Abstract
High-intensity focused ultrasound (HIFU) is a non-invasive
modality that uses an extracorporeal source of focused ultrasound energy. This
technique was introduced by Lynn et al
and is able to induce coagulative necrosis in selected tissues without
damaging adjacent structures. Although HIFU has been studied for 50 years,
recent technological developments now allow its use for tumours of the liver,
prostate and other sites.
In liver disease, HIFU has been used to treat unresectable,
advanced stages of hepatocellular carcinoma (HCC) and liver metastases.
Hepatocellular carcinoma is a serious health problem worldwide and is endemic in
some areas because of its association with hepatitis B and C viruses (in 20% of
cases). Liver transplantation (LT) has become one of the best treatments
available because it removes both the tumour and the underlying liver disease
such as cirrhosis (which is present in approximately 80% of cases).The
prerequisite for long-term transplant success depends on tumour load and strict
selection criteria regarding the size and number of tumour nodules.The need to
obtain the optimal benefit from the limited number of organs available has prompted
strict selection criteria limited to only those patients with early HCC who
have a better long-term outcome after LT. The so-called “bridging therapy” has the
aim of controlling disease burden for patients who are on the organ transplant waiting list. Amongst various
treatment options, transarterial chemoembolisation and radiofrequency ablation
are the most popular treatment choices. Recently, Cheung et al demonstrated that HIFU ablation is a safe and
effective method for the treatment of HCC patients with advanced cirrhosis as a
bridging therapy and that it reduced the drop-out rate from the liver
transplant waiting list. In this commentary, we discuss the current value of
HIFU in the treatment of liver disease, including its value as a bridging
therapy, and examine the potential advantages of other therapeutic strategies.
© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.
Key words: High-intensity focused ultrasound; Hepatocellular carcinoma; Liver transplantation; Bridging therapy; Waiting list
Core tip: High-intensity focused ultrasound (HIFU) is a
non-invasive modality used to destroy tissue. It has been used to treat
unresectable advanced stages of hepatocellular carcinoma (HCC) and liver metastases.
In some HCC cases, liver transplantation has become one of
the best treatments because it removes the tumour and the underlying liver
disease such as cirrhosis.
The so-called “bridging therapy” has the aim of controlling
disease burden for patients who are on the organ transplant waiting list. Here,
we discuss various treatment options including transarterial chemoembolisation and
radiofrequency ablation, and we examine the utility of HIFU as a safe and
effective method of bridging therapy that can reduce the dropout rate of
patients who are on the liver transplant waiting list.
Mearini L. High intensity focused ultrasound, liver disease
and bridging therapy. World J Gastroenterol 2013; 19(43):
7494-7499
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