Background WD repeat and SOCS box containing protein 1 (WSB1) promotes tumor progression and metastasis; however, its role in the response to hyperthermia combined with chemoradiotherapy in cervical cancer remains unclear. Therefore, this study investigated the involvement of WSB1 and the c-Myc/Wnt/β-catenin axis in the antitumor effects of this combined treatment.Methods WSB1 expression was examined in multiple cervical cancer cell lines, and its functional roles were evaluated using the cell counting kit-8, colony formation, wound healing, Transwell migration/invasion, and apoptosis assays. The c-Myc-mediated transcriptional regulation of WSB1 was analyzed using chromatin immunoprecipitation and dual-luciferase reporter assays. Wnt/β-catenin signaling activity and DNA damage were assessed via western blotting and immunofluorescence. Antitumor efficacy was further evaluated in a cervical cancer xenograft model treated with hyperthermia, chemoradiotherapy, or both.Results WSB1 was highly expressed in both HeLa and SiHa cells and promoted proliferation, migration, and invasion, while inhibiting apoptosis. c-Myc directly transcriptionally activated WSB1, and WSB1 was required for c-Myc-driven activation of Wnt/β-catenin signaling, thereby forming a positive feedback loop. Combined hyperthermia and chemoradiotherapy markedly suppressed malignant phenotypes in vitro and tumor growth in vivo, increased DNA damage, and downregulated c-Myc, WSB1, and Wnt/β-catenin pathway components, with minimal systemic toxicity.Conclusions WSB1 acts as an oncogenic driver in cervical cancer by sustaining c-Myc/Wnt/β-catenin signaling across different histological subtypes. Axis disruption via combined hyperthermia and chemoradiotherapy effectively inhibits tumor progression. This presents WSB1 and its signaling network as potential therapeutic targets for a broad range of patients with cervical cancer.
Objective: This study aims to evaluate and compare the photothermal responses of gold nanostars (AuNSs) and graphene-coated gold nanostars (G-AuNSs), which are considered promising photothermal agents due to their high plasmonic absorption and efficient light-to-heat conversion.Method: A combined experimental and numerical approach was employed to assess the photothermal behavior of AuNSs and G-AuNSs under tissue-mimicking phantom conditions. A three-dimensional finite element method (FEM)-based optical-thermal model was developed and validated using a multilayer liver-mimicking phantom. Star-shaped AuNSs and G-AuNSs with sizes of approximately 80-250 nm were synthesized via seed-mediated growth and subsequent graphite oxide coating. Each nanoparticle system was examined at its respective plasmon-matched excitation wavelengths: 810 nm for AuNSs and 1064 nm for G-AuNSs.Results: The FEM predictions were found to be in good agreement with infrared thermography measurements, with maximum temperature differences below 2 °C under the tested conditions. Under the irradiation conditions (1 W·cm-2 for 700 seconds), AuNSs achieved peak temperatures of approximately 44-45 °C, while G-AuNSs produced temperature elevations of approximately 57-58 °C. Cumulative thermal dose (CEM43) analysis indicated significantly higher thermal dose accumulation for G-AuNSs compared to AuNSs. Additionally, cooling-curve analysis revealed higher photothermal conversion efficiencies for G-AuNSs (67.8% experimentally and 71.1% from phantom-matched FEM estimation) in contrast to AuNSs (51.2% experimentally and 55.4% from FEM estimation).Conclusion: The findings of this study demonstrate that G-AuNSs exhibit superior photothermal heating performance compared to AuNSs under the investigated NIR-I and NIR-II irradiation conditions. This highlights the potential of graphene-coated gold nanostars for improved photothermal applications in the NIR-II range, while also acknowledging the limitations associated with phantom-based validation and wavelength-dependent excitation effects.
BACKGROUND:Water-filtered infrared-A (wIRA) mild hyperthermia (mHT) combined with radiotherapy can effectively treat superficial tumors. While in vitro models are essential for mechanistic studies, existing approaches mostly rely on monolayer cultures and non-clinical heating. We present a multilayer agarose-based platform enabling clinically relevant wIRA-hyperthermia of 3D-tumor spheroids using a clinical device, reproducing spatial thermal gradients and thermographic feedback control without an external heat source. METHODS:We designed a multilayer stack with alternating layers of hemoglobin-agarose chips (2% Hb, 2% talcum) as infrared absorbers, spacers, and microwell chips containing tumor spheroids at 5 and 11 mm depth. Temperature profiles were characterized using thermocouples, and evaluated according to European Society for Hyperthermic Oncology (ESHO) guidelines. We monitored T47D breast cancer spheroid growth by optical scanning for 28 days, and assessed cell death by flow cytometry 48 h post-treatment. RESULTS:The system achieved stable heating from room temperature within 15 ± 8 min, with mean steady-state temperatures of 41.9 ± 0.5 °C (n = 26) and 40.3 ± 0.4 °C at 5 mm and 11 mm depth, respectively. T50 (42.1 ± 0.5 and 40.5 ± 0.3 °C) and T90 values (41.3 ± 0.7 and 39.8 ± 0.7 °C) at these depths met or approached ESHO guidelines. Spheroids at higher temperatures (upper layer) were modestly larger than controls (p < 0.01) at 14 and 28 days; lower temperatures had no effect. mHT did not induce apoptosis or necrosis. CONCLUSION:The novel model replicates in vivo wIRA temperature profiles in 3D cell culture and supports several downstream analyses. It enables investigation of cellular responses to clinically relevant mHT and provides a technical basis for future translational research.
PURPOSE:To evaluate whether skull density ratio (SDR) estimates required for high-intensity focused ultrasound (HIFU) treatment of tremor can be accurately derived from zero echo time (ZTE) magnetic resonance images (MRI) by comparing them with measurements from computed tomography (CT) scans using an intensity profile-based approach. MATERIALS AND METHODS:Fifty-seven patients with essential tremor (n = 44), Parkinson's disease (PD) tremor (n = 10), both (n = 1) or uncategorized tremor-dominant disease (n = 2), underwent ZTE imaging before a neuro-HIFU treatment. Skull attenuation estimates, i.e. skull density ratios, were calculated from ZTE and CT images using the developed in-house SDR calculation pipeline and compared with the vendor-provided benchmark SDR values. To statistically evaluate the linear relationships between the datasets, Pearson correlation coefficients (r) and their corresponding p-values were calculated. A novel ZTE-based SDR inclusion threshold was derived. RESULTS:A statistically significant positive correlation (r = 0.96, p< 0.0001) was detected between the CT-derived SDRs and the benchmark values, indicating that the in-house pipeline achieved high accuracy. Statistically significant positive correlation (r = 0.80, p< 0.0001) between the benchmark SDR values and the ZTE-derived SDR values was detected. A novel ZTE-based inclusion threshold of 0.51-0.53 was suggested. CONCLUSIONS:To our knowledge, this research was the first to take an intensity-profile-based approach when comparing high-resolution ZTE images and CT scans for skull density ratio calculation. The findings of this study support the possibility of the zero echo time sequence being validated for clinical use.
BACKGROUND:Magnetic nanoparticle thermal therapy (MNTT) can localize heat within tumors, but non-uniform nanoparticle distribution can limit thermal dose coverage. Spatially confined MNTT (SC-MNTT) addresses this limitation by using a static magnetic field (SMF) to suppress heating outside a selected field-free region (FFR). However, SC-MNTT platforms require improved FFR steering and closed-loop temperature control. PURPOSE:This study developed and validated a low-cost, four-permanent-magnet SC-MNTT platform for spatially selective heating, dynamic FFR steering, and controlled thermal dose delivery in phantom models. METHODS:The device combined four permanent magnets, an induction coil, motion and heating control, fiber-optic thermometry, and autotuning proportional-integral-derivative (PID) control. SMF maps and alternating magnetic field (AMF) defined operating conditions. Three-vial verification experiments evaluated spatially selective heating under pulsed AMF exposure. Liver-phantom validation experiments tested pulsed heating and autotuning PID control using prescribed temperature setpoint, a CEM43 target of 8 [min], and a healthy-tissue limit of 39.50 [°C]. RESULTS:The four-magnet configuration shifted the FFR between selected targets and concentrated heating at the intended nanoparticle location. In three-vial experiments, the selected vial reached normalized heating intensity near 1.00, while non-target vials remained lower between 0.09-0.26, corresponding to selective heating with reduced off-target activation. In liver-phantom experiments, autotuning PID control maintained a mean target temperatures 43.44 ± 0.01 [°C], achieved prescribed CEM43 at selected tumor probes, and kept the designated healthy-tissue probe below the safety threshold. Mean overshoot remained below 1.1 [%]. CONCLUSION:The four-magnet SC-MNTT platform enabled repeatable in-plane FFR steering, spatially confined heating, and closed-loop thermal dose delivery in phantom models.
OBJECTIVE:To evaluate the efficacy and safety of ultrasound-guided thermal ablation (TA)for the treatment of T1N0M0 papillary thyroid carcinoma (PTC) in adolescent patients. METHODS:This retrospective study enrolled adolescent patients with solitary T1N0M0 PTC who underwent TA between January 2015 and January 2025. Patients were stratified into T1a and T1b subgroups based on maximum tumor diameter. The primary outcomes were tumor progression rate and progression-free survival (PFS); secondary outcomes included ablation zone volume dynamics, volume reduction rate, complications, thyroid function, and patient-reported satisfaction. RESULTS:A total of 82 patients were included (56 in T1a group, 26 in T1b group), with a technical success rate of 100%. The overall median follow-up duration was 36 months (interquartile range [IQR]: 24-60 months). Ablation zone volumes progressively decreased and eventually vanished in all cases. The median time to complete disappearance of the ablation zone was significantly longer in the T1b group than in the T1a group (18 months vs. 12 months, p = 0.014). The overall tumor progression rate was 2.4% (2/82), with no significant difference between subgroups (p = 0.579). Progression-free survival (PFS) rates were comparable between T1a and T1b groups (96.5% vs. 94.0%, p = 0.550). No major complications occurred. CONCLUSION:Ultrasound-guided TA is a safe and effective treatment modality for both T1a and T1b subgroups of adolescent patients with solitary T1N0M0 PTC.
Purpose High-intensity focused ultrasound (HIFU) is a noninvasive ablation technology with increasing relevance for preclinical research and clinical translation. Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal cancers, with limited therapeutic options and poor response to current treatments, underscoring the urgent need for alternative strategies. To address this, we developed a mobile HIFU platform optimized for small-animal studies with an immersion-free design that improves usability while maintaining reproducible thermal ablation.Materials and methods The system was evaluated in a PDAC mouse model using KPC tumor cells. HIFU-induced tumor ablation and tumor growth were assessed, and histological and flow cytometric analyses were performed to evaluate treatment-assossiacted changes in the tumor microenvironment. To recapitulate the PDAC immune microenvironment in vitro, we further established a co-culture system of tumor organoids and CD8+ T cells.Results HIFU treatment induced tumor necrosis and significantly suppressed tumor growth. Histological and flow cytometric analyses revealed treatment-associated immune modulation, including increased proportions of activated CD8+ T cells, APC-like cells, and macrophage populations. In the organoid coculture model, activated CD8+ T cells accumulated around tumor organoids and were associated with increased tumor organoid death.Conclusions The proposed mobile HIFU system demonstrated reliable technical performance and biological efficacy in a preclinical PDAC model. This platform offers a practical tool for reproducible small-animal HIFU studies and highlights the potential of ultrasound-based tumor ablation as a strategy to address unmet therapeutic needs in pancreatic cancer.
Purpose To perform a series of microwave ablation phantom heating experiments while monitoring the temperature with microwave tomography and to assess whether the heating patterns differ when the HeatSYNC gel is positioned close to the microwave ablation device.Materials and methods The heating proceeded over 10 minutes with a cooling period of 5 minutes afterwards. Data was acquired at 10 second intervals in 0.5 second snap shots. The images were reconstructed off-line using our fast, discrete dipole approximation-based algorithm. The study was repeated for the case with just the microwave ablation antenna embedded in an agar gel and afterwards in a similar gel but with two thin cylinders of HeatSYNCTM gel positioned next to the antenna. The HeatSYNCTM gel is a protein-based formulation that is designed to absorb electromagnetic energy. The gel is developed to enhance the performance of thermal ablation of large tumors. its high conductivity acts to direct more of the heating towards it and away from the opposite side of the ablation antenna. The purpose of the gel is to enable the technician to tailor the heating and ablation patterns to larger and specific tumor configurations.Results The results show good correlation between the recovered microwave images and the associated temperature rises. It also shows expected changes to the heating patterns for the case when the HeatSYNC gel is placed close to the microwave ablation device.Conclusions These pilot results demonstrate that the microwave imaging is capable of recovering accurate property distributions that reflect the heating patterns. It also shows that the HeatSYNCTM gel has the desired effect on the heating pattern and the results are consistent with previous simulation investigations.
OBJECTIVE:Non-surgical treatments for benign thyroid nodules (BTN) have shown variable effects across different outcome domains, but randomized comparative evidence remains fragmented, particularly regarding both structural efficacy and thyroid function effects. This study aimed to compare available non-surgical interventions for nodule volume and thyroid function parameters using a Bayesian network meta-analysis. METHODS:PubMed, Embase, Web of Science, and Cochrane Library were searched through August 17, 2025. RCTs evaluating levothyroxine (L-T4), radiofrequency ablation (RFA), microwave ablation (MWA), percutaneous ethanol injection (PEI), or percutaneous laser ablation (PLA) in adults with BTN were included. Outcomes were nodule volume, TSH, FT3, and FT4. Bayesian random-effects network meta-analysis used R Studio (gemtc) and STATA; rankings employed SUCRA. RESULTS:Fourteen RCTs (545 participants) were included. For nodule volume, PLA (WMD≈-5.23, 95% CI: -8.26 to -2.15) and RFA (WMD≈-4.11, 95% CI: -6.19 to -2.38) were superior to L-T4 and placebo. L-T4 showed strongest TSH suppression (vs. MWA: WMD≈-1.59, 95% CI: -2.42 to -0.79). No significant differences were observed for FT3 or FT4. CONCLUSIONS:Within the available randomized evidence base, non-surgical treatments for BTN showed outcome-specific differences. Thermal ablation techniques, particularly PLA and RFA, were associated with greater reductions in nodule volume, whereas levothyroxine showed the strongest effect on TSH suppression. However, because the network was largely built on historical comparators and did not include several key patient-centered clinical outcomes, the applicability of these findings to current practice remains limited. Further head-to-head trials comparing contemporary minimally invasive treatments are needed.
Purpose To evaluate the 2-year nodule volume reduction rate (VRR), recurrence rate, and safety of ultrasound-guided microwave ablation (MWA) for benign thyroid nodules with different compositions, and to identify independent risk factors affecting therapeutic outcomes.Methods A single-center retrospective cohort study was conducted on 508 benign thyroid nodules (from 462 patients) treated with MWA between January 2018 and December 2023. Nodules were categorized as solid (G1), predominantly solid (G2), or predominantly cystic (G3). VRR, recurrence, and complications were assessed at 1, 3, 6, 12, and 24 months post-ablation. Multivariate regression and Kruskal-Wallis tests were used for statistical analysis.Results A significant interaction between follow-up duration and nodule composition was observed for VRR (p < 0.001). At 24 months, the overall median VRR was 86.02%, with G3 (92.46%) significantly higher than G1 (84.32%) and G2 (85.55%) (p < 0.001). The 2-year recurrence rate was 2.56% (G1: 3.35%, G3: 0%), and the overall complication rate was 7.48% (G1: 14.50% > G3: 6.36%, p = 0.028). Multivariate analysis identified nodule composition as an independent predictor of VRR (β = 0.783, p < 0.001) and recurrence (OR = 4.21, p = 0.005), while a maximum nodule diameter >60 mm was a recurrence risk factor (OR = 3.87, p = 0.020). Higher ablation parameters in G1 correlated with increased complications (p < 0.05).Conclusion Ultrasound-guided MWA is effective and safe for benign thyroid nodules, with cyst-dominant nodules demonstrating the best prognosis. Nodule composition is a core determinant of efficacy and recurrence, and higher ablation parameters are associated with increased complication risks.
BACKGROUND:Desmoid tumor (DT) is a rare, locally invasive soft tissue tumor that does not metastasize but has a high recurrence rate after surgery. DTs can be divided into three types: abdominal wall, intra-abdominal and extra-abdominal DTs. The primary treatment options for abdominal wall DT include active surveillance (AS) and surgical resection. However, many patients experience progression during AS, whereas surgical resection carries a high risk of recurrence. Therefore, an effective, noninvasive and safe local treatment method is currently needed in clinical practice. METHODS:This study included all patients with abdominal wall DT treated by high-intensity focused ultrasound (HIFU) at the Oncology Department of the Second Affiliated Hospital of Zhejiang University School of Medicine from July 2015 to May 2023. Thermal ablation of the abdominal wall DT was conducted using focused ultrasound beams. Following tumor ablation, treatment outcomes were evaluated for all patients. RESULTS:A total of 55 abdominal wall DT cases underwent HIFU treatment, including 46 and 9 initial and recurrent tumors, respectively. The median follow-up time was 58 months. The median ablation rate for all patients after 1 month of HIFU treatment was 61%. The objective response rate (ORR) and disease control rate (DCR) were 82% (45/55) and 98% (54/55), respectively. Based on disease course, ORRs were 87% and 56% in treatment-naïve patients and re-treated patients, respectively. CONCLUSION:HIFU demonstrates a high DCR for abdominal wall DT with few side effects, representing an effective treatment, especially for treatment-naïve patients.
BACKGROUND:Pancreatic cancer remains largely refractory to immune checkpoint inhibitors. High-intensity focused ultrasound (HIFU) may modulate the immunosuppressive tumor microenvironment via immunogenic cell death, yet clinical evidence on HIFU combined with programmed cell death protein 1 (PD-1) inhibitors in elderly patients is scarce. METHODS:This single-center retrospective study enrolled 13 elderly (≥60 years) patients with advanced pancreatic cancer receiving HIFU plus PD-1 inhibitors (January 2017-December 2024). The primary outcome was safety; secondary outcomes included pain relief (numerical rating scale [NRS]; a decrease of ≥2 points considered clinically meaningful), disease control (RECIST 1.1), progression-free survival (PFS), and overall survival (OS). Exploratory analyses comprised a composite risk score (high-sensitivity C-reactive protein, albumin, and CA19-9) and peripheral immune profiling. RESULTS:Median age was 68.0 years; 76.9% had stage IV disease and 61.5% had received ≥2 prior lines of systemic therapy. HIFU-related adverse events occurred in 46.2% (predominantly grade 1-2) and PD-1-related events in 15.4%; no treatment-related deaths occurred. Clinically meaningful pain relief was achieved in 76.9% of patients (10/13; p = 0.0016), with a median NRS reduction of 3.0 points (IQR: 2.0-3.0). Disease control rates were 75.0% (9/12) in the evaluable and 69.2% (9/13) in the intention-to-treat population. Median PFS was 3.2 months (95% CI: 1.9-3.9) and median OS was 3.7 months (95% CI: 2.1-7.2). CONCLUSIONS:In this small cohort of elderly, heavily pretreated patients with advanced pancreatic cancer, HIFU combined with PD-1 inhibitors showed a manageable safety profile and notable pain relief. Prospective validation in larger studies is warranted.
Objective To compare the effects of high-intensity focused ultrasound (HIFU) ablation and laparoscopic myomectomy on ovarian function and endometrial receptivity in patients with uterine fibroids.Materials and methods In this prospective, non-randomized cohort study, 60 patients with uterine fibroids were either treated with HIFU (n = 30) or laparoscopic myomectomy (n = 30) based on patient preference after standardized counseling. Ovarian function and endometrial receptivity were evaluated preoperatively and at 1, 3, and 6 months post‑treatment. Ovarian reserve was assessed using anti‑Müllerian hormone (AMH), sex hormone levels of luteinizing hormone (LH), follicle‑stimulating hormone (FSH), estradiol (E2), and antral follicle count (AFC). Endometrial receptivity was evaluated using endometrial thickness and vascular indices, including endometrial artery resistance index (RI), pulsatility index (PI), and the systolic/diastolic velocity ratio (S/D).Results Regarding endometrial receptivity, the HIFU group exhibited significantly greater endometrial thickness at the 1‑month follow‑up compared to the laparoscopic group (mean difference: 1.5 mm, 95% CI: 0.6 to 2.4 mm; Cohen’s d = 0.72, p < 0.05). Both groups showed a reduction in PI after treatment, though the change was not statistically significant. RI and S/D ratios were comparable between the two groups at any time point (p > 0.05).Conclusions Both HIFU and laparoscopic myomectomy preserved ovarian function in patients with uterine fibroids. HIFU was associated with faster short-term endometrial recovery at 1 month post-treatment, but no differences in ovarian function or other receptivity markers were observed between the two groups of patients. Randomized trials with pregnancy outcomes are needed before clinical recommendations can be made.
BACKGROUND:Microwave ablation (MWA) has emerged as a minimally invasive alternative to surgery for selected patients with low-risk papillary thyroid carcinoma (PTC). While thyroid autoimmunity is frequently observed in PTC, the impact of preoperative thyroid autoantibodies (TAb) on post-ablation absorption kinetics remains unclear. METHODS:This retrospective study included 150 patients with PTC who underwent MWA between December 2019 and December 2024 with a median follow-up of 18 months (range: 6-54 months). Patients were categorized according to preoperative thyroid autoantibody status. Volume reduction rate, complete absorption rate, tumor recurrence rate, incidence of new nodules, and thyroid function were evaluated during follow-up. Kaplan-Meier analysis and Cox proportional hazards regression were used to assess factors associated with time to complete absorption. RESULTS:During follow-up, ablation zone volume gradually decreased in all patients, but absorption was significantly slower in TAb-positive patients. The TAb-positive group exhibited a longer median time to complete absorption than the TAb-negative group (median: 30 vs. 19 months; log-rank p = 0.01). Subgroup analyses demonstrated that preoperative thyroglobulin antibody (TgAb) positivity, but not thyroid peroxidase antibody (TPOAb) positivity, was significantly associated with delayed absorption. TgAb positivity remained independently associated in multivariate Cox analysis (adjusted hazard ratio = 0.27; 95% confidence interval: 0.09-0.78; p = 0.015). No malignant recurrence occurred. TPOAb-positive patients showed a higher incidence of newly detected benign nodules. Thyroid function remained stable throughout follow-up. CONCLUSIONS:Preoperative TgAb positivity is associated with delayed absorption of the ablation zone after MWA for PTC without compromising treatment completeness.
Background/Objective Histotripsy is a novel non-thermal, noninvasive, non-ionising ablation modality that is under investigation for the treatment of renal cell carcinoma (RCC). Histotripsy utilizes a focused ultrasound transducer that creates high peak negative pressures at a focal point to cause cavitation in tissue. The rapid expansion and collapse of endogenous gas bubbles mechanically destroy targeted tissue while sparing collagen-containing critical structures such as the renal pelvis and ureter. This review aims to prepare physicians for the clinical translation of cavitation histotripsy for the treatment of RCC by introducing the basic principles, tissue effects, and results of ex vivo and live animal studies.Methods This review synthesizes the current literature on cavitation histotripsy for RCC. Special emphasis is placed on the differences between histotripsy and current minimally invasive ablative modalities, the potential of histotripsy for managing kidney tumors, a comprehensive review of preclinical studies, and preliminary findings from early human clinical trials.Results Preclinical studies have demonstrated that histotripsy can effectively ablate target tissue while sparing nearby critical structures. Histotripsy is not limited by heat-sink effects and may have a reduced risk of off-target damage due to its tissue-selective properties.Conclusion Histotripsy is currently in clinical trials for use in treating RCC. Ongoing clinical trials, CAIN and HOPE4KIDNEY, will provide critical data on the efficacy, potential complications, and limitations of histotripsy for treating RCC.
OBJECTIVE:Microwave ablation (MWA) is a minimally invasive therapy for liver metastases. Image guidance, primarily ultrasound (US) and computed tomography (CT), is critical for precision, but their comparative safety profiles remain debated. This study aims to compare the incidence and severity of complications between US-guided and CT-guided MWA in patients with liver metastases. METHODS:After propensity score matching (PSM), retrospective analysis of 120 patients (2022-2024) undergoing US-guided (n = 60) or CT-guided (n = 60) MWA at a single tertiary referral center. Complications were classified using the Clavien-Dindo system. Statistical analysis included Student's t test, χ2 tests, and logistic regression. RESULTS:Major complications (Clavien-Dindo ≥ III) occurred in 5% of US-guided vs. 13.3% of CT-guided cases (p = 0.04). US guidance correlated with fewer pneumothoraxes (0% vs. 8.3%, p = 0.02) and reduced radiation exposure (p < 0.001). There was no statistically significant difference in the 12-month local tumor progression (LTP) rate between the two groups (p = 0.79). CONCLUSION:US-guided MWA demonstrates comparable tumor control to CT guidance with fewer complications and avoids radiation exposure, supporting its preferential use for high-risk patients.
OBJECTIVE:To systematically evaluate the efficacy of doxorubicin (DOX)-loaded graphene nanoplatform chemo-photothermal therapy (CPT) compared with photothermal therapy (PTT) alone on relative tumor volume (RTV) in breast cancer xenograft models and to summarize reported secondary safety and translational endpoints. METHODS:PubMed, Embase, Web of Science, and Cochrane Library were searched for animal studies published from January 2010 to December 2025 investigating DOX-loaded graphene nanomaterial-mediated CPT in breast cancer xenograft tumors. Hedges' g was used as the effect size measure, and standardized mean differences (SMDs) were pooled using a random-effects model. Heterogeneity, publication bias, subgroup analyses, sensitivity analyses, and qualitatively reported secondary endpoints were assessed. RESULTS:Nine breast cancer xenograft studies were included, involving 46 animals in the CPT group and 46 in the PTT group. The pooled SMD was -2.20 (95% CI: -2.76 to -1.65, p < 0.0001), with negligible heterogeneity (I2 = 0.0%). Subgroup analyses showed no statistically significant differences by cell line, graphene type, or publication period (all p > 0.05). Leave-one-out sensitivity analyses yielded pooled SMDs from -2.09 to -2.37. Funnel plot inspection and Egger's test suggested mild small-study asymmetry, but Trim-and-Fill correction did not change the direction or significance of the result. Secondary endpoint extraction showed limited survival, toxicity, biodistribution, and clearance reporting, supporting short-term tolerability but not definitive clinical translation. CONCLUSION:DOX-loaded graphene nanoplatform CPT was associated with significantly greater suppression of RTV than PTT alone in breast cancer xenograft models. The evidence supports a robust preclinical antitumor association while highlighting the need for standardized survival, long-term toxicity, biodistribution, and elimination studies before clinical application.
BACKGROUND:Since its introduction in 2010, Ultrasound-guided High-Intensity Focused Ultrasound (USgHIFU) has rapidly expanded in South Korea, despite the absence of widely accepted standardized clinical protocols. This study evaluated the long-term clinical outcomes of USgHIFU and proposed a standardized MRI-integrated treatment framework incorporating MRI-based planning, treatment verification, and structured follow-up. METHODS:In this retrospective analysis, we included 2,992 patients (1,620 with uterine fibroids and 1,372 with adenomyosis) treated with USgHIFU between 2010 and 2025. Therapeutic efficacy was assessed using non-perfused volume (NPV) ratio, volume reduction rates (VRR), and reintervention rates. Long-term durability, defined as freedom from reintervention, was evaluated using Kaplan-Meier analysis in 476 patients with follow-up durations of 3-9.7 years. RESULTS:Immediate post-treatment contrast-enhanced MRI demonstrated a mean NPV ratio of 86.5 ± 7.2%, with 94.2% of patients achieving an NPV ratio ≥ 80%. At 12 months, the mean VRRs were 77.4% and 61.4% for fibroids and adenomyosis, respectively. In the long-term follow-up subset (n = 476), volume reduction was maintained and then increased, reaching 78.8% for fibroids and 66.3% for adenomyosis at 3-9.7 years. Freedom from reintervention was 99.1% at 12 months, 98.4% at 3 years, and 97.6% at 9.7 years. No major complications were observed after implementation of the standardized treatment framework. CONCLUSION:Standardized USgHIFU treatment, achieving an NPV ratio ≥ 80%, is associated with sustained long-term clinical outcomes and a favorable safety profile. These findings support the clinical value of a standardized MRI-integrated treatment framework and may contribute to future clinical standardization of USgHIFU practice.
