Search Results (73)

Minimally invasive ablative therapies have emerged as effective and safe alternate approach for the management of renal cell carcinoma (RCC), particularly in patients who are ineligible for surgery due to comorbidities or high operative risk. Techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), and high-intensity focused ultrasound (HIFU) offer kidney-sparing treatment with reduced morbidity. Current evidence suggests that for cT1a tumors (<4 cm), thermal ablation achieves technical success rates exceeding 95%, with local recurrence rates ranging from 1% to 9% and major complication rates generally below 5–7%. RFA is particularly suitable for small peripheral tumors, MWA enables rapid and deeper heating for larger or more vascular lesions, and CA provides precise control near critical structures. HIFU remains largely experimental with limited clinical applicability. Overall, these strategies demonstrate favorable oncological outcomes, emphasizing the importance of careful patient selection, multidisciplinary evaluation, and further studies to refine technique-specific indications and integration with systemic therapies. Full article

Focused ultrasound (FU) technology is extensively employed in clinical applications such as tumor ablation, Parkinson’s disease treatment, and neuropathic pain management. The safety and efficacy of FU therapy critically depend on the accurate quantification of the acoustic field, particularly the high-pressure distribution in focal region. To address the limitations of existing acoustic measurement techniques—including invasiveness, inability to measure high sound pressure, and system complexity—this study proposes a non-invasive method termed Laser Deflection Acoustic Field Quantification (LDAQ), based on the laser deflection principle. An experimental system was constructed utilizing the acousto-optic deflection effect, which incorporates precision displacement control, rotational scanning, and synchronized triggering. Through tomographic scanning, laser deflection images of the acoustic field were acquired at multiple orientations. An inversion algorithm using Radon transforms was proposed to reconstruct the refractive index gradient distributions from the variations of light intensity and spot displacement. An adaptive weighted fusion strategy was then employed to map these optical signals to the sound pressure field. To validate the LDAQ technique, an acoustic field generated by an FU transducer operating at 0.84 MHz was measured. The reconstructed results were compared with both hydrophone measurements and numerical simulations. The findings demonstrated high consistency among all three results within the focal zone. Full-field analysis yielded a root mean square error (RMSE) of 0.1102 between LDAQ and simulation, and an RMSE of 0.1422 between LDAQ and hydrophone measurements. These results confirm that LDAQ enables non-invasive and high-precision quantification of megapascal-level focused acoustic fields, offering a reliable methodology for acoustic field characterization to support FU treatment optimization and device standardization. Full article

Artificial intelligence (AI) is increasingly shaping interventional oncology, with growing interest in its application across thermal ablation modalities such as radiofrequency ablation (RFA), cryoablation, high-intensity focused ultrasound (HIFU), and microwave ablation (MWA). This review characterises the current landscape of AI-enhanced thermal ablation, with particular emphasis on emerging opportunities within MWA technologies. We examine how AI-driven methods—convolutional neural networks, radiomics, and reinforcement learning—are being applied to optimise patient selection, automate image segmentation, predict treatment response, and support real-time procedural guidance. Comparative insights are provided across ablation modalities to contextualise the unique challenges and opportunities presented by microwave systems. Emphasis is placed on integrating AI into clinical workflows, ensuring safety, improving consistency, and advancing personalised therapy. Tables summarising AI methods and applications, a conceptual workflow figure, and a research gap analysis for MWA are included to guide future work. While existing applications remain largely investigational, the convergence of AI with advanced imaging and energy delivery holds significant promise for precision oncology. We conclude with a roadmap for research and clinical translation, highlighting the need for prospective validation, regulatory clarity, and interdisciplinary collaboration to support the adoption of AI-enabled thermal ablation into routine practice. Full article

Background/Objectives: Sacroiliitis is a painful inflammatory disorder of the sacroiliac joint, estimated to account for up to 25% of chronic low back pain. Treatment options are often limited, and many patients continue to experience symptoms despite conservative or interventional management. High-Intensity Focused ultrasound (HIFU) has emerged as a novel noninvasive neuromodulation technique. However, the contribution of individual lumbosacral nerve branches (L5–S3) to pain generation during such interventions remains unclear. This study aimed to characterize the distribution of pain-related interruptions during HIFU procedures, with a particular focus on identifying the most pain-sensitive targets. Methods: Eight patients with clinically confirmed sacroiliitis underwent HIFU ablation targeting the L5–S3 branches. Procedural data, including the total number of sonications and interruptions due to pain, were prospectively recorded. Statistical analyses were performed using chi-square tests, including overall distribution testing, pairwise branch comparisons, and an aggregated comparison of S3 versus all other branches combined. Effect sizes were calculated using Cohen’s w. Results: Across 243 sonications, 162 interruptions (66.7%) occurred due to pain. Interruptions were unevenly distributed: 81% occurred at S2 and S3, with S3 alone accounting for 42%. S3 showed significantly more interruptions than L5 (p = 0.0022), S1 (p = 0.0150), S2 (p = 0.0055), and all other branches combined (p < 0.001; w = 0.58, large effect). S2 also demonstrated greater sensitivity than L5 (p = 0.003) and S1 (p = 0.001). Subdivision analysis revealed uniformly high sensitivity across S3, whereas S1 and S2 displayed heterogeneous patterns. Conclusions: HIFU stimulation revealed disproportionate pain sensitivity in sacral branches, with S3—and to a lesser extent S2—emerging as dominant contributors. These findings provide new insight into sacroiliitis pathophysiology and suggest prioritization of S3 in targeted interventional management. Full article

High-intensity focused ultrasound (HIFU) has recently emerged as a novel non-invasive treatment modality in dermatology, offering precise ablation of cutaneous lesions with minimal damage to surrounding tissue. Originally developed for deep-seated tumors, dermatological HIFU platforms operating at ~20 MHz enable submillimeter-scale treatment of thermal or mechanical injuries localized to the epidermis and superficial dermis, making them suitable for managing benign, premalignant, and malignant skin conditions. This review outlines the mechanistic basis of HIFU—including thermal coagulation, acoustic cavitation, and immunomodulatory effects—and presents the current evidence for its efficacy in treating actinic keratoses and basal cell carcinomas (BCCs), where early studies report clearance rates of 70–97% and excellent cosmetic outcomes. Compared to conventional therapies such as surgery, photodynamic therapy, or cryotherapy, HIFU offers reduced procedural pain, faster healing, and the ability to treat multiple lesions in a single session. Its role in field cancerization and potential utility in prophylaxis for high-risk skin areas are also explored. While promising, long-term oncologic outcomes and standardized treatment protocols remain under investigation. HIFU represents a significant advancement in non-invasive skin cancer management, aligning oncologic efficacy with patient-centered care. Full article

Cancer immunotherapy has redefined oncology’s goals, aiming for durable systemic immunity rather than mere cytoreduction. However, many solid tumors remain refractory due to immunosuppressive microenvironments and antigenic heterogeneity. Local tumor ablation techniques—including radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, irreversible electroporation (IRE), and high-intensity focused ultrasound (HIFU)—are being re-evaluated beyond their historic cytoreductive role. This comprehensive review synthesizes the paradigm of tumor ablation as an in situ vaccination strategy, a concept that leverages the tumor itself as a source of antigens and the ablation process to generate endogenous adjuvants. We detail the mechanistic underpinnings, highlighting how ablation induces immunogenic cell death (ICD), releasing damage-associated molecular patterns (DAMPs) such as calreticulin, ATP, HMGB1, and cytosolic DNA. These signals activate innate immunity via pathways like cGAS-STING, promote dendritic cell maturation, and facilitate epitope spreading. We critically examine the determinants of efficacy, including the critical impact of ablation modality on the “DAMP signature,” the necessity of complete ablation, and the pivotal role of the host’s immune contexture. Furthermore, we explore the induction of tertiary lymphoid structures (TLS) as a key anatomical site for sustained immune priming. Translational strategies are extensively discussed, focusing on optimizing procedural techniques, rationally combining ablation with immune checkpoint inhibitors (ICIs) and innate immune agonists, and developing a robust biomarker framework. By adopting the core principles of vaccinology—meticulous attention to antigen, adjuvant, route, and schedule—ablation can be engineered into a reproducible platform for systemic immunotherapy. This review concludes by addressing current limitations and outlining a roadmap for clinical translation, positioning interventional oncology as a central discipline in the future of immuno-oncology. Full article

Background/Objectives: Adenomyosis is increasingly being identified in women of childbearing age as a cause of infertility and adverse pregnancy outcomes. As hysterectomies are not suitable for fertile women, conservative surgical management has become a promising solution. We aimed to synthesize current evidence on conservative uterus-sparing surgical techniques for adenomyosis, focusing on implications for infertility treatment and pregnancy outcomes. Methods: A search of PubMed, Google Scholar, and Europe PMC from 2022 to July 2025 was conducted using combinations of the words “adenomyosis,” “fertility,” “infertility,” “pregnancy outcomes,” “adenomyomectomy,” and “uterine-sparing surgery.” Sixteen high-relevance studies were chosen that included reproductive-aged women who had conservative surgery for adenomyosis. Results: Excisional techniques such as adenomyomectomy yield pregnancy rates of >50% and live birth rates of up to 70% in focal disease, with less success in diffuse disease. Non-excisional approaches—high-intensity focused ultrasound (HIFU), radiofrequency ablation (RFA), and uterine artery embolization (UAE)—yield equivalent pregnancy (40–53%) and live birth (35–74%) rates in selected patients, with fewer surgical complications. Adjunctive hormonal therapy, particularly GnRH agonists, appears to improve outcomes. Risks include placenta accreta spectrum disorders and uterine rupture (≤6%), especially in diffuse adenomyosis. The type of lesion, location, and junctional zone thickness are strong predictors of fertility outcomes. Conclusions: Conservative surgery can augment fertility in appropriately chosen women with adenomyosis, with removal being the preferred treatment for focal disease and non-removal techniques offering encouraging alternatives in mild or intracorporeal disease. The addition of adjunct hormonal therapy and standardized patient selection criteria will optimize results. The lack of European professional society guidelines underscores the need for harmonized protocols in order to standardize the diagnosis, surgery, and reporting of results. Full article

The repeated head impacts experienced by athletes have attracted significant interest from both the public and the scientific community; however, the neurobiological effects following the games are not well understood. For example, a single football match carries the risk of repeated concussive and subconcussive head impacts, which can increase the risk of developing neurodegenerative diseases. Chronic traumatic encephalopathy (CTE) is one of the neurodegenerative conditions athletes often face or are unaware of. However, addressing the disease progression in CTE is difficult to determine due to several reasons, such as the failure to identify risk factors, difficulty in differentiating CTE from other neurodegenerative diseases, and the lack of a specific mechanism by which CTE leads to tau protein accumulation. In addition, CTE symptoms overlap with other neurodegenerative conditions, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), which poses a challenge to producing specific targeted therapy. In this case, ultrasound represents a promising non-invasive technique that enables clear visualization of brain structures and may modulate neuronal activity. The term ultrasound encompasses various modalities; for example, high-intensity focused ultrasound (HIFU) employs thermal energy to ablate cells, whereas low-intensity pulsed ultrasound (LIPUS) delivers mechanical energy that activates molecular signaling pathways to impede the progression of CTE. Therefore, the LIPUS application could potentially minimize the risk of damage in the surrounding tissues of the brain and reduce the disease progression in individuals with CTE. Nevertheless, limited studies have been reported in the literature, with a poor mechanistic approach. Hence, this review aims to highlight the molecular signaling pathways, such as AKT, MAPK, and ERK, affected by LIPUS and emphasize the need for additional research to clarify its mechanistic effects in CTE management. Ultimately, this review aims to contribute to a nuanced understanding of LIPUS as a therapeutic strategy in addressing the complexities of CTE and its associated neurodegenerative disorders. Full article

Background and objective: Minimally invasive interventions, including irreversible electroporation (IRE), cryoablation, and high-intensity focused ultrasound (HIFU), offer promising alternatives for the treatment of low- and intermediate-risk prostate cancer. We aimed to evaluate the oncological efficacy and safety of these treatments. Methods: A systematic search of MEDLINE, Central, and EMBASE was conducted up to 5 January 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Recurrence, complication, survival, biochemical, and retreatment rates were evaluated, with risk of bias assessed using the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) and Risk of Bias 2 (RoB2) tools. Results: 85 studies met the inclusion criteria, comprising 42 prospective cohort studies, 36 retrospective cohort studies, six registries, and one randomized controlled trial. Whole-gland HIFU showed significantly lower recurrence (15%) and postoperative mean PSA levels (0.68 ng/mL) than focal HIFU (24%, 2.81 ng/mL). Recurrence rates were similar for focal vs. extended IRE (30% vs. 26%) and focal vs. whole-gland cryoablation (18% vs. 13%). In-field and out-of-field recurrence rates were similar across treatment modalities (5–15%). Retreatment rates were low, with 6–7% of patients receiving a second ablation and 2–8% progressing to radical or hormonal therapy. Major complications were consistently rare. One-year biochemical recurrence-free survival (BRFS) exceeded 95%, and five-year BRFS approached 80% for HIFU and cryoablation. Conclusions: Minimally invasive focal and whole-gland therapies are safe and effective for treating low- and intermediate-risk prostate cancer, with high survival and low major complication rates. Notably, whole-gland HIFU achieves superior biochemical control and lower recurrence than focal HIFU, emphasizing the clinical importance of treatment extent. Full article

Background: To compare the costs of open retropubic radical prostatectomy (RRP), robotic-assisted radical prostatectomy (RALP), intensity-modulated radiation therapy (IMRT), low-dose brachytherapy (LDBT), stereotactic body radiotherapy (SBRT), cryotherapy (Cryo), and high-intensity focused ultrasound (HIFU) for low/intermediate-risk prostate cancer (PCa), from the healthcare system perspective. Methods: This retrospective, IRB-approved study compared the costs and charges of primary treatment options for localized PCa at Duke University Hospital between January 2018 and December 2019. We identified cases by querying the relevant disease, procedural, and charge codes from Duke Finance. Consecutive cases with NCCN high-risk disease, prior treatment, or missing institutional financial information were excluded. Costs were calculated from the point at which the treatment option was selected until the last treatment session (SBRT and IMRT) or hospital discharge (other modalities). All modalities except RRP were considered technology-intensive. Results: A total of 552 patients with a mean age of 65.0 years met the inclusion criteria. NCCN risk categories included 85 (13%) low, 218 (41%) favorable-intermediate, and 249 (46%) unfavorable-intermediate risk cases. RALP, RRP, Cryo, and HIFU were single-session treatments, whereas IMRT, SBRT, and LDBT were delivered over multiple sessions. IMRT and SBRT were the most expensive modalities, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of sessions (ρ = 0.55, p < 0.001) and being technology-intensive (ρ = 0.58, p < 0.001) were significantly correlated with treatment costs. Conclusions: In this cohort of PCa patients, treatment costs were highest for IMRT and SBRT, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of treatment sessions was a significant predictor of higher costs. Full article

Sarcomas are tumors of mesenchymal origin that are generally resistant to systemic therapies and prone to local recurrence despite current multimodal treatment approaches. Focused ultrasound (FUS) is a noninvasive therapeutic technology that may enhance standard treatment strategies for primary solid malignancies. FUS exerts its effects through diverse mechanisms, including high-intensity focused ultrasound (HIFU) thermal ablation, histotripsy, sonodynamic therapy, immunomodulation, and hyperthermia-enhanced drug delivery. In this narrative review, we summarize the mechanisms of focused ultrasound that have been investigated for the treatment of sarcomas and highlight the results of preclinical, veterinary, and clinical studies related to this area. Full article

Bacteria-mediated cancer therapy represents a novel and promising strategy for targeted drug delivery to solid tumors. Multiple studies have demonstrated that various Bifidobacterium species can selectively colonize the hypoxic microenvironments characteristic of solid tumors. Leveraging this property, Bifidobacterium has been explored as a delivery vector for a range of anti-cancer approaches such as immunotherapy, nanoformulated chemotherapeutics, and gene therapy. Notably, anti-angiogenic genes such as endostatin and tumstatin have been successfully delivered to colorectal tumors using Bifidobacterium infantis and Bifidobacterium longum, respectively. Additionally, Bifidobacterium bifidum has been employed to transport doxorubicin and paclitaxel nanoparticles to breast and lung tumor sites. Furthermore, both Bifidobacterium longum and Bifidobacterium bifidum have been utilized to deliver nanoparticles that act as synergistic agents for high-intensity focused ultrasound (HIFU) therapy, significantly enhancing tumor ablation, particularly in triple-negative breast cancer (TNBC) models. While these pre-clinical findings are highly encouraging, further clinical research is essential. Specifically, studies are needed to investigate the colonization dynamics of different Bifidobacterium species across various tumor types and to evaluate their potential in delivering diverse cancer therapies in human patients. Full article

Despite advances in surgery, chemotherapy, and radiation treatments for pancreatic ductal adenocarcinoma (PDAC), 5-year survival rates remain at nearly 11%. Cholangiocarcinoma, while not as severe, also possesses similar survival rates. Fewer than 20% of patients are surgical candidates at time of diagnosis; therefore, it is imperative that alternative therapies are effective for non-surgical patients. There are several thermal ablative techniques, including radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), microwave ablation (MWA), alcohol ablation, stereotactic body radiotherapy (SBRT), cryoablation, irreversible electroporation (IRE), biliary intraluminal brachytherapy, and biliary photodynamic therapy (PDT). Emerging literature in animal models and human patients has demonstrated that endoscopic ultrasound (EUS)-guided RFA (EUS-RFA) prevents tumor progression through coagulative necrosis, protein denaturation, and activation of anticancer immunity in local and distant tumor tissue (abscopal effect). RFA treatment has been shown to not only reduce tumor-associated immunosuppressive cells but also increase functional T cells in distant tumor cells not treated with RFA. The remarkable ability to reduce tumor progression and promote tumor microenvironment (TME) remodeling makes RFA a very promising non-surgical therapy technique that has the potential to reduce mortality in this patient population. EUS-RFA offers superior precision and safety compared to other ablation techniques for pancreatic and biliary cancers, due to real-time imaging capabilities and minimally invasive nature. Future research should focus on optimizing RFA protocols, exploring combination therapies with chemotherapy or immunotherapy, and expanding its use in patients with metastatic disease. This review article will explore the current data and underlying pathophysiology of EUS-RFA while also highlighting the role of ablative therapies as a whole in immune activation response. Full article

Background/Objectives: The degree of vascularization of myomas plays an important role in both diagnosis and the selection of appropriate treatment. This is particularly relevant for minimally invasive therapies such as uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), or radiofrequency ablation (RFA) in uterine myomas, as their effectiveness is highest in well-vascularized lesions. This study aimed to analyze the perfusion of uterine myomas using dynamic contrast-enhanced magnetic resonance imaging and to develop a new quantitative classification of lesion vascularization, referencing the Funaki classification. Methods: The study included 56 female patients. Three parameters were determined for each lesion: the maximum signal enhancement (Ratio), time to peak, and mean signal intensity (Mean). A KMeans cluster analysis (k = 3) was performed, dividing the data into three groups corresponding to Funaki types I–III. Results: Significant differences were observed between the groups. Type III myomas were found only in older patients, which may be relevant when qualifying patients for vascularization-targeted therapies such as HIFU or radiofrequency ablation. Conclusions: The proposed classification may serve as a basis for automating the assessment of myomas and supporting clinical decision-making. Full article

Background/Objectives: Focal therapy (FT) and technology are closely connected. Advanced imaging allows for precise identification of the index lesion, enabling the targeted use of various thermal and non-thermal energy sources through different approaches, with specific techniques tailored to lesion location and operator expertise. This personalized approach enhances both safety and effectiveness, facilitating customized treatment planning. Methods: The International Consultation on Urological Diseases formed a committee to review the current literature on FT for prostate cancer (PCa), focusing specifically on the technique. Following in-depth discussions, the committee chose a “by lesion” approach rather than the traditional “by energy” approach to structure the review. A comprehensive PubMed search was conducted to gather relevant articles on the various energy modalities and procedural approaches used in FT for PCa. Results: Lesions in the apex, anterior, and posterior regions of the prostate can be accessed through several FT approaches, each associated with specific energy modalities and techniques. The transrectal approach utilizes high-intensity focused ultrasound (HIFU) and focal laser ablation (FLA), while the transperineal approach is compatible with energy sources such as cryotherapy, irreversible electroporation (IRE), brachytherapy, and FLA. The transurethral approach supports methods such as transurethral ultrasound ablation (TULSA). Each approach offers distinct advantages based on lesion location, treatment area, and energy modality. The choice of technique evaluated the safety and efficacy of each energy source and approach based on specific treatment areas within the prostate, highlighting the need for robust research across lesion locations and modalities, rather than focusing solely on each modality for a specific region. Conclusions: FT is rapidly advancing with new energy sources, technological improvements, and increasing operator expertise. To further optimize FT, research should prioritize evaluating the safety and effectiveness of different energy sources for various lesion locations, focusing on the treatment area rather than the energy modality itself. Full article