High intensity focused ultrasound (HIFU) has emerged in recent years as a new noninvasive treatment for solid malignant tumors, including pancreatic cancer (1). An early clinical study concluded that HIFU was safe and feasible for the treatment of advanced pancreatic cancer with a median overall survival (OS) of 11.25 months (range: small molecule 2-17 months) (2). Their results suggested that HIFU offers survival benefits given that the median OSs of gemcitabine and of gemcitabine-capecitabine chemotherapies are 6-10 months for patients with advanced pancreatic cancer (3-6). However, they treated patients using a continuous (not pulsed) HIFU machine with a very high acoustic intensity of 5-20 kW/cm2, which required general anesthesia or spinal anesthesia because these intensities delivered as a continuous beam cause intolerable pain and severe injury to the adjacent organs due to subtle target movement (2, 7).
Some reports have found that skin burns and pain in the treated regions were common and that severe complications, such as gastrointestinal perforation and SMA infarction, occurred after treatment with this type of HIFU machine (8, 9). However, such side effects should be avoided in patients with unresectable pancreatic cancers for the following reasons: they can destroy the quality of the remaining life, they can postpone chemotherapy, which is vital in these patients, and they can impair the patient’s performance status. Indeed, a good performance status is known to be significantly associated with the median OS of pancreatic cancer patients (4).
Researchers have recently begun to focus more on pulsed HIFU therapy with low energy because animal and human research has indicated its potential to enhance the chemotherapeutic effect (10-13). In addition, pulsed HIFU with low energy employs much lower acoustic energy intensities (< 3 kW/cm2) than continuous HIFU, and exposure to these levels does not require hospitalization or general anesthesia and it has a low complication rate (13, 14). Accordingly, pulsed HIFU with a low energy appears to be a more reasonable, safer option for patients with unresectable pancreatic cancer because it allows patients to maintain staying on routine chemotherapy and have a normal life, and it offers the opportunity of achieving some benefit by enhancing the effect of chemotherapy.
Twelve patients were treated with pulsed HIFU with low energy from October 2008 to May 2010. In particular, three patients underwent concurrent chemotherapy and pulsed HIFU therapy (CCHT) Anacetrapib with low energy. This study evaluated the potential clinical value of CCHT and the safety of pulsed HIFU for the treatment of unresectable pancreatic cancer, and here we summarize our experiences before we commence conducting a large prospective study.
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