title: High intensity focused ultrasound (HIFU) therapy for local treatment of hepatocellular carcinoma: role of partial rib resection.
abstract: OBJECTIVE
  It has long been known that high intensity focused ultrasound (HIFU) can kill tissue through coagulative necrosis. However, it is only in recent years that practical clinical applications are becoming possible. Since the ribs have strong reflections to ultrasonic beams, they may affect the deposition of ultrasound energy, decreasing the efficacy of HIFU treatment and increasing the chance of adverse events when the intra-abdominal tumours concealed by ribs are treated. The aim of this study was to evaluate the influence of partial rib resection on the efficacy and safety of HIFU treatment.
  
  
  METHODS
  This prospective study was approved by the ethics committee at Chongqing University of Medical Sciences. An informed consent form was obtained from each patient and family member. A total of 16 patients with hepatocellular carcinoma (HCC), consisting of 13 males and 3 females, were studied. All patients had the successful HIFU treatment. To create a better acoustic pathway for HIFU treatment, all of the 16 patients had the ribs that shield the tumour mass to be removed. Magnetic resonance imaging (MRI) was used to evaluate the efficacy of HIFU treatment.
  
  
  RESULTS
  Sixteen cases had 23 nodules, including 12 cases with a single nodule, 1 case with 2 nodules, 3 cases with 3 nodules. The mean diameter of tumours was 7.0+/-2.1 cm (5-10 cm). According to TNM classification, 9 patients were diagnosed as stage II, 4 patients were stage III, and 3 patients were stage IV. Follow-up imaging showed an absence of tumour blood supply and shrinkage of all treated lesions. The survival rates at 1, 2, 3, 4, and 5 years were 100%, 83.3%, 69.4%, 55.6%, and 55.6%, respectively. No serious complications were observed in the patients treated with HIFU.
  
  
  CONCLUSIONS
  Partial rib resection can create a better acoustic pathway of HIFU therapy. Even though it is an invasive treatment, this measure offers patients an improved prospect of complete tumour ablation when no other treatment is available.
authors: Clinical Center for Tumor Therapy of 2nd Hospital of Chongqing University of Medical Sciences, Chongqing 400010, China.
authors: Hui
authors: H
authors: Zhu
authors: Kun
authors: K
authors: Zhou
authors: Lian
authors: L
authors: Zhang
authors: Chengbin
authors: C
authors: Jin
authors: Song
authors: S
authors: Peng
authors: Wei
authors: W
authors: Yang
authors: Kequan
authors: K
authors: Li
authors: Haibing
authors: H
authors: Su
authors: Wenzhi
authors: W
authors: Chen
authors: Jin
authors: J
authors: Bai
authors: Feng
authors: F
authors: Wu
authors: Zhibiao
authors: Z
authors: Wang
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012272:Ribs / Q000601:surgery*; D016896:Treatment Outcome