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Treatment options for liver and pancreatic cancer have always been a vital part of modern clinical research, and for now, patients with unresectable liver or pancreatic tumors are usually administered with local treatment. As high intensity focused ultrasound (HIFU) enjoys unique strengths of noninvasiveness, repeatability and availability of combined therapy, it has emerged as a new option in the treatment of liver and pancreatic tumors. Therefore, International Society of Minimally Invasive and Virtual Surgery (ISMIVS) launched “New Option, New Hope” webinars to discuss the safety and efficacy of HIFU for liver and pancreatic cancer with global experts, as well as deepen the understanding of its clinical value and application prospect.

The 1st episode finished perfectly on November 18th, on which Prof. Zhang Lian, Prof. Xu Yonghua and Prof. Zhou Kun were invited to be the special guests while Prof. Holdger Strunk and Prof. David Cranston chairing the seminar, attracting 150 worldwide doctors and academics from over 30 countries and regions (UK, Germany, Indonesia, Singapore, Japan, etc.) to attend.

Prof. Zhang Lian, Secretary-General of ISMIVS and Director of Chongqing Haifu Hospital, first introduced the fundamental principle of HIFU. Then, based on the inclusion criteria of HIFU treatment for small hepatocellular carcinoma (HCC) in his institution including patients who were deemed not candidates for surgery, not suitable for local treatment such as radiofrequency ablation (RFA), or with a solitary tumor ≤ 5cm/tumor number ≤ 3 with each tumor ≤ 3 cm in diameter, he shared the characteristics, survival rates and recurrence rates of the 35 patients with small HCC treated with HIFU. Prof. Zhang Lian also compared the survival rates of transcatheter arterial embolization (TAE) and TAE followed by ultrasound-guided HIFU (USgHIFU) for advanced HCC. After the elaboration of several case reports, he concluded that USgHIFU ablation could be considered a safe and effective approach for liver tumors.

Prof. Holger Strunk from the University Hospital Bonn, Germany, discussed the safety and efficacy of HIFU treatment for pancreatic cancer. One of the cases he shared was a 56-year-old male patient with an inoperable pancreatic tumor who received HIFU treatment. Significant pain relief was achieved 2 days after HIFU and tumor remission was observed 12 months after HIFU. Based on the clinical data his institution collected, he summarized that HIFU therapy can bring effective and lasting reduction of cancer-related pain burden in 85% of patients, significant tumor volume reduction persisting over time in 80% of patients and possible tumor regression after the second HIFU procedure. HIFU also seems to provide a possible survival benefit for advanced pancreatic cancer.

Prof. David Cranston, the President of ISMIVS, shared a fascinating story about how HIFU was introduced to his research team in the Surgery University of Oxford and the clinical trials of HIFU therapy conducted therein. He particularly indicated the drug delivery procedure and result for liver tumor by using focused ultrasound to release doxorubicin from circulating thermosensitive liposomes: out of 9 patients with complete radiological assessment, 4 demonstrated PR on CHOI and/or PERCIST. He also talked about HIFU ablation for pancreatic cancer and targeted drug delivery. Among 8 patients with unresectable pancreatic cancer treated with HIFU, total pain relief was observed and the median survival time was 11 month. In his view of the development of HIFU application, advanced machines, faster treatment and more accurate imaging would emerge in the nearer future.

Prof. Xu Yonghua from Xuhui Hospital of Fudan University mainly discussed the MRI evaluation for focused ultrasound ablation in the treatment of hepatic and pancreatic cancer. He compared MRI images before and after HIFU therapy of 19 cases with liver cancer. As one of the examples, a 60-year-old male patient with hepatic metastasis after sigmoid colon cancer surgery received HIFU treatment due to the bleeding risks and thrombus for RF ablation, and the lesion was almost completely ablated with intact vessels. He also shared 6 cases with pancreatic cancer and indicated that HIFU was a feasible and safe therapy for liver and pancreatic tumor with less complication, and he believed with the development 5G technology, the remote surgery of HIFU can be performed to benefit more patients around the world.

Prof. Zhou Kun from the Second Affiliated Hospital of Chongqing Medical University further shared a surgery video of a patient with pancreatic cancer who were receiving HIFU treatment and elaborated the procedure and precautions, including the patient’s surgical position, sedation administration and imaging analysis. He also shared two case reports of his hospital and concluded that HIFU therapy was a safe minimally invasive treatment which can benefit cancer-related pain release and was an potential option as a pre-surgery for borderline resectable tumor.