Soft tissue tumors of the extremity, benign and malignant, occur in people of all ages. The incidence of these tumors will likely increase in the coming years due both to an aging population and to the longer survival of patients with a previous cancer treated with radiation and/or chemotherapy, both known to be risk factors for sarcoma. The gold standard for treatment of soft tissue tumors is complete surgical resection of the tumor and in the case of malignant tumors an additional margin of healthy tissue. Despite advances in surgical techniques, imaging technologies, chemotherapy regimens, and radiotherapy neither the morbidity associated with treating these tumors nor the survival for patients with malignant tumors has significantly improved over the past 20 years. Accordingly, there is a need for novel treatment modalities to improve the outcomes for patients who have soft tissue tumors both in terms of survival and of treatment-related morbidity. Magnetic Resonance guided High Intensity Focused Ultrasound (MRgHIFU) ablation is a noninvasive treatment modality that is currently in clinical use for treating uterine fibroids and in investigational use to treat prostate, breast, and other types of cancer. We will adapt MRgHIFU techniques to the treatment of benign and malignant soft tissue tumors of the extremities with the goal of safely and effectively performing HIFU ablation on human subjects. A series of cadaver experiments will define the best methods to couple the ultrasound transducer to the extremity, determine the accuracy of MRgHIFU treatment in different tissues such as tendon, fat, muscle and near bone, and characterize the effect of using different ultrasound frequencies on the ablation of target tissue and the surrounding healthy tissue. In an animal model, we will determine how closely MRgHIFU ablation can be performed relative to important anatomic structures such as major peripheral nerves without causing injury. We will test the accuracy and effectiveness of the HIFU treatment in patients prior to standard of care surgical removal of the tumors. Also, we will optimize the post ablation imaging techniques to assess effectiveness of treatment.

Public Health Relevance

Soft tissue tumors of the extremity are common problems that affect people of all ages. The treatment options, morbidity, and clinical outcomes for these tumors have remained stagnant over the past decade, and there is a need for innovative treatment techniques that reduce morbidity and improve outcomes. Magnetic Resonance Guided High Intensity Focused Ultrasound (MRgHIFU) is a noninvasive technique that can ablate soft tissue tumors while sparing adjacent healthy tissue, thereby minimizing patient morbidity.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Program Projects (P01)
Project #
5P01CA159992-02
Application #
8555393
Study Section
Special Emphasis Panel (ZCA1-GRB-P (M1))
Project Start
2011-09-22
Project End
2016-08-31
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
2
Fiscal Year
2012
Total Cost
$299,483
Indirect Cost
$98,368
Name
Stanford University
Department
Type
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Johnson, Ethan M; Vyas, Urvi; Ghanouni, Pejman et al. (2016) Improved cortical bone specificity in UTE MR Imaging. Magn Reson Med :
Zhu, Kangrong; Dougherty, Robert F; Wu, Hua et al. (2016) Hybrid-Space SENSE Reconstruction for Simultaneous Multi-Slice MRI. IEEE Trans Med Imaging 35:1824-36
Marx, Michael; Butts Pauly, Kim (2016) Improved MRI thermometry with multiple-echo spirals. Magn Reson Med 76:747-56
Vyas, Urvi; Ghanouni, Pejman; Halpern, Casey H et al. (2016) Predicting variation in subject thermal response during transcranial magnetic resonance guided focused ultrasound surgery: Comparison in seventeen subject datasets. Med Phys 43:5170
Adams, Matthew S; Salgaonkar, Vasant A; Plata-Camargo, Juan et al. (2016) Endoluminal ultrasound applicators for MR-guided thermal ablation of pancreatic tumors: Preliminary design and evaluation in a porcine pancreas model. Med Phys 43:4184
Gaur, Pooja; Partanen, Ari; Werner, Beat et al. (2016) Correcting heat-induced chemical shift distortions in proton resonance frequency-shift thermometry. Magn Reson Med 76:172-82
Avedian, Raffi S; Bitton, Rachelle; Gold, Garry et al. (2016) Is MR-guided High-intensity Focused Ultrasound a Feasible Treatment Modality for Desmoid Tumors? Clin Orthop Relat Res 474:697-704
Ghanouni, Pejman; Dobrotwir, Andrew; Bazzocchi, Alberto et al. (2016) Magnetic resonance-guided focused ultrasound treatment of extra-abdominal desmoid tumors: a retrospective multicenter study. Eur Radiol :
Bitton, Rachel R; Webb, Taylor D; Pauly, Kim Butts et al. (2016) Improving thermal dose accuracy in magnetic resonance-guided focused ultrasound surgery: Long-term thermometry using a prior baseline as a reference. J Magn Reson Imaging 43:181-9
Adams, Matthew S; Scott, Serena J; Salgaonkar, Vasant A et al. (2016) Thermal therapy of pancreatic tumours using endoluminal ultrasound: Parametric and patient-specific modelling. Int J Hyperthermia 32:97-111

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