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 #
5P01CA159992-03
Application #
8568005
Study Section
Special Emphasis Panel (ZCA1-GRB-P)
Project Start
Project End
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
3
Fiscal Year
2013
Total Cost
$277,575
Indirect Cost
$91,331
Name
Stanford University
Department
Type
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Ellenor, Christopher W; Stang, Pascal P; Etezadi-Amoli, Maryam et al. (2015) Offline impedance measurements for detection and mitigation of dangerous implant interactions: an RF safety prescreen. Magn Reson Med 73:1328-39
Etezadi-Amoli, Maryam; Stang, Pascal; Kerr, Adam et al. (2015) Interventional device visualization with toroidal transceiver and optically coupled current sensor for radiofrequency safety monitoring. Magn Reson Med 73:1315-27
Scott, Serena J; Salgaonkar, Vasant; Prakash, Punit et al. (2014) Interstitial ultrasound ablation of vertebral and paraspinal tumours: parametric and patient-specific simulations. Int J Hyperthermia 30:228-44
Vyas, Urvi; Kaye, Elena; Pauly, Kim Butts (2014) Transcranial phase aberration correction using beam simulations and MR-ARFI. Med Phys 41:032901
Bitton, Rachel R; Pauly, Kim R Butts (2014) MR-acoustic radiation force imaging (MR-ARFI) and susceptibility weighted imaging (SWI) to visualize calcifications in ex vivo swine brain. J Magn Reson Imaging 39:1294-300
Rube, Martin A; Holbrook, Andrew B; Cox, Benjamin F et al. (2014) Wireless MR tracking of interventional devices using phase-field dithering and projection reconstruction. Magn Reson Imaging 32:693-701
Prakash, Punit; Salgaonkar, Vasant A; Diederich, Chris J (2013) Modelling of endoluminal and interstitial ultrasound hyperthermia and thermal ablation: applications for device design, feedback control and treatment planning. Int J Hyperthermia 29:296-307
Rieke, Viola; Instrella, Ron; Rosenberg, Jarrett et al. (2013) Comparison of temperature processing methods for monitoring focused ultrasound ablation in the brain. J Magn Reson Imaging 38:1462-71
Sommer, Graham; Pauly, Kim Butts; Holbrook, Andrew et al. (2013) Applicators for magnetic resonance-guided ultrasonic ablation of benign prostatic hyperplasia. Invest Radiol 48:387-94
Sommer, Graham; Bouley, Donna; Gill, Harcharan et al. (2013) Focal ablation of prostate cancer: four roles for magnetic resonance imaging guidance. Can J Urol 20:6672-81

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