie B et al. Effective ablation therapy of adenomyosis with ultrasound-guided high-intensity focused ultrasound. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2014; 124: 207-211
    CrossrefPubMedGoogle Scholar
  • 39 Fukunishi H, Funaki K, Sawada K et al. Early results of magnetic resonance-guided focused ultrasound surgery of adenomyosis: analysis of 20 cases. Journal of minimally invasive gynecology 2008; 15: 571-579
    CrossrefPubMedGoogle Scholar
  • 40 Rabinovici J, Inbar Y, Eylon SC et al. Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis: a case report. Hum Reprod 2006; 21: 1255-1259
    CrossrefPubMedGoogle Scholar
  • 41 Ideyi SC, Schein M, Niazi M et al. Spontaneous endometriosis of the abdominal wall. Digestive surgery 2003; 20: 246-248
    CrossrefPubMedGoogle Scholar
  • 42 Wang Y, Wang W, Wang L et al. Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: preliminary results. European journal of radiology 2011; 79: 56-59
    CrossrefPubMedGoogle Scholar
  • 43 Wu CX, Liu CG, Wu F. Comparative study of high intensity focused ultrasound with surgery for the treatment of rabbit imolanted breast tumor. Chin J Ultrasound Med 2003; 19: 1-3
    PubMedGoogle Scholar
  • 44 Huber PE, Jenne JW, Rastert R et al. A new noninvasive approach in breast cancer therapy using magnetic resonance imaging-guided focused ultrasound surgery. Cancer research 2001; 61: 8441-8447
    PubMedGoogle Scholar
  • 45 Gianfelice D, Khiat A, Amara M et al. MR imaging-guided focused US ablation of breast cancer: histopathologic assessment of effectiveness-- initial experience. Radiology 2003; 227: 849-855
    CrossrefPubMedGoogle Scholar
  • 46 Zippel DB, Papa MZ. The use of MR imaging guided focused ultrasound in breast cancer patients; a preliminary phase one study and review. Breast Cancer 2005; 12: 32-38
    CrossrefPubMedGoogle Scholar
  • 47 Gianfelice D, Khiat A, Boulanger Y et al. Feasibility of magnetic resonance imaging-guided focused ultrasound surgery as an adjunct to tamoxifen therapy in high-risk surgical patients with breast carcinoma. Journal of vascular and interventional radiology: JVIR 2003; 14: 1275-1282
    CrossrefPubMedGoogle Scholar
  • 48 Furusawa H, Namba K, Thomsen S et al. Magnetic resonance-guided focused ultrasound surgery of breast cancer: reliability and effectiveness. Journal of the American College of Surgeons 2006; 203: 54-63
    CrossrefPubMedGoogle Scholar
  • 49 Wu F, Wang ZB, Cao YD et al. A randomised clinical trial of high-intensity focused ultrasound ablation for the treatment of patients with localised breast cancer. Br J Cancer 2003; 89: 2227-2233
    CrossrefPubMedGoogle Scholar
  • 50 Wu F, ter Haar G, Chen WR. High-intensity focused ultrasound ablation of breast cancer. Expert Rev Anticancer Ther 2007; 7: 823-831
    CrossrefPubMedGoogle Scholar
  • 51 Wu F, Wang ZB, Zhu H et al. Extracorporeal high intensity focused ultrasound treatment for patients with breast cancer. Breast cancer research and treatment 2005; 92: 51-60
    CrossrefPubMedGoogle Scholar
  • 52 Lu P, Zhu XQ, Xu ZL et al. Increased infiltration of activated tumor-infiltrating lymphocytes after high intensity focused ultrasound ablation of human breast cancer. Surgery 2009; 145: 286-293
    CrossrefPubMedGoogle Scholar
  • 53 Hynynen K, Pomeroy O, Smith DN et al. MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study. Radiology 2001; 219: 176-185
    CrossrefPubMedGoogle Scholar
  • 54 Wang SW, He XY, Li MZ. High-intensity focused ultrasound compared with irradiation for ovarian castration in premenopausal females with hormone receptor-positive breast cancer after radical mastectomy. Oncology letters 2012; 4: 1087-1091
    PubMedGoogle Scholar
  • 55 Shehata IA, Ballard JR, Casper AJ et al. High-intensity focused ultrasound for potential treatment of polycystic ovary syndrome: toward a noninvasive surgery. Fertility and sterility 2014; 101: 545-551
    CrossrefPubMedGoogle Scholar