Preliminary experience using high intensity focused ultrasound for treating liver metastasis from colon and stomach cancer

Figures & data

Table I.  Summary of findings in colon cancer group (10 cases). All patients had chemotherapy treatment.

Age/Sex	Number of lesions	Total size of lesions (cm)	Last FU (days)	Recurrence (days)	Category	Notes
63M	3	8.8	142	50	III	HIFU → recur → surgical resection Increase of CEA after HIFU
57M	1	1.8	154	127	III	HIFU → TACE → recur → surgical resection
59M	3	12.8	25	IA	IV	TACE → HIFU → PEI Decrease of CEA after HIFU
82M	1	4.0	434	IA	IV	PEI → HIFU
73M	1	2.2	328	110	III	TACE → HIFU Had to wake patient from anesthesia early due to anesthesia complications
49M	2	4.6	275		I
63M	1	11.3	116	IA	IV	RFA → lobectomy → recur → HIFU Pleural effusion treated with drainage and antibiotics. Death due to biliary obstruction
72F	1	2.2	210	45	II	TACE → HIFU Pleural effusion after HIFU treated with diuretics
49M	3	21.4	180	IA	IV	RFA → HIFU Due to large size some portions of the targeted masses were not ablated
56M	2	15.3	89	IA	IV	Decrease of CEA after HIFU

Abbreviations: IA, incomplete ablation; HIFU, high-intensity focused ultrasound ablation; CEA, carcinoembryonic antigen; PEI, percutaneous ethanol injection; TACE, transarterial chemoembolization.

Figure 1. Picture of the HIFU device during an ablation procedure. The patient is under general anesthesia and in the prone position for treatment of metastatic tumor in the left lobe of the liver.

Table II.  Summary of findings in stomach cancer group. All patients had chemotherapy treatment.

Age/ Sex	No. of lesions	Total size of lesions (cm)	Last FU (days)	Recurrence (days)	Category	Notes
69M	1	1.7	534		I	PEI → HIFU Imaging done only with CT
35F	1	8.4	403		I	TACE → HIFU Abscess formation after HIFU with fistula to subcutaneous layer, treated with drainage and antibiotics
50F	3	16.3	273	Only non-targeted lesions	II	TACE → HIFU Only larger lesions were targeted with HIFU, small non-targeted lesions showed decrease in size after systemic chemotherapy, but increased in size at further follow up

Abbreviations: HIFU, high-intensity focused ultrasound ablation; PEI, percutaneous ethanol injection; TACE, transarterial chemoembolization.

Figure 2. Targets were ablated using mostly multiple HIFU row ablation zones with single ellipsoidal HIFU ablation zones when necessary. Deep portions were targeted first with shallower areas targeted subsequently.

Table III.  Classification of results into four categories.

Category	Immediate response (technical success)	Follow up (technical effectiveness)	Terminology according to Goldberg et al.
I	Complete ablation	No evidence of local tumor progression or metastasis	Complete ablation
II	Complete ablation	No local tumor progression New foci of disease in the target organ or distant malignancy	New foci of disease in the target organ or distant malignancy
III	Complete ablation	Local tumor progression	Local tumor progression
IV	Incomplete ablation	Not applicable	Local incomplete therapy

Figure 3. A 63-year-old man with multiple hepatic metastasis from colon carcinoma. Initial contrast enhanced coronal T1-weighted MR image shows one (arrow) of three metastatic nodules to the right lobe of liver (a). Ultrasonographic images showing the target before (b, left image) and after HIFU ablation (b, right image) demonstrate the hyperechoic changes representing optimal ablation. Follow-up contrast-enhanced coronal T1-weighted image two weeks after HIFU shows complete coagulative necrosis of the lesion (arrow). Pericostal ablation is noted in the sonification port (arrowheads) (c). Further follow-up contrast-enhanced CT 114 days after HIFU shows interval increase of the tumor size (arrows), indicating recurrence (d).

Figure 4. A 50-year-old woman with multiple hepatic metastasis from stomach carcinoma. Initial contrast-enhanced axial T1-weighted MR image shows one of multiple metastatic nodules in both lobes of the liver (a). Follow-up T1-weighted image two weeks after HIFU shows complete coagulative necrosis of the lesions (b). Although further follow up 107 days after HIFU shows progression of new lesions at non-ablated portions of the liver, no recurrence was seen at the ablated sites and decrease in size of the ablated sites are seen (c).