High intensity focused ultrasound — a big hitter with low impact?

Here is my latest highlight from the journal HPB which has recently increased its impact factor to 1.94. The article is on High intensity focused ultrasound and its role in treating small hepatocellular carcinoma. HIFU has been used in the niche of treatment of uterine fibroids and this use for small liver cancers is an interesting and potentially useful development which of course is also non-invasive. 

High-intensity focused ultrasound (HIFU) as a technology has been around for a while but with limited availability and application in human medicine. The technique focuses a particular frequency of ultrasound waves within tissues very accurately and the oscillation of molecules at the point of focus produces heat creating a thermal burn.

Cheung and colleagues from Hong Kong have used HIFU to target small (<3 cm) hepatocellular carcinomas (HCC) in a group of 47 patients. They compared their outcomes with a group of 59 patients who underwent radiofrequency ablation during the same time period. Accepting that this was not a randomized controlled trial and that there may therefore be some selection bias, HIFU performed extremely well with good ablation rates and comparable if not better survival than RFA treated patients. In addition more than half of the patients in this study had failed the screening criteria for radiofrequency ablation due to poor tumour visualization or technical difficulties making this an important indication.

This may prove to be a very valuable tool for patients who don’t want surgery or who are at risk of decompensating from underlying liver disease or who may require major surgery such as liver transplantation in the future.

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