title: High-intensity focused ultrasound provides palliation for liver metastasis causing gastric outlet obstruction: case report.
abstract: BACKGROUND
  Surgery is the standard of care in several oncologic diseases. However, when non-surgical candidates are not suitable for radical treatment, palliation must be achieved at least. High-intensity focused ultrasound uses ultrasound power that can be sharply focused for highly localised application, as it is a completely non-invasive procedure. Its non-invasiveness appears to be of paramount importance in critically ill patients.
  
  
  METHODS
  We describe the use of ultrasound-guided high-intensity focused ultrasound for a large liver metastasis from breast cancer causing gastric outlet obstruction in a metastatic disease. The left liver deposit did not allow the stomach to empty due to its large volume, and the patient was unable to eat properly. The tumour was metastatic, resistant to chemotherapy and had a size that contraindicated an ablation percutaneous technique. To improve the patient's quality of life, ultrasound-guided high-intensity focused ultrasound ablation seemed the only and most suitable option. Therefore, a high-intensity focused ultrasound treatment was performed, no complications occurred and the patient's general condition has improved since the early post-procedural period. Three months after treatment, two body mass index points were gained, and the lesion decreased by 72% in volume as detected through multi-detector computed tomography follow-up.
  
  
  CONCLUSIONS
  Quality of life is an unquestionable goal to achieve, and palliation must be achieved while causing as little harm as possible. In this view, debulking surgery and percutaneous ablation technique seemed not appropriate for our patient. Instead, high-intensity focused ultrasound combined several advantages, no lesion size limit and a totally non-invasive treatment. Thus, this technique proved to be a clinically successful procedure, offering better disease control and quality of life. In circumstances where other alternatives clearly seem to fail or are contraindicated, high-intensity focused ultrasound can be used and can provide benefits. We recommend its use and development in several oncologic diseases, not only for therapeutic purposes but also for the improvement of patient's quality of life.
authors.affiliation: Surgical Endoscopy Unit, Careggi Academic and Regional Hospital of Florence, Florence 50134, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Rossi
authors.affiliation: Interventional Radiology Unit, Careggi Academic and Regional Hospital of Florence, Florence 50134, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Raspanti
authors.affiliation: Interventional Radiology Unit, Careggi Academic and Regional Hospital of Florence, Florence 50134, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Mazza
authors.affiliation: Radiology Department, Careggi Academic and Regional Hospital of Florence, Florence 50134, Italy.
authors.forename: Ilario
authors.initials: I
authors.lastname: Menchi
authors.affiliation: Department of Anesthesia and Critical Care, Careggi Academic and Regional Hospital of Florence, Florence 50134, Italy.
authors.forename: Angelo Raffaele
authors.initials: AR
authors.lastname: De Gaudio
authors.affiliation: Surgical Endoscopy Unit, Careggi Academic and Regional Hospital of Florence, Florence 50134, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Naspetti
keywords: Gastric Outlet Obstruction; High-intensity Focused Ultrasound; Liver Metastasis; Metastatic Disease; Non-invasive Debulking