Optimization and Safety Modeling of a Miniaturized Multidirectional Ultrasound Ablation Array (MiDUSa) for Endobronchoscopic Lung Nodule Ablation
Abstract
Objective and Background: Externally administered high intensity focused ultrasound (HIFU) is capable of focusing and directing high acoustic power ultrasound waves, resulting in frictional heat and elevating tissue temperatures to >60°C, causing tissue death with minimal damage to surrounding structures, making ultrasound safer than other ablative technologies. Skin surface HIFU devices have attracted much attention in pancreatic, liver, and prostate cancer due to their noninvasive nature. This noninvasive treatment option allows targeted tissue destruction without surgical incision, expediting the recovery time after the treatment. However, current clinical applications of HIFU is via a surface probe, which poses some inherent technical limitations to its use for lung cancer treatment. The most critical limitation is that ultrasound waves do not propagate through air; therefore, considering that the lung is an air-filled organ, surface HIFU cannot be used for lung cancer treatment. A miniaturized ultrasound transducer that can be placed directly into or next to peripheral lung tumor targets from a minimally invasive bronchoscopic approach with simultaneous image guidance would mitigate these issues. Direct internal contact between the ultrasound probe and tumor would allow more accurate destructive power output to the lesion while avoiding nearby normal structures. In these respects, the internal HIFU probe is more promising for the treatment of lung cancers. Instead of treating from outside the body, we propose that it is possible to ablate from within the tumor itself. In this proposal, we seek to develop and model a novel miniature HIFU device that is compatible with bronchoscopes for minimally invasive lung cancer diagnosis, staging, and treatment procedures and is capable of safely delivering customizable ablation fields for lung nodules of various sizes and shapes up to 4cm. LCRP Area of Emphasis: Identify innovative strategies for the treatment of lung cancer. Applicability: Lung cancer continues to be the leading cause of cancer deaths worldwide. Over 200,000 new cases of lung cancer are identified in the United States per year, with lung cancer deaths exceeding the total estimated deaths from breast, prostate, and colon cancer combined. Lung cancer screening is shown to decrease lung cancer deaths by identifying more patients at a potentially curable early stage. Currently, more than 20% of new lung cancer cases are made up of curable, early-stage disease. Currently, surgical resection is the gold standard for diagnosis, staging, and treatment for surgically appropriate patients with early-stage lung cancer. Unfortunately, the population is aging and is overall less healthy, making surgery very high risk. In fact, >20% of patients with early-stage lung cancer are considered very high risk for surgery. Additionally, there is an estimated rate of local recurrence following curative intent surgery of 13-46%. Often, these patients cannot undergo further surgical resection. For the high-risk surgical patients, curative intent treatment is largely limited to stereotactic body radiation therapy (SBRT). Like surgery, SBRT has a significant 5-year local recurrence rate of ~20% and up to 47% after repeat SBRT (which is limited due to radiation dosage and toxicity), leaving a significant number of patients without additional local control options after surgery and SBRT has been previously employed or has been deemed unacceptably high risk. The device proposed in this project poses an additional option for these patients and may become a first-line approach, as it offers the advantage of being able to diagnose, stage, and treat early-stage lung cancer during a single, minimally invasive procedure. This would serve to decrease time from nodule detection to treatment and assure accurate staging. The current project seeks to optimize and model the ablative zones of a prototype device previously
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210285
Entities
People
- Allen C Burks
Organizations
- United States Army
- University of North Carolina at Chapel Hill