High Intensity Focused Ultrasound (HIFU)
A PROMISING NEW TECHNOLOGY FOR THE TREATMENT OF SOLID TUMORS
High Intensity Focused Ultrasound (HIFU) is a non-invasive new treatment
modality for solid tumors.1 Using sound waves, which when focused create
heat at a specific point, tumors can be destroyed with little damage
to surrounding, healthy tissue.
HIFU is a promising new technology because
it is a procedure that does not involve incisions or needle insertions
and, as opposed to many forms of radiation, can be repeated multiple
There are two types of HIFU
technology: The first is transrectal HIFU, generally used for prostate
cancer whereby the sound waves are directed at the prostate using a rectal
probe. The second is extracorporeal HIFU, whereby the sound waves are
directed at tumor lesions using a device located outside of the body.
HIFU is currently FDA and CE (European) approved
for the treatment of uterine fibroids. It is also available for the treatment
of prostate cancer in over one hundred clinical centers in Europe, South
America, and Canada, and is currently being used in various clinical
trials here in the United States. In Europe, HIFU is also approved for
tumors of the liver and kidney. Additionally, in China, England, Malaysia,
Korea, and Japan, HIFU treatment of various other solid tumor cancers
is approved and available to patients who are able to travel.
WHY HIFU WORKS
Ultrasound is sound with a frequency range above the threshold of human
hearing. While the upper limit for humans is around 20kHz, HIFU typically
operates in a frequency range from 250kHz to 2000kHz. Ultrasound waves
pass through the body tissues causing compression (increased pressure)
and rarefaction (decreased pressure). This energy is absorbed by the
body and converted into heat. With HIFU, these waves are focused on a
small target to generate intense heat at a specific point, similar to
the way one can focus light with a magnifying glass. Only at the precise
target, where the sound waves converge, are the energy levels of the
ultrasound high enough to bring about a rise in temperature to cause
instantaneous tumor cell death. Cells die when they are exposed to temperatures
above 56ºC (133ºF) for at
least one second; during HIFU, the temperatures are usually raised to
80ºC (176ºF) or higher at the precisely defined target area.
The surrounding tissues, meanwhile, are not damaged because the energy
is not focused enough to generate this kind of heat, making HIFU a non-invasive
procedure much safer than many types of radiation or surgery.
the precise target is relatively small, to treat a whole tumor or tumors,
the ultrasound is repeatedly and systematically focused to produce many
side-by-side lesions, causing complete cell death of the whole tumor
volume; this is commonly referred to as coagulative necrosis.
the procedure, the dead tissue remains corresponding in size to the initial
tumor plus an appropriate margin of normal tissue. There is an immediate
inflammatory response at the periphery of the ablated tumor, but two
weeks after the treatment, the periphery is replaced by repair tissue.
Beyond this time, there is a gradual shrinking of the treated regions,
which indicate the development of fibrous scar tissue.2
ADVANTAGES & LIMITATIONS OF HIFU
The major advantages of HIFU are that it is not a systemic treatment
and it is non-invasive, meaning that there are no incisions through skin
or muscle and there are no punctures into the tumor with needles (an
injection for anesthesia, however, is sometimes necessary). Compared
to surgery, which damages the surrounding tissues and is associated with
mortality through complications of the procedure, HIFU only destroys
the tumor along with a small margin. Whereas chemotherapy is a systemic
treatment, HIFU, like 3D conformal or gamma-knife radiotherapy, is highly
targeted. And as opposed to radiotherapy, with HIFU, there tends to be
much less damage to normal tissue. Finally, along with the advantages
of a highly targeted, non-invasive treatment, HIFU generally only requires
one or two sessions at the hospital and is generally compatible with
other kinds of treatment.
There are limitations, however. Although HIFU
has a high degree of precision, if a tumor lies adjacent to another organ,
especially a hollow structure like the bowels or lungs, damage to the
adjacent structures may occur, leading to further complications. While
HIFU can treat bone cancer, in most cases it cannot treat cancer that
lies in soft tissue behind the bone, such as inside the skull. Also,
a HIFU procedure could take between one and six hours, during which time
the patient must be completely immobile (to ensure accuracy in ablating
each side by side segment without leaving gaps of cancerous tissue),
which makes local or general anesthesia necessary. Finally, HIFU to the
prostate can result in incontinence and impotence, side effects that
are similar to prostatectomy.3, 4
In contrast to surgery, HIFU does not increase the potential risk of
metastasis.5 The side effects resulting from HIFU are different for each
type of cancer treated and compare favorably to the treatment methods
currently available. Side effects include mild to moderate pain of
typically short duration, superficial skin burns, and transient fever.
In addition, rare incidences of infection at the ablation site have been
WHO IS A GOOD CANDIDATE FOR HIFU?
HIFU treatment for uterine fibroids is currently available here in the
United States. The size, number, and location of fibroids are important
criteria to consider. In general, ExAblate 2000 (see "Various HIFU
Systems" below) treatment is best for people who can
go into an MRI, which excludes people who have metallic implants, claustrophobia,
or allergy to contrast agents used to see blood vessels. In particular,
submucosal, subserosal, and intramural uterine fibroids may be treated.
However, fibroids that are pedunculated (hanging from a stalk) or fibroids
adjacent to organs, such as the bladder and bowel, may be untreatable.
Additionally, women who are pregnant or desire future pregnancy are not
suited for HIFU as its impact on the ability to become pregnant or carry
a fetus to term has not been adequately studied.
Good candidates for treatment are patients with localized cancer (Stage
T1-T2) who are not candidates for a prostatectomy (because of age, state
of general health, or an associated disease) or patients who want an
alternative to surgery. If gland volume is larger than 40cc, hormonal
therapy to reduce size may be required first. Additionally, this treatment
can be used with patients who have local recurrence after external radiotherapy
("salvage" treatment). Patients can choose between the Sonablate 500
and Ablatherm devices (two different types of HIFU machines), and can
consider enrolling in Sonablate Phase I or Ablatherm Phase II or Phase
III clinical trials in the United States. Patients can also consider
traveling to Canada, Mexico, or Europe for treatment.
Liver, Kidney, Bone,
Pancreatic, & Breast Cancers
These types of cancer have been treated extensively in China and treatment
is just emerging in European countries. Interested patients may investigate
options of enrolling in a clinical trial using the ExAblate 2000 device,
seeking treatment in Oxford, England, or traveling to a center in Asia,
such as in Chongqing, China.
VARIOUS HIFU SYSTEMS
Extracorporeal HIFU for Solid Tumors
The ExAblate 2000 device, made by InSightec of Israel (see "Online
Resources" below), is approved by the FDA and is available in the
United States for the treatment of uterine fibroids. This device uses
magnetic resonance imaging (MRI) to identify lesions and monitor the
delivery of focused ultrasound. The ExAblate device is also being used
in clinical trials in other countries for bone, liver, and breast cancers,
as well as brain lesions without the need for opening the skull; these
trials are recruiting patients now (see "Current Clinical
For the treatment of other solid tumors,
there are two companies in China that make competing systems. One company
is called Haifu, with a important branch based in Chongqing, China. The
Chongqing Haifu device has CE approval and has been used to treat thousands
of patients in China where treatment is available for foreign patients.
This device is also being used in clinical trials in England, Malaysia,
Japan, and Korea. Another company is called Shanghai A&S Science
and Technology Development Co. Their HIFU system has been tested in China
in over 1,000 patients6 for sarcoma and cancers of the liver, bone, breast,
kidney, and pancreas.6, 7
Transrectal HIFU for Prostate Cancer
One device is made in the US by Focus Surgery and is called Sonablate
500. Another device is made in France by EDAP and is called Ablatherm.
Both are approved in Europe and the FDA has given approval in the United
States for Phase I, II, and III clinical trials for prostate cancer.
Additionally, the device is currently available for prostate cancer treatment
in Mexico, Canada, and Europe.
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General Information: http://en.wikipedia.org/wiki/Hifu
Prostate Cancer Research Institute Review: http://www.prostate-cancer.org/education/novelthr/Chinn_TransrectalHIFU.html
Uterine Fibroids Treatment Center: http://www.uterine-fibroids.org/index.html
Exablate 2000: http://www.insightec.com
Sonablate 500: http://www.focus-surgery.com
Sonablate 500 International: http://www.internationalhifu.com
Ablatherm International: http://www.hifu-planet.com
Haifu in China: http://www.haifu.com.cn
Haifu in England: http://www.hifucancertreatment.co.uk
Shanghai A&S: http://www.aishen.com.cn/doce/gsjj1.htm
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CURRENT CLINICAL TRIALS (Winter 2006)
Patients with pain due to bone metastases for whom other available treatments
are neither effective nor feasible.
» Toronto General Hospital. Toronto, Canada.
Debbie Havill. (416) 946-4501 x 4310. firstname.lastname@example.org
pain due to bone metastases for whom other available treatments are neither
effective nor feasible or
patients with inoperable or unresectable malignant, primary, or metastatic
» Charite Hospital. Berlin, Germany.
Svenia Podlowski. 49 (30) 450-557175.
» St Mary’s NHS Trust. London, England.
Dennis Baker, MD. 44 (20) 7886-6496. email@example.com
» Chaim Sheba Medical Center in Tel Hashomer.
Tel Aviv, Israel. Rafael Catane, MD. 972 (3) 530-2064. firstname.lastname@example.org
» Breastopia Namba Hospital. Miyazaki, Japan.
Hidemi Furusawa. 81 (985) 32-7177. email@example.com
Patients with brain
» University Children’s Hospital. Zurich,
Beat Werner. 41 (44) 266-8123. firstname.lastname@example.org
Phase I Clinical Trial in the United States
Eligibility: Men, 40 to 80 years old, with prostate cancer. No metastatic
disease, previous biological therapy or chemotherapy for prostate Cancer,
previous transurethral resection of the prostate or prostatectomy, or previous
rectal surgery. Must be at least three months since hormone therapy.
» Indiana University Cancer Center. Indianapolis, IN.
Rhoda Loman. (317) 274-1791. email@example.com
Phase II and III Clinical Trials in the United States
Eligibility: Men, at least 50 years old, with prostate cancer. No metastatic
disease and no hormonal therapy within last six months. Radiation treatment
at least 18 months ago. Disease recurred following radiation treatment.
» Georgetown University Medical Center.
Washington, DC. John Lynch. (202) 784-4000. RXAU@gunet.georgetown.edu
» Baylor University Medical Center. Houston, TX.
Dr. Brian Miles. (713) 798-8514. firstname.lastname@example.org
» Florida Foundation for Healthcare Research. Ocala, FL.
Ellen Metivier. (352) 237-3949. email@example.com
» Chinn & Chinn Urology Associates. Arcadia, CA.
Eva Chinn. (626) 574-7111. firstname.lastname@example.org
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QUESTIONS TO ASK A HIFU FACILITY
The following are examples of the sort of questions patients should
ask when evaluating foreign HIFU treatment facilities.
What are the clinical specialties of your hospital?
Euromed Clinic in Germany: The Department of Urology is focused on uro-oncology
and continence procedures.
University College in London: University College London Hospitals
NHS Trust is a tertiary referral centre that covers all medical and surgical
Capio Springfield Hospital in Chelmsford, UK: All major medical
and surgical specialities including urology, oncology, orthopaedics and cosmetic
surgery are catered for at the hospital.
How many patients are treated with HIFU technology per year in
Germany: Calculating for 2006, we will approach 30 therapies.
London: About two men per week for prostate cancer.
Chelmsford: Currently an average of 4-5 patients per month are treated with
this procedure. As you have stated this is a new technology and over
time more and more patients have requested information and chosen the Ablatherm
HIFU treatment as an option of treatment for their prostate cancer.
are eligible for treatment at your center?
Germany: We treat patients with presumably localized disease only:
PSA less than 15ng/ml, Gleason Score less than 7, prostate volume less than
London: Men with localized prostate cancer of low-moderate risk
or who have refused other treatments. Prostate glands larger than 40ml will
need to be placed on hormonal therapy for three months to reduce the size
before HIFU. Men who have failed other therapies will be assessed on an individual
Chelmsford: Essex Urology in association with Capio Springfield
Hospital has been carrying out HIFU treatments for the past year. The
team offers a combined HoLAP/HIFU procedure which enables patients to be
discharged the following day usually catheter free. The Essex Urology
team at Capio Springfield Hospital carried out the first combined HoLAP/HIFU
procedure in the world successfully in October 2005. HoLAP is Holmium ablation
of the prostate which is similar to a TURP coring of the prostate to enable
the patient to be catheter free much earlier than when under the normal HIFU
procedure. Due to swelling of the prostate
at the time of standard HIFU procedure catherisation times can normally be
as long as three to four weeks. Prostate cancer treatment using the
Ablatherm HIFU equipment has been successful in keeping with international
data results. HIFU treatment is reserved for patients with localised prostate
cancer. Patients undergo an extensive consultation, staging investigations
including bone scan and MRI scans to exclude metastatic disease. The
procedure itself takes three to four hours and therefore patients must be
assessed to ensure that they will tolerate a general anaesthetic for this
patients cannot be treated?
Germany: Huge prostatic calcifications do not allow HIFU for prostate
cancer. A missing rectal access (e.g. previous rectal cancer, rectal stricture)
also excludes patients from HIFU.
London: Only prostate cancer patients can be treated. No other types
of cancer at this time.
Chelmsford: HIFU treatment has been developed specifically for
the treatment of prostate cancer. The HIFU technology can be applied to any
solid cancer (eg. liver, kidney, etc.). The difficulty to date has
been how the energy is delivered to these organs. Current technological
research is in the process of developing probes which will be suitable for
treatment of these other cancers at some point in the future.
What are the adverse effects from treatment? How many and what
kinds of adverse effects have occurred at the hospital?
Germany: So far, we have observed dysuria, pollakisuria, and short-term urinary
London: Urinary tract infection (5 in 100), urethral stricture (narrowing
in the urine passage) (1 in 10), retrograde ejaculation (semen going into
the bladder rather than out through the penis) (3 in 100), epididymitis (infection
of the tubes surrounding the testicles) (3 in 100), urinary retention requiring
surgery (2 in 100), impotence (1-2 in 4), urinary incontinence (temporary)
(0-2 in 100), and recto-urethral fistula (an abnormal connection between
the rectum and urinary passage (0-1 in 200).
Chelmsford: HIFU treatment is considered a non-operative curative
therapy for prostate cancer. As such the side effects as compared to other
prostate cancer treatments such as radical prostatectomy and radical radiotherapy
are much less. Adverse effects include the following:
» Grade I incontinence can affect up to 5.8% of patients. This
represents a "dampness" rather true urinary leakage. This
compares with radical surgery where rates can be between 5-11% of more obvious
» Impotence occurs in up to 60% of patients. This figure, again, can
be higher in patients undergoing radical surgery or radiotherapy. Such
patients are usually responsive to oral measures such as Sildenafil
» Rectal fistula is rare but described with this treatment. It
can occur in men undergoing salvage HIFU therapy post radiotherapy.
» Urinary retention can occur as a short-term complication. It
is much less of a problem with the combined HoLAP/HIFU procedure.
» To date, there have been no complications of incontinence and
post-operative impotence has been avoided or treated successfully with
There have been no rectal fistulae complications in the patients
treated with the combined HoLAP/HIFU at Springfield Hospital.
Who are the doctors in charge of HIFU treatment at the center? What specialty
training do your doctors have, and where did they receive training?
Germany: Dr. E. Bismarck and Dr. T. Ebert do these procedures.
Dr. Ebert started with this technique in the 1990s and was the first
to use this procedure in Germany. He was trained at his site by the company
and has since trained others in Germany. Dr. Ebert has treated some 100
patients with the Sonablate device. In May 2004, he was retrained on
the latest device (software).
London: The Consultant Urological Surgeon is Mark Emberton,
who has a special interest in minimally invasive treatment
of the prostate. He has the UK approved qualifications to practice as
an independent medical practitioner.
Chelmsford: Mr Ranjan Thilagarajah MS FRCS FRCS(Urol) is leading
the Ablatherm HIFU
treatment program at the Capio Springfield Hospital. He trained in Lyon,
France under Professor Gelet, who is considered by some to be the "Father
of HIFU development".
What is their level of written and spoken English understanding?
Germany: Dr. Ebert has spent two years at Memorial Slone-Kettering in New
York as a post-doctorate fellow and still has close relations to many American
urologists. English language is not a problem in our department.
London: Dr. Emberton is fully conversant in English and Spanish. He is also
able to communicate somewhat in French.
Chelmsford: The team at Essex Urology and Springfield Hospital are native
English speakers and were brought up and schooled in the UK
What is the nurse to patient
ratio in your hospital?
Germany: Intensive care 1:2, regular urology 1:5.
London: I do not have this information.
Chelmsford: Depends on patient dependency but generally ward acute
surgical elective is 1:5/6 days and 1: 8 nights. High Dependency Unit ratio
is is 1:2
What accreditation does the hospital
have? Do you have United States accreditation?
Germany: We are a private clinic, which is not restricted by any accreditation.
I personally have permission to treat members of the US Forces in Germany
(TRICARE Europe Preferred Provider).
London: The hospital is a teaching hospital of the National Health Service.
It recently was awarded Foundation Trust status by the government, which
is a mark of recognition.
Chelmsford: Capio Springfield Hospital is fully accredited by the
Healthcare Commission in the UK. We are able to treat all patients within
the UK and Europe and some patients are occasionally coming from further
Does the hospital staff have training and or experience
working with foreign patients? With American patients?
Germany: Yes, they definitely have experience with both American and other
London: Our group has experience treating American patients in our other
trials in Photodynamic therapy of prostate cancer.
Springfield Hospital regularly treats overseas patients, including from the
United States, Middle East, Far East, Greece, and Thailand
What is the cost of treatment
(including hospital fees)?
Germany: 12,000 Euros including hospital and doctors.
London: Contact the treatment center for this information.
Chelmsford: Currently, the cost of the combined HoLAP/HIFU treatment
is in the region of £16,000. This includes all pre and post care with
consultations, hospital fees and the operation itself. Travel packages will
be may made available for US patients wishing to be treated that will include
a "door-to-door" service
if necessary according to requirements. This can be arranged as necessary
but is not included in the above estimate.
What type of HIFU
system is used at the hospital?
Germany: Sonablate 500.
London: Sonablate 500.
Chelmsford: Ablatherm HIFU.
What are the regulations regarding foreigners
Germany: No regulations. Payment can be made by credit card.
London: Not sure, but we are fairly flexible as patients would be
Chelmsford: Patients will be asked to provide specific medical data prior
to be accepted as patients. Patients should expect to be in the UK for about
one week in total to ensure that they are safe to travel post treatment.
All fees should be paid in advance of any proposed treatment i.e. on booking
travel package or on arrival in the UK depending on package chosen.
Euromed Clinic in Germany
Tom Ebert, MD, Chief of Urology
University College in London
Hashim Uddin Ahmed, MRCS(Ed), BM, BCh (Oxon)
Clinical Research Fellow (Uro-Oncology)
Institute of Urology, University College London
Capio Springfield Hospital/Broomfield Hospital
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Am J Obstet Gynecol 2003;189:48-54.
Patients/Disease: 55 women with fibroids
causing significant symptoms.
Effectiveness: They plan to follow the women who did not have a subsequent
hysterectomy to see how well the ultrasound treatment reduces fibroid symptoms.
Side Effects: No major complications.
Hospital: Dr. Elizabeth A. Stewart, of Brigham and Women's Hospital, Boston
Obstetrics and Gynecology, November 2004.
Patients/Disease: 76 women with different types of vulvar dystrophy
Effectiveness: 49 patients were cured with ultrasound therapy, and 23 more
had a good improvement in their condition. Just four women had persistent
Hospital: Dr. Zhibiao Wang, from the Institute of Ultrasound Engineering
in Medicine in Chongqing
Blana, A., S. Rogenhofer, et al. (2006). World J Urol.
Patients/Disease: 223 consecutive patients with localized prostate cancer
174 (78%) patients had one treatment, while 49 (22%) needed a second treatment.
Effectiveness: No improvement in symptom score or quality of life.
Side Effects: After one HIFU (223 patients): urinary tract infection
(0.4%), chronic pelvic pain (0.9%), infravesical obstruction (19.7%), stress
incontinence (7.6%), impotence (49.8%). After second HIFU (49 patients):
incontinence (12.2%; P = 0.024), impotence (55%; P < 0.001).
Hospital: Department of Urology, University of Regensburg, St. Josef Hospital,
Landshuterstraße 65, 93053 Regensburg, Germany. Andreas Blana: email@example.com
Lee, H. M., J. H. Hong, et al. (2006). Prostate Cancer Prostatic Dis.
Patients/Disease: 58 patients with localized prostate cancer with or without
transurethral resection of the prostate.
Effectiveness: The success rates of HIFU were 85, 77 and 47% in low-, intermediate-
and high-risk groups, respectively.
Side Effects: The operation-related complications were minimal.
Hospital: Department of Urology, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Republic of Korea.
Jin, C. B., F. Wu, et al. (2003). Zhonghua Zhong Liu Za Zhi 25(4):
Patients/Disease: Fifty patients with unresectable hepatocellular carcinoma.
Technology: HIFU combined with transcatheter arterial chemoembolization (TACE)
Effectiveness: The median survival time, 6-month and 1-year survival rates
were 11.3 months, 80.4 - 85.4% and 42.9% in T + H group, in contrast to
4 months, 13.2% and 0% in T group with significant differences (P < 0.01).
The average survival time of patients who died was 10.21 +/- 4.12 months
in T + H group, as compared with 4.35 +/- 2.39 months in T group also with
significant differences (P < 0.01).
Side Effects: Not reported.
Hospital: Clinical Center for Tumor Therapy, Second Hospital, Institute of
Ultrasonic Engineering in Medicine, Chongqing Medical University, Chongqing
Li, C. X., G. L. Xu, et al. (2004). World J Gastroenterol 10(15):
Patients/Disease: 100 patients with liver cancer.
Technology: JC type Chongqing HIFU Technology.
Effectiveness: Clinical symptoms relieved 86.6%. Ascites disappeared in 6 patients.
ALT and AST were reduced to normal in 83.3% and 72.9% of patients, AFP was lowered
by more than 50% in 65.3% of patients. MRI or CT findings indicated coagulation
necrosis and blood supply reduction or disappearance of tumor in the target region.
Effects: Not reported.
Hospital: Chuan-Xing Li, Department of HIFU, Cancer Center,
Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China. firstname.lastname@example.org or
+86 (20) 8734-3381.
Thuroff, S., C. Chaussy, et al. (2003). J Endourol 17(8): 673-7.
Patients/Disease: 402 Patients presenting with localized (stage T(1-2)N(0-x)M(0))
Effectiveness: Patients received a mean of 1.4 HIFU sessions. The negative biopsy
rate in the T1-2 primary-care population was 87.2%. A 92.1% negative biopsy rate
was observed in low-risk patients.
Hospital: Department of Urology, Munchen-Harlaching Krankenhaus, Munchen, Germany.
T., S. Baba, et al. (2005). Hinyokika Kiyo 51(10): 651-8.
Patients/Disease: 72 consecutive patients with stage T1c-2NOM0 prostate cancer.
Technology: Sonablate 500TM HIFU device (Focus Surgery, Indianapolis, USA).
Effectiveness: Biochemical disease-free survival rates in all patients at 1 and
2 years were 78% and 76%, respectively. No viable tumor cells were noted in 68%
of patients by postoperative prostate needle biopsy. Prostatic volume was decreased
from 24.2 ml to 14.0 ml at 6 months after HIFU (p < 0.01).
Hospital: The Department of Urology, Tokai University Hachioji Hospital.
Uchida, T., H. Ohkusa, et al. (2006). BJU Int 97(1): 56-61.
Patients/Disease: 63 patients with stage T1c-2bN0M0 localized prostate cancer.
Technology: Sonablate system (Focus Surgery, Inc., Indianapolis, IN, USA).
Effectiveness: The overall biochemical disease-free rate was 75% (47 patients).
Final follow-up sextant biopsies showed that 87% of the patients were cancer-free.
Side Effects: Urethral stricture (24%), retrograde ejaculation (3%), epididymitis
(3%), TURP for prolonged urinary retention (2%), grade 1 transient incontinence
for a month (2%), and recto-urethral fistula (2%). Eight of the 34 patients
who were sexually active complained of erectile dysfunction after HIFU;
two of these eight who desired treatment were treated with sildenafil citrate,
Hospital: University of Tokai Hachioji Hospital, Hachioji, Japan. email@example.com
Top of Page
1. Kennedy JE, Ter Haar GR, Cranston D. High intensity
focused ultrasound: surgery of the future? Br J Radiol. Sep 2003;76(909):590-599.
JE. Innovation: High-intensity focused ultrasound in the
treatment of solid tumours.
Nat Rev Cancer. Apr 2005;5(4):321-327.
3. Blana A,
Rogenhofer S, Ganzer R, Wild PJ, Wieland WF, Walter B. Morbidity associated with
repeated transrectal high-intensity focused ultrasound treatment of localized
prostate cancer. World J Urol. Jul 19 2006.
C, Thuroff S. The status of high-intensity focused ultrasound in the treatment
of localized prostate cancer and the impact of a combined resection. Curr Urol
Rep. Jun 2003;4(3):248-252.
5. Wu F, Wang
ZB, Jin CB, et al. Circulating tumor cells in patients with solid malignancy
treated by high-intensity focused ultrasound. Ultrasound Med Biol. Apr 2004;30(4):511-517.
6. Wu F, Wang
ZB, Chen WZ, et al. Extracorporeal high intensity focused ultrasound ablation
in the treatment of 1038 patients with solid carcinomas in China: an overview.
Ultrason Sonochem. May 2004;11(3-4):149-154.
JE, Wu F, ter Haar GR, et al. High-intensity focused ultrasound for the treatment
of liver tumours. Ultrasonics. Apr 2004;42(1-9):931-935.
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