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Treatment of human pancreatic cancer using combined ultrasound, microbubbles, and gemcitabine: A clinical case study
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10.1118/1.4808149
/content/aapm/journal/medphys/40/7/10.1118/1.4808149
http://aip.metastore.ingenta.com/content/aapm/journal/medphys/40/7/10.1118/1.4808149

Figures

Image of FIG. 1.
FIG. 1.

1D and 2D beam profiles at sonoporation settings using the 4C probe at two focal depths: 6.7 and 8.4 cm for the 1D plots and 8.4 cm for the 2D plots. The beam profile was characterized in water and derated for values (Refs. and ). Lines A-A, B-B, and C-C in panels (d) and (e) represent the position of the 1D scans shown in panels (a), (b), and (c), respectively. The bounding boxes in panels (d) and (e) represent the area visible on the clinical scanner screen. In the elevation direction, the bounding box was defined by when a 0.5 mm needle could not be distinguished on screen. The tumor was positioned at the intersection of lines B-B and C-C in frame (e), and at an elevation distance of 0 mm in frame (d).

Image of FIG. 2.
FIG. 2.

Ultrasonic pulse generated by the clinical scanner. The top panel shows the pulse repetition frequency and pattern. The lower panel shows the temporal extent of the pulse with the largest amplitude. The pulses were amplitude-modulated. Each pulse consisted of four cycles (2.1 s) every 210 s.

Image of FIG. 3.
FIG. 3.

Fast Fourier transform of ultrasonic signal. The center frequency of the transmitted signal is 1.9 MHz. A bandwidth of 1.1 MHz can be seen.

Image of FIG. 4.
FIG. 4.

Images captured using customized sonoporation settings using a clinical ultrasound scanner. The dense vasculature in early arterial phase to the right of the main tumor (circled in the B-mode frame) can be seen in panel (a). Panel (b) shows the dimensions of the main tumor, indicated by lines 1 and 2, using the sonoporation settings.

Image of FIG. 5.
FIG. 5.

Time frame of each chemotherapy cycle [panel (a)] and photograph of probe and custom-made probe holder during patient treatment using microbubble sonoporation for pancreatic cancer [panel (b)]. Panel (a) shows the time frame for each treatment cycle from the start of the gemcitabine infusion. Arrows indicate intravenous injection time of 0.5 ml SonoVue followed by a 5-ml intravenous injection of saline. Time between each injection () is 3.5 min.

Image of FIG. 6.
FIG. 6.

CT [panel (a)] and PET [panels (b) and (c)] images of patient 5 showing pancreatic adenocarcinoma prior to treatment. Panel (a) shows a CT scan in the transverse plane with the primary tumor in the head of the pancreas, and the pancreas indicated by the dashed lines. Panels (b) and (c) show PET scans in transverse and coronal planes, respectively. The location of the tumor can be clearly identified by the brighter region in the middle of the abdomen. In panels (b) and (c), the tumor and pancreas are, respectively, indicated by the dashed lines. The pancreas tail is behind the large colon in panel (c).

Image of FIG. 7.
FIG. 7.

Normalized microbubble presence in tumor locality during the first 800 s of treatment. Arrows indicate contrast injection time.

Image of FIG. 8.
FIG. 8.

Change in tumor diameter over time measured from CT images in patients with pancreatic malignancy.

Tables

Generic image for table
TABLE I.

Parameters as indicated on a GE LOGIQ 9 clinical ultrasound scanner.

Generic image for table
TABLE II.

Acoustic conditions generated by the 4C probe for sonoporation and derated for values (Refs. and ).

Generic image for table
TABLE III.

Patient characteristics prior to treatment. ND denotes nondiscernable values. Start and end date of treatment are also stated.

Generic image for table
TABLE IV.

Maximum tumor diameter as measured from CT images. Empty values denote skipped CT scans.

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/content/aapm/journal/medphys/40/7/10.1118/1.4808149
2013-06-06
2014-04-23
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752b84549af89a08dbdd7fdb8b9568b5 journal.articlezxybnytfddd
Scitation: Treatment of human pancreatic cancer using combined ultrasound, microbubbles, and gemcitabine: A clinical case study
http://aip.metastore.ingenta.com/content/aapm/journal/medphys/40/7/10.1118/1.4808149
10.1118/1.4808149
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