Transcostal High Intensity Focused Ultrasound for the Treatment of Cancer

Lead Research Organisation: University College London
Department Name: Mechanical Engineering

Abstract

The efficacy of high intensity focused ultrasound (HIFU) for the non-invasive treatment of cancer has been clearly demonstrated for a range of different cancers including those of the liver, prostate and breast. As a non-invasive focal therapy, HIFU offers considerable advantages over other techniques such as chemotherapy and surgery, in terms of invasiveness and risk of harmful side-effects. Despite its advantages, however, there are a number of significant challenges currently hindering its widespread clinical application, specifically: the need to transmit energy through the rib cage and the associated risk of skin burns and damage to the rib surface, the effects of organ motion on treatment accuracy, a poor understanding of cavitation processes in vivo and, finally, the lack of effective techniques for real-time image guidance and treatment monitoring. The overall objective of the research programme described in this document is to develop practical solutions for these issues. Successful completion of this proposal will result in a prototype clinical device for the safe and effective HIFU treatment of tumours of the liver, kidney and pancreas that has undergone preclinical testing and conforms to the necessary safety standards for patient use.

Publications

10 25 50
 
Description In this project, which was part of a 3-centre collaboration, we have developed Treatment planning software for High Intensity Focused Ultrasound (HIFU) ablation of tumours from input of pre-operative CT scans which can be provided as segmented and registered surfaces or directly as volumes. Target specification can be performed on surface or volumetric data. Optimal location of therapy head can be determined subject to a number of constraints such as the maximum number of elements and whether the beam passes through an area at risk (lungs, bowel). In addition we have acquired a better understanding of safety margins based on tissue characterisation in perfused livers. Detailed modelling of discrete vasculature has also been developed together with a new model of micro-perfusion. Given the challenges posed by targeting a tumour in a moving organ, a new motion management strategy has been developed.

A rigorous investigation of a range of focusing methods discussed in the literature has been conducted for a set of HIFU array-3D human rib configurations after which we propose a new method of focusing based on a constrained minimisation as the best approach. We have discussed the ramifications of this for treatment planning applications.

Finally, in collaboration with our colleagues at ICR and Oxford, we have developed and tested an experimental pre-clinical HIFU platform, which incorporates and demonstrates the techniques developed in the programme.
Exploitation Route Since the completion of this grant, we have set up new collaborations with clinical colleagues at the Royal Free Hospital, St. Mary's Hospital and the Royal Marsden to continue development of treatment planning software, our monitoring methods and the pre-clinical HIFU system for the HIFU ablation of hepatocellular carcinomas, as well as renal and pancreatic tumours.

Further funding has been obtained via two EPSRC grants and one EPSRC Network Plus to continue developing this technology for clinical applications.
Sectors Healthcare

 
Description Since the end of the project in December 2013, the immediate impact of the project has been academic but more significantly this has been followed by a very strong interest shown by clinical research colleagues. The fact remains that HIFU is still the only non-invasive, non-ionising treatment alternative to surgery and chemotherapy. As such, the long term impact of our research will be enormous. This is because there are more than 20,000 people in the UK affected by upper abdominal cancers per annum, with more than 50% mortality. For up to 90% of them, surgery is not an option, whilst chemotherapy offers poor outcomes. Since the completion of this grant, we have set up new collaborations with clinical colleagues at the Royal Free Hospital, St. Mary's Hospital and the Royal Marsden to continue development of our treatment planning software, our monitoring methods and the pre-clinical HIFU system for the HIFU ablation of hepatocellular carcinomas, as well as renal and pancreatic tumours. Further funding has been obtained via two EPSRC grants and also an EPSRC Network Plus has been set up to continue developing this technology for clinical applications and removing any obstacles in the way of clinical uptake of the technology.
First Year Of Impact 2014
Sector Healthcare
Impact Types Societal,Economic

 
Description Optimising patient specific treatment plans for ultrasound ablative therapies in the abdomen (OptimUS)
Amount £930,000 (GBP)
Funding ID EP/P013309/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 02/2017 
End 01/2020
 
Description Sound bullets for enhanced biomedical ultrasound systems
Amount £943,000 (GBP)
Funding ID EP/K032070/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 11/2013 
End 11/2016
 
Description Therapy Ultrasound Network for Drug Delivery & Ablation Research (ThUNDDAR)
Amount £676,000 (GBP)
Funding ID EP/N026942/1 
Organisation Engineering and Physical Sciences Research Council (EPSRC) 
Sector Public
Country United Kingdom
Start 08/2016 
End 08/2020