Pancreatic Cancer and High Intensity Focused Ultrasound Ablation (HIFU)

 

Pancreatic Cancer

The early diagnosis of pancreatic cancer is very difficult. It is a highly malignant cancer that usually has a poor prognosis. The National Institutes of Health reports that the 1-year survival rate for pancreatic cancer is only 8%, the 5-year survival rate is less than 5%, and the average life expectance is 2 to 3 months. Most patients are often diagnosed only at the advanced stage of the disease, as the symptoms of pancreatic cancer are often only noticeable when the disease has progressed. The symptoms include abdominal pain, unexplained weight loss and difficulty in digesting fatty foods. At the advanced stage the symptoms of severe lower back pain do dramatically affect the quality of the patient’s life and the use of analgesic drugs may provide some relief, but usually is not sufficient. Furthermore at the advanced stage of this disease, the option of surgery may not be viable and in most of the cases the commonly used interventional therapies and chemotherapy bring with them many undesirable side effects and toxicity.

The newly introduced HIFU non-invasive-ultrasound ablation at the Beijing Puhua International Hospital (BPIH) has significant advantages over the commonly used procedures in treating pancreatic cancer.

For patients with early stage pancreatic cancer, HIFU can completely ablate the lesion. For patients with middle or advanced stage pancreatic cancer, HIFU therapy can immediately alleviate the severe abdominal and lower back pain caused by the pancreatic cancer.

What is HIFU?

HIFU is short for high-intensity focused ultrasound ablation and it represents the next generation of minimally invasive treatments for cancer.

HIFU utilizes ultrasound’s good penetrability, and intensity as the ultrasound beam travels through the transducer probe and is focused into a point, precisely targeting the tumour, which is heated up between 60 to 100 Degrees Celsius. The cellular proteins of the tumour coagulate leading to tumour ablation (thermal destruction of tissue), without surrounding tissue being harmed.  The dead tumour tissues are then gradually reabsorbed by the body.

In the case of an inoperable pancreatic cancer, HIFU treatment can effectively reduce tumor burden and more interestingly reduced tumor pain through tissue denervation, tumour mass reduction and neuromodulation, thereby prolonging the patient’s survival and improving the quality of life.

Following treatment, 88% of patients obtained different degrees of pain relief,

without serious complications such as upper gastrointestinal haemorrhage or gastric-intestinal perforation and enhanced MRI scans reveal effective tissue ablation in the HIFU therapy area.

After conducting extensive research and development, HIFU treatment has become widely accepted and promoted in the treatment of pancreatic cancer.

Due to it’s non-invasive nature, surgery has in most cases got to be avoided and most patient only require one HIFU treatment to achieve the desired result  of tumor destruction. Amazingly, after only one day of receiving treatment, most patients can return back home, as there are no after effects impacting the patients’ health.

Comparison of HIFU and standard treatment options

Unfortunalty 70% – 80% of pancreatic cancer patients are not diagnosed in the early stage of the condition. When the diagnosis of pancreatic cancer occurs, the patient usually has already progressed to the middle or advanced stage of this condition, with an usual life expectancy of only 3-6 months.  Once diagnosed, less than 10% of patients with pancreatic cancer are suitable candidates for surgery, which is traumatic and risky and usually only extends the patient’s life by only up to 9 months. Even if combined with radiotherapy and chemotherapy, the survival period can usually only be extended by an additional 0.5-1 months. Standard treatment options are costly and ineffective, as they hardly extend the life expectancy and provide pain relief for the patient.

However almost all pancreatic cancer patients are eligible for the non-invasive, low risk HIFU treatment.

According to our statistics, patients’ survival can be extended from standard 3 to 6 months to 1 to 2 years and an impressive 98% of patients gaining noticeable improvements in pain relief and life extension after receiving HIFU treatment!

Advantages of HIFU Ultrasound Ablation Therapy

  • Noninvasivetreatment to preserve organs and structures, with no blood transfusion and no radiation.
  • 3D targeting module defines the boundary oftumorsand calculates a 3D therapeutic plan, constantly monitoring the tissue responses and adjusting the therapeutic parameters accordingly, achieving an individual treatment protocol.
  • Conformal and precise ablation. With plus and minus 1mm accumulative error, the accurate movement of the 6-dimensional motion system can ablate tumours adjacent to major vessels or nerves safely.
  • In most cases only one treatment session is required and there are no limitations due to tumour size and shape, The margin between treated and untreated tissue can be as narrow as 6 to 10 cells wide.
  • Real-time colour doppler ultrasound-guided therapy with digital quantitative analysis allows monitoring during the whole treatment and provides an immediate ultrasound image to evaluate the overall result following treatment.
  • The energy of the focal region is high enough to induce an immediate thermal toxicity (temperature above 56Derees Celsius) which will causes irreversible coagulative necrosis.
  • Activation of immune system, as the necrotic tissue is disposed off by the body’s own healing response.

Case studies

1.

In June 2018, a 68-year-old patient went to a local hospital complaining about upper abdominal pain and discomfort, with significant and unexplainable, recent weight loss of about 20kg. His CA 19-9 test result were significantly raised and CT scans revealed a pancreatic tumor with vascular invasion. He was diagnosed with an inoperable and advanced form of pancreatic cancer. Due to his poor physical condition, chemotherapy was also not appropriate. His family sought medical help from many different hospitals, but no solution was found.

One of the Doctors friends recommended HIFU treatment and the results were astonishing! After 3 month of treatment tumor volume was reduced by 90.1% and after 12 months of treatment the Ca19-9 count dropped from 648.8 U/ml to 15.8u/ml, which is almost normal.

Before HIFU treatment started: pancreatic head carcinoma, CA19-9 648.8U/ml

One day after HIFU treatment: Tumour necrotic area without contrast

Six weeks after HIFU treatment: Tumour size decreased 62.6%, CA19-9 336.3U/ml

Three months after HIFU treatment: Tumour size decreased 90.1%, CA19-9 205.6U/ml

Twelve months after HIFU treatment: Tumour almost disappeared, CA19-9 count is almost normal 15.8U/ml

2.The second patient is a 41-year-old female patient, who went to the hospital for right lower quadrant pain in October 2017. First a diagnosis of appendicitis was considered and an appendectomy was planned. During the operation multiple abdominal metastases were found and a PET-CT scans revealed a pancreatic cancer with multiple abdominal metastases. The standard recommendations were chemo and radiotherapy.

As the pancreatic cancer was inoperable, the patient was informed by her friends about how HIFU treatment can ablate the pancreatic tumour lesion without surgery, so she came to visit our hospital for treatment. The pre-operative evaluation concluded that the patient was a suitable candidate for HIFU treatment and after the treatment was explained to the patient, she consented to treatment.

The HIFU treatment was successful and the patient had almost no discomfort except for mild pain during the procedure. Amazingly on the following day the patient returned back home to conduct her normal daily duties.

The following week a new PET-CT was performed and the doctors were surprised to find that the pancreatic tumor was almost all necrotic. It was suggested that a further two session of HIFU treatment would be sufficient to completely eliminate the remaining tumour.

3.The third patient is a 75-year-old retired police officer from Beijing Public Security Bureau. He was diagnosed with pancreatic cancer in October 2017, as a digestive tract obstruction occurred due to the pancreatic mass pressing onto the pylorus. As the tumor was obstructing the digestive system a nasojejunal feeding tube was inserted at the Beijing Friendship Hospital. Surgical treatment was not appropriate in this case as the tumor was encasing the intestines and blood vessels. The top three hospitals in Beijing had no treatment options and he patient arrived at BPIH for treatment.

At BPIH the patient learned about how HIFU -High Intensity Focused Ultrasound Ablation can treat pancreatic cancer and then consented to treatment. The preoperative evaluation concluded that the size of the pancreatic tumor was about 6×6cm and was located relatively deep.

Contrast-enhanced CT before HIFU treatment

Following a case discussion and planning, our medical team performed the HIFU treatment on the patient, which was a successful and the patient returned home after just 2 hours of rest.

At the follow up examination, the test result showed that the tumor markers had returned back to normal and the tumour showed a reduction size. The patient returned back to our hospital in February 2018 and looked very healthy. Our medical team suggested regular examinations and to stay in touch.

Contrast-enhanced CT after HIFU treatment