Effect Of Microbubble Contrast Agent On High-intensity Focused Ultrasound Treatment For Patients With Early Hepatocellular Carcinoma

BackgroundHigh-intensity focused ultrasound(HIFU),as an newly clinical strategy,has been used in the treatment for varies of tumors.The efficacy and safety of HIFU in combination with transcatheter arterial chemoembolization(TACE)for treatment of patients with hepatocellular carcinoma(HCC)has been widely reported before.Meanwhile,the microbubble contrast agent(SonoVue)has been reported as one of the HIFU synergists in some researches,which HIFU was used to treat uterine myoma,adenomyosis and so on.However,using SonoVue microbubble in HIFU treatment was not often reported in clinical researches for patients with HCC,but in animal experiments.ObjectiveTo compare the efficacy and safety of HIFU in combination with TACE and HIFU in combination with SonoVue microbubbles,and preliminary investigate the factors affected energy efficiency factor(EEF).MethodsFrom January 2015 to January 2018,52 patients with early HCCs,who conformed criteria at the second affiliated hospital of Chongqing Medical University,were selected to a retrospective study.Patients were divided into SonoVue group and TACE group with different therapies.TACE was performed 1-2 weeks before HIFU in TACE group,and SonoVue microbubbles were administrated before HIFU sonication in SonoVue group.Tumors were evaluated by contrast-enhanced magnetic resonance imaging.Change of lesions,AFP values,hepatic and renal function were measured pre-and postoperatively.Then,adverse events were observed and clinical follow-up was performed.ResultsClinical efficacy and accumulative survival rates were similar between two groups.There were no significant difference in majority of treatment parameters,such as rates of massive grey-scale changes,treatment power,HIFU time,total energy,and treatment time.Contrarily,time and energy required for the first massive grey-scale changes in SonoVue group were significantly lower than those in the TACE group(P < 0.05).Additionally,the AFP values after HIFU treatment were significantly decreased in the SonoVue group(P = 0.005),but not in the TACE group.The major adverse events included soft-tissue edema,pain in treated region,fever,and transitional elevation of serum transaminase.Only rate of fever(3.85%)in SonoVue group was significantly lower than that in TACE group(50.00%,P < 0.01).The “diagnosis and treatment cycle” in SonoVue group was remarkably shorter than TACE group [(11.5 ± 2.90)vs.(22.7 ± 6.3)d,P < 0.01].EEF was positively correlated with distance from the deepest layer of lesion to the hepatic capsule or to the abdominal wall in SonoVue group,while that was negatively correlated with iodized oil deposition in TACE group.ConclusionThe efficacy and safety in HIFU combined with SonoVue microbubbles were similar to HIFU combined with TACE for patients with early HCCs.HIFU combined with SonoVue microbubbles,which had a shorter “diagnosis and treatment cycle” and less influence on EEF compared with HIFU in combination of TACE,present a new strategy in clinical treatment,especially for patients with early HCC.