Dr. Vidal-Jové is a specialist in General Surgery at the University of Barcelona and Hospital Mútua de Terrassa, reference in Integrative Oncology and expert in Oncologic Surgery and at the George Washington University in Washington DC (USA) where he specialized in surgery of peritoneal carcinomatosis.
What does HIFU ultrasound tumor ablation consist of?
Tumor ablation by HIFU ultrasound is a system that consists of destroying liver, pancreatic or soft tissue tumors by means of an ultrasound beam that is observed in the abdominal cavity and that is directed towards it without sticking any needle, without making any incision, without making any wound, it is therefore an absolutely non-invasive ablation. It is the solution for inoperable patients who have liver or pancreatic tumors and some soft tissue tumors. This type of ablation has been available to our patients for several years. At the Hospital Universitario Mutua de Terrassa we have already performed more than two hundred cases, the results are published and the combination of this type of ablation plus chemotherapy improves survival, doubles replacement, more than doubles survival in our latest results in patients with pancreatic tumors, in fact, ablation is a technique that is currently being performed by surgeons and interventional radiologists and this is the only ablation that is truly feasible and reliable for pancreatic tumors.
The procedure requires general anesthesia, the patient will require this general anesthesia which will be performed by an anesthesia professional, we will place the patient in this system. Here is the transducer and the sonicator that concentrate, shall we say, the ablative energy, the ablative ultrasonic energy at a point in the patient’s abdominal cavity. Once the patient is placed here, we control, by means of this screen system that is here. Here we have the previous images, MRI, CT, and here the ultrasound images that we are obtaining in direct vision of the patient, therefore, it is in real time, we are seeing where we are sending our ultrasound focus, therefore, it is an absolutely safe means, a system, which also allows us to see the ablation in real time at all times.
So we see where we are performing the tumor destruction and the response we are getting from the tumor immediately. This system means that it is very safe and allows us to practically ensure that we have no complications. We have already performed two hundred cases and, once the learning curve that is called for in any surgical procedure has been done, in this case our complications at this time are very few, if not none at all. The procedure lasts, depending on the intensity and texture and size of the tumor. Tumors of about three centimeters, we do, we resolve them or treat them in forty-five, fifty minutes. Tumors of five centimeters, one and a half to two hours. And a pancreatic tumor that requires more dedication, needs to be a little bit slower and to be more on top of it and to go through the treatment a little bit slower, we take between two and three hours.
Advantages of tumor ablation
Tumor ablation allows three things in the context of oncology patients: first, it reduces the volume and tumor burden of the patient. Secondly, it allows activation of the immune response: an ablation of this type has been seen, and increasingly in immunotherapy treatments, that the patient’s immune response is activated if he has undergone an ablation. And thirdly, it makes it possible to increase the penetrability of other treatments, for example, chemotherapy inside the tumor.
These three advantages are very important for the oncology patient. At the same time, ablation allows patients who are not resectable, that is, who cannot be operated on because their tumor is either too large or is located in an area that cannot be approached by surgery, to be treated by ablation; they can be approached, partially treated and at different times the tumor can be completely treated. This is another advantage. And, in this specific case, the specific advantage of our HIFU ablation system is that it is absolutely non-invasive, therefore, it does not stick any needle, it does not stimulate any growth factor, it does not generate any scarring, and so on.
Importance of early diagnosis in the fight against cancer
Early diagnosis in the treatment of cancer is one of the great advantages of our times, of our civilization, because it allows the patient to be diagnosed with the disease as early as possible. This is very important when it comes to explaining why this type of treatment, ablations, should be considered initially in the treatment of oncology patients. There should be in all tumor committees an expert in ablations, in most of the referral hospitals in our country there are, and these are surgeons or interventional radiologists, and consider this treatment as a first-line treatment in many aspects of the oncological treatment of patients.
Because at the moment, if we do this, we can treat patients who were not treatable before because they were considered unresectable or were considered metastatic patients, therefore, we are not going to treat them with a curative intention. At this time, for us, we define early diagnosis or the advantages of early diagnosis so that ablative techniques appear at the time of the patient’s first treatment. We consider that ablative techniques should be in the first line when the first treatment of the oncologic patient is considered, because the first treatment of the oncologic patient is very important and is going to mark the evolution and prognosis of the disease.