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Title: Aspects of clinical high-intensity focused ultrasound : urological and oncological
Author: Leslie, Thomas Alexander
ISNI:       0000 0001 3608 3862
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2007
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This thesis investigated the use of high-intensity focused ultrasound (HIFU) as a treatment for prostate cancer and kidney tumours. The work also looked at treatment regimes and treatment monitoring. Three HIFU devices were assessed in clinical trials. Phase II clinical trials were designed to assess safety and efficacy of both the Sonablate-500® transrectal HIFU device in treating localised prostate cancer, and the extracorporeal Model-JC HIFU device as a non-invasive technique for the ablation of renal tumours. A phase I clinical trial assessed the Sonablate-Laparoscopic® HIFU device's ability to ablate renal tumours. Potential limitations of HIFU arise as a result of the time taken to treat, the accuracy of a treatment and treatment monitoring itself. These variables were therefore explored ex vivo as a non-clinical component of the thesis. Transrectal HIFU in the treatment of prostate cancer was shown to be safe and had relatively low morbidity with no major complications. 12/15 (80%) patients, treated with an average of 1.4 HIFU treatments, remained free from biochemical relapse and biopsy negative at a mean follow up of24 months. The only significant treatment-related side-effect with extracorporeal HIFU encountered was pain. Low grade discomfort occurred in 17/21 (71%) of the cases, however, all patients went home the next day. Overall, 'technical success' was seen in 12/21 (57%) tumour targets. Where complete ablation was the aim, the technique was effective in 4/14 (29%) patients. The laparoscopic HIFU trial resulted in successful ablation of both normal kidney and renal cell carcinoma. Treatment protocols were amended and the surgical technique refined. The non clinical experimental results have shown that ultrasound imaging of HIFU ablation does give a reliable indication of success. Also, large areas of tissue can be ablated rapidly to improve treatment time, however accuracy was limited in the ex vivo models used.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available