Endoscopic Ultrasound Guided Antitumor Therapy

This paper will review the possibilities of EUS guided anti-tumor therapy. Ablative energy may be delivered to a tumor under EUS guidance to destruct tumor cells by ultrasound itself, radiofrequency or radiation. Pilot results of endoscopic high intensity focused ultrasound in a human trial have been reported. The feasibility of performing EUS guided radiofrequency ablation has been reported in a swine model. An EUS bases radiation target simulation method has been developed for anal cancer therapy. Targeted delivery of an anti-cancer agent into a tumor under EUS guidance is possible as reported in an early clinical trial of local immunotherapy (Cytoimplant) or modified viruses delivered by EUS guided fine needle injection in patients with advanced pancreatic carcinoma. Image guided injection of alcohol is another approach used for local tumor ablation. Application of other ablation therapies such as laser, microwave and cryo is also conceptually feasible. We will have to wait and see where these initial and ongoing attempts for applying EUS against cancer take us.

References

• 1 Vilmann P, Jacobsen G K, Henriksen F W. et al . Endoscopic ultrasonography with guided fine-needle aspiration in pancreatic disease.  Gastrointest Endosc. 1992;  38 172-173
• 2 Giovannini M, Seitz J F, Monges G. et al . Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.  Endoscopy. 1995;  27 171-177
• 3 Chang K J, Katz K D, Durbin T E. et al . Endoscopic ultrasound-guided fine-needle aspiration.  Gastrointest Endosc. 1994;  40 694-699
• 4 Bhutani M S, Hawes R H, Hoffman B J. A comparison of the accuracy of echo features during endoscopic ultrasound (EUS) and EUS guided fine needle aspiration for diagnosis of malignant lymph node invasion.  Gastrointest Endosc. 1997;  45 474-479
• 5 Bhutani M S. Interventional endoscopic ultrasound. Amsterdam; Harwood Academic Publishers 1999
• 6 Lübbe A S, Bergemann C. Ultrasound therapy for malignant tumors. A conceptual assessment.  J Clin Ultrasound.. 1994;  22 113-117
• 7 Sanghvi N T, Hawes R H. High-intensity focused ultrasound.  Gastrointest Endosc Clin N Am. 1994;  4 383-395
• 8 Sanghvi N T, Foster R S, Bihrle R. et al . Noninvasive transrectal ultrasound device for prostate tissue visualization and tissue ablation in the focal zone using high intensity focused beam.  J Ultrasound Med. 1991;  10 101-104
• 9 Yang R, Kopecky K K, Rescorla F J. et al . Sonographic and computed tomography characteristics of liver ablation lesions induced by high-intensity focused ultrasound.  Invest Radiol. 1993;  28 796-801
• 10 Wiersema M J, Kochman M L, Sanghvi N T. et al . Initial experience using intraluminal high-intensity focused ultrasound (HIFU) to ablate rectal pseudo tumors in a canine model [abstract].  Gastrointest Endosc. 1993;  39 260
• 11 Prat F, Chapelon J-Y, Arefiev A, Cathignol D, Souchon R, Theilliere Y. High-intensity focused ultrasound transducers suitable for endoscopy:feasibility study in rabbits.  Gastrointest Endosc. 1997;  46 348-351
• 12 Melodelima D, Lafon C, Prat F. et al . Ultrasound cylindrical phased array for transesophageal thermal therapy: initial studies.  Phys Med Biol. 2002;  47 4191-4203
• 13 Prat F, Lafon C, DeLima D M. et al . Endoscopic treatment of cholangiocarcinoma and carcinoma of the duodenal papilla by intraductal high-intensity US: results of a pilot study.  Gastrointest Endosc. 2002;  56 909-915
• 14 Goldberg S N, Mallery S, Gazelle G S. et al . EUS-guided radiofrequency ablation in the pancreas: preliminary results in a porcine model.  Gastrointest Endosc. 1999;  50 392-401
• 15 Lohnert M, Doniec M J, Kovacs G. et al . New method of radiotherapy for anal cancer with three-dimensional tumor reconstruction based on endoanal ultrasound and ultrasound-guided afterloading therapy.  Dis Colon Rectum. 1998;  41 169-176
• 16 Doniec M J, Loehnert M S, Kovacs G. et al . Rectal EUS guided HDR-brachytherapy in patients with anal and peri-anal malignancies.  Gastrointest Endosc. 2000;  51 AB 106
• 17 Wiersema M J, Wiersema L M. Endosonography-guided celiac plexus neurolysis.  Gastrointest Endosc. 1996;  44 656-662
• 18 Hoffman B J, Bhutani M S, Knapple W L. et al . Treatment de l’achalasie par injection de toxine botulinique sons controle echoendoscopique. [Treatment of achalasia by injection of botulinium toxin under endoscopic ultrasound guidance].  Acta Endosc. 1995;  25 485-490
• 19 Chang K J, Nguyen P T, Thompson J A. et al . Phase I clinical trial of local immunotherapy (Cytoimplant) delivered by endoscopic ultrasound (EUS)-guided fine needle injection (FNI) in patients with advanced pancreatic carcinoma [abstract].  Gastrointest Endosc. 1998;  47 AB 144
• 20 Bedford R A, Hecht J R, Lahoti S. et al . Tolerability and efficacy of direct injection of pancreatic adenocarcinomas with ONYX-015 under endoscopic ultrasound (EUS) guidance.  Gastrointest Endosc. 2000;  51 AB 97
• 21 Barclay R L, Perez-Miranda M, Giovannini M. EUS-guided treatment of solid hepatic metastasis.  Gastrointest Endosc. 2002;  55 266-270
• 22 Gunter E, Lingenfelser T, Eitelbach F. et al . EUS-guided ethanol injection for treatment of a GI stromal tumor.  Gastrointest Endosc. 2003;  57 113-115