title: Extracorporeal high intensity focused ultrasound ablation in the treatment of patients with large hepatocellular carcinoma.
abstract: BACKGROUND
  High intensity focused ultrasound (HIFU) is a noninvasive treatment modality that induces complete coagulative necrosis of a deep tumor through the intact skin. The current study was conducted to determine the safety, efficacy, and feasibility of extracorporeal HIFU in the treatment of patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 55 patients with HCC with cirrhosis were enrolled in this prospective, nonrandomized clinical trial. Among them, 51 patients had unresectable HCC. Tumor size ranged from 4 to 14 cm in diameter with mean diameter of 8.14 cm. According to tumor, node, metastasis (TNM) classification, 15 patients corresponded to stage II, 16 to stage IIIA, and 24 to IIIC. All patients had HIFU, and the median number of HIFU session was 1.69. Safety and efficacy of HIFU were assessed in this trial.
  
  
  RESULTS
  No severe side effect was observed in the patients treated with HIFU. Follow-up imaging showed an absence of tumor vascular supply and the shrinkage of treated lesions. Serum alpha-fetoprotein returned to normal level in 34% of patients. The overall survival rates at 6, 12, and 18 months were 86.1%, 61.5%, and 35.3%, respectively. The survival rates were significantly higher in patients in stage II than those in stage IIIA (P = .0132) and in stage IIIC (P = .0265).
  
  
  CONCLUSIONS
  As a noninvasive therapy, HIFU appears to be effective, safe, and feasible in the treatment of patients with HCC. It may play an important role in the ablation of large tumors.
authors.affiliation: Institute of Ultrasonic Engineering in Medicine and Clinical Center for Tumor Therapy of 2nd Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing, China. mfengwu@yahoo.com
authors.forename: Feng
authors.initials: F
authors.lastname: Wu
authors.forename: Zhi-Biao
authors.initials: ZB
authors.lastname: Wang
authors.forename: Wen-Zhi
authors.initials: WZ
authors.lastname: Chen
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.forename: Jin
authors.initials: J
authors.lastname: Bai
authors.forename: Jian-Zhong
authors.initials: JZ
authors.lastname: Zou
authors.forename: Ke-Quan
authors.initials: KQ
authors.lastname: Li
authors.forename: Cheng-Bing
authors.initials: CB
authors.lastname: Jin
authors.forename: Fang-Lin
authors.initials: FL
authors.lastname: Xie
authors.forename: Hai-Bing
authors.initials: HB
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects* / Q000379:methods*; D014463:Ultrasonography