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Title: Novel therapeutic and diagnostic ultrasound techniques in cancer management
Author: Abel, Mark Joshua
ISNI:       0000 0004 6347 0501
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2017
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Introduction: The aim of this thesis is to assess novel therapeutic and diagnostic ultrasound techniques in cancer management. A drive to improve prognosis in cancer patients has resulted in a vast array of recent medical advances and new approaches using ultrasound technology may enhance outcome in patients with a diagnosis of malignancy. Methods: A new 256 element random phased-array high intensity focused ultrasound (HIFU) device was designed, developed and tested for use in treating hepatic tumours. An existing intra-cavitary HIFU transducer (Sonablate 500®) currently under investigation for use in prostate cancer was adapted to determine safety and efficacy in the treatment of other pelvic malignancies. Doppler, dynamic contrast-enhanced ultrasound (DCE-US) and shearwave elastography (SWE) were used to assess changes in perfusion and elasticity respectively of hepatic tumours and liver parenchyma in patients undergoing therapy for primary or secondary liver malignancy with cytotoxic chemotherapy, selective internal radiation therapy and biological agents. Measurements were correlated with serum tumour and inflammatory markers and hepatic cancer volume. Results: The new HIFU device was able to cause rapid and directed large volume tissue ablations deep to a simulated rib cage in an ex vivo setting. The Sonoblate® device was safely used for symptomatic relief in a patient with cervical cancer, although device design limitations prevented successful implementation in rectal carcinoma. In multiple circumstances, Doppler, DCE-US and SWE were able to prognosticate outcomes to cancer therapy at pre-treatment and 2-week time points and showed a level of correlation with serum markers and tumour volume. Conclusion: Novel ultrasound techniques, including HIFU, Doppler ultrasound, DCE-US and SWE show promise in both the treatment and response monitoring of patients diagnosed with malignancy.
Supervisor: Leen, Edward ; Price, Patricia ; Spalding, Duncan Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral