MR-Guided HIFU of Soft Tissue Tumors

四肢软组织肿瘤，良性和恶性，发生在所有年龄段的人。这些事件的发生率 由于人口老龄化和肿瘤患者的生存期延长， 既往接受过放疗和/或化疗的癌症患者，已知这两种治疗都是 肉瘤。治疗软组织肿瘤的金标准是完全手术切除肿瘤 并且在恶性肿瘤的情况下，健康组织的附加边缘。尽管外科手术取得了进步， 技术、成像技术、化疗方案和放疗既不影响发病率， 与治疗这些肿瘤相关，恶性肿瘤患者的生存率也显著降低。 在过去的20年里有所改善。因此，需要新的治疗方式来改善治疗效果。 软组织肿瘤患者在生存期和治疗相关性方面的结局 发病率。磁共振引导的高强度聚焦超声（MRgHIFU）消融是一种 目前临床上用于治疗子宫肌瘤的非侵入性治疗方式 用于治疗前列腺癌、乳腺癌和其他类型癌症的研究用途。我们将采用MRgHIFU技术， 治疗四肢的良性和恶性软组织肿瘤，目标是安全， 有效地对人类受试者进行HIFU消融。一系列的尸体实验将确定最好的 方法将超声换能器耦合到肢体，确定MRgHIFU的准确性 治疗在不同的组织，如肌腱，脂肪，肌肉和骨附近，并表征使用的效果 不同的超声频率对靶组织和周围健康组织的消融。中 动物模型，我们将确定如何密切MRgHIFU消融可以执行相对于重要的 解剖结构，如主要周围神经，而不会造成损伤。我们将测试其准确性， 在标准护理手术切除肿瘤之前，HIFU治疗对患者的有效性。还有， 我们将优化消融后成像技术，以评估治疗的有效性。

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.