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Posted by rbanffy 11 hours ago

Ultrasound Cancer Treatment: Sound Waves Fight Tumors(spectrum.ieee.org)
234 points | 64 comments
CGMthrowaway 10 hours ago|
What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? 2024 meta analysis of seeding I didn't see ultrasound in there: https://pubmed.ncbi.nlm.nih.gov/39605885/

Here is a study on AEs specifically from this type of ultrasound: https://journals.plos.org/plosone/article?id=10.1371/journal...

Quote: "Cavitation detaches cancer cells/emboli from the primary site and thereby releases them into the circulation, leading to metastasis"

amypetrik8 2 hours ago||
What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body?

Welp I put it to you like this - if you DON'T use this then you have a gorillion cancer cells among which very likely one genetically predisposed to adventure throughout the body as turbocancer.

If you use this, or radiotherapy, or whatever, presumably there is just a lump of dead tissue where the cancer was, signifying at best you cured it but at worst, knocked it down - specifically if you knocked it down from a gorillion to a million cells, genereally speaking if the body has been seeded or the tumor persists - the tumor will take longer to rebuild back up where it was. The latter is manifested as another such and such months of life, making the therapy "life extending"

TaupeRanger 9 hours ago|||
We simply won’t know until they do the inevitable phase2/3 RCTs. They will need to show that this method helps people survive longer or with better quality of life than the current standard of care.
cowsandmilk 8 hours ago||
HistoSonics has studies published with 50 patients. Their upcoming study with 5000 liver patients obviously will give more information, but we already have some.

And with that said, these studies are more relevant than the top of thread linking to a review from 2011 looking at papers from 2005-2006 for ultrasound cavitation causing metastases.

observationist 7 hours ago|||
>>> ... the study found that removing the parachute prior to jumping led to a shocking increase in mortality among skydivers.

When there's a clear causal mechanism, additional research that doesn't propose a clear resolution to the underlying problem doesn't negate the clear causal mechanism. Releasing a bunch of loose cancer into the body is a clear causal mechanism, so unless you're filtering it or killing the loose cancer somehow, I'm not sure what those studies could tell you that overcomes the underlying problem. And until they address that problem, it's going to be limited to a quality of life type application - stopping the tumor from killing you now with the certainty of metastasis killing you later.

kaibee 4 hours ago|||
The thing about this kind of 'just so' story causal mechanism is that we still have to actually do the science to find out. Your body does filter and kill potentially cancerous cells all the time already. And cancer cells aren't like, some super thing that evolved to kill you specifically. My just-so story goes like this: 'the cancer cells die because they're suddenly outside of the specific bodypart that they were exploiting'. And we're probably both right, depending on the location of the cancer, the type of cancer, etc.
WalterBright 47 minutes ago||
All life, from humans to cells to chromosomes, has only one purpose - to survive. It turns out that reproduction is an effective way to survive. Also, cooperation is an effective way to survive. The cells in our bodies cooperate for survival. Sometimes cells survive better by no longer cooperating, and reproducing as fast as possible. This winds up killing the host, but the cancer cells don't know that.

And so humans evolve to enforce better cooperation among the cells.

So, no, cancer cells did not evolve to kill you. They do evolve for short term gain, however.

It's an endless struggle.

It's not unlike the struggle between civilized people and criminals.

gcanyon 4 hours ago||||
Some tumor types metastasize well, others not so much. But the article doesn't say anything about metastasis, or leaving any cells behind from the target. Rather, it talks about destroying the targeted cells entirely, leaving behind only proteins.
nradov 7 hours ago|||
So what's the problem? The vast majority of cancer treatments seek only to put the condition into remission for a while. Realistically that's often all that can be done.
thaumasiotes 6 hours ago||
Putting it into remission is basically the opposite of causing it to metastasize.
binarycrusader 2 hours ago|||
...they also appear to have been acquired by an investment group this past year:

https://www.fusfoundation.org/posts/transformational-milesto...

adamredwoods 9 hours ago|||
Chemo post-histrophy would remove any lingering cancer cells effectively. Cancer cells need lots of fuel or they stop replicating, and this is what traditional chemo is great at stopping.
makestuff 5 hours ago|||
Is the idea that you would need less chemo after the tumor is broken up to remove any remaining cancer cells versus just starting out with chemo to remove the tumor?
adamredwoods 5 hours ago||
Chemotherapy isn't always successful, and depends on the tumor's characteristics, but the idea is yes, less chemo. Histrophy is similar to resection, physically removing a tumor. I've seen chemo options for both scenarios with resectable cancers. For example, hormonal therapy is usually prescribed after resectable breast cancer, regardless of outcome. Or, chemo first to shrink the tumor, and have better surgical margins.
gamblor956 3 hours ago|||
The keto diet is also very good for this because many (but not all) cancer cells can't metabolize ketones. However recent research from Columbia Medical School suggests that it can promote metastasis.
jjtheblunt 10 hours ago|||
> What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body?

that's discussed in the article

pedalpete 9 hours ago|||
It seems they are initially focused on pancreatic cancer, which has a very low survival rate ~14% [1].

In theory, this may mean that metastisizing this tumour could destroy it in the pancreas, but allow the cells to spread to more treatable locations?

1 - https://www.canceraustralia.gov.au/cancer-types/pancreatic-c...

cowsandmilk 8 hours ago||
?? HistoSonics first target was the liver, second was kidney. Pancreas is the third organ they’ve targeted.
agumonkey 10 hours ago|||
It would not be the first therapy that may promote spread while curing the primary site. Hopefully there are measures to assess the cost / benefits.
CGMthrowaway 10 hours ago||
For sure. Goes without saying in any cancer treatment that cost/benefit is a prime consideration. Still, that will not stop me from asking the question. You can't do that analysis without the answers after all.
agumonkey 9 hours ago||
Stopping you wasn't my intent. I'm just a visitor sharing some stuff.

If any medical professional could give answers that would be neat.

candiddevmike 9 hours ago||
> The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood

Seems a little too speculatively worded, IMO.

flir 8 hours ago|||
If it was true, couldn't you get the same effect by taking a biopsy, fragmenting the cells, and injecting them back in? Like a vaccination, in fact. Somebody must have studied that approach already.
rincebrain 32 minutes ago|||
There were reports that if you inject the goo from melting the tumor into another mouse, that mouse became much more resistant to that class of tumor[1], so...

[1] - https://news.engin.umich.edu/2023/10/these-bubbles-kill-canc...

londons_explore 6 hours ago||||
I assume the immune system probably already reacts to this in a specific way. For example, a major bruise has a lot of broken up cells, but doesn't warrant a big immune response.
klipt 6 hours ago||||
Cancer immunotherapy is a whole field of research and treatment, yes.
cowsandmilk 7 hours ago|||
Major damage tends to cause a much larger immune response than a vaccination. That said, they do have therapeutic cancer vaccines that present proteins from cancer (sometimes patient-specific) with adjuvants to help stimulate the immune response.
underlipton 6 hours ago|||
Interested layman here: IIUC, immunotherapy is currently the holy grail for difficult-to-treat cancers like pancreatic. There are designer mRNA vaccines available that have ridiculous efficacy, but they must be tailored to each individual and so are extremely expensive (and are currently undergoing trials). mRNA COVID vaccines have been shown in some studies to increase the lifespan of pancreatic cancer patients. So, it's not hard for me to imagine that a treatment that gives the immune system a crack at learning to identify and destroy pancreatic cancer cells will boost survivability.

Part of the freak-out about the Trump admin's attacking of scientific research (including, especially, of mRNA research) earlier in the year is that it threatened these trials.

chaboud 9 hours ago||
I had the opportunity to meet with folks from Histosonics at a Canopy Cancer Collective (pancreas cancer focused group - https://canopycancer.org/) annual meeting a couple of years ago. They had shown very promising results (and approval) with liver cancer, and the applicability to any soft-tissue openly-addressable masses (e.g., not brains in skulls, not lungs full of air) seemed very likely, based on the physics. (Note: I'm a consumer electronics and ML engineer, not a medical devices engineer).

I'm excited to see this option become more broadly available. The ability to precisely target and illicit an inflammatory response is impressive, and Whipples are no joke.

YossarianFrPrez 10 hours ago||
Per the article, this seems even better than the headline would suggest:

> Histotripsy generally seems to stimulate an immune response, helping the body attack cancer cells that weren’t targeted directly by ultrasound. The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood. Researchers are now exploring ways to pair histotripsy with immunotherapy to amplify that effect.

jtbaker 10 hours ago||
As someone who was recently diagnosed and treated for Uveal Melanoma (get your annual eye exam and retinal scans!), and occasionally struggling with some intrusive thoughts about the potential for liver mets, reading about this treatment brought me so much joy. Bless Zhen Xu!
moralestapia 10 hours ago|
Hey, I'm curious, did you have symptoms or did you just find it by chance?
jtbaker 10 hours ago||
no symptoms. first identified the lesion a few years back and it hadn't changed over a few subsequent appointments. exam this year, it had grown a small amount 5mmx5mm to 6mmx8mm - still considered small, but the change was enough for the Drs to recommend treatment. I have been treated by Dr. Dan Gombos[1] at MD Anderson and received excellent care.

[1] https://faculty.mdanderson.org/profiles/dan_gombos.html

moralestapia 9 hours ago||
Interesting, thanks.

Best wishes!

jtbaker 3 hours ago||
Thank you!
melling 10 hours ago||
The machine has been available for a couple years to treat liver tumors. It’s available in several US cities but not widely available. It uses cavitation to destroy the tumor.

https://www.mdanderson.org/cancerwise/histotripsy-for-liver-...

snowless 6 hours ago||
Could this be applicable and available to the public within a reasonable time horizon? My mother is dealing with a brain tumor located in the pons, and no surgeons will operate because of its location, as the risk is too high. Radiation treatments have also been exhausted and have already caused some necrosis. There was another form of light-based therapy, but it is experimental and carries an incredibly high risk as well. The prognosis has never been good, but we’ve been holding out hope. At this point, treatment consists of nonstop chemotherapy.
Nevermark 3 hours ago||
Being non-invasive and incredibly precise, this could be a fantastic therapy for brain cancer treatment.

Assuming the costs of the precise powerful machines needed are not too high (this isn't anything like MRI), it could be a therapy for almost any kind of cancer tumor, and even small potential/pre-cancer tumors that are safe to remove without bothering to do a diagnosis.

0xWTF 10 hours ago||
Histotripsy means "cell pulverizing". We know disruption (pulverization or otherwise) of a tumor bed tends to incite a local inflammatory reaction, and a brisk inflammatory reaction seems to correlate with survival. So the idea here seems to be an extension of high energy ultrasound methods developed for lithotripsy (breaking up kidney stones) to disrupt tumor beds. Not something I'd want for a pre-cancerous lesion, but if it's stage 4 liver mets ... sure. Have at it.
cogman10 10 hours ago||
Due to some family stuff, this is something I've been investigating. My oncologist has said "this will probably be standard care in a few years". The results and studies around this have been excellent.

What this does better than pretty much anything else is it isolates the destruction of cells to just the target. The liver is a VERY "bleedy" organ. It has a ton of blood that flows through it which makes surgery extra hard. In fact, the not this surgery that's next best for our circumstances laparoscopic through the arteries to drop a radioactive pellet in the center of the cancer.

The non-invasive nature of this is going to be very good for the future of cancer treatment. Minimizing scaring and damage to tissue is the number 1 factor to better results.

The only reason my local oncologist does not have this machine is they are still pretty pricey.

When I first learned about this, I thought it was pseudo-science BS. It's crazy what can be done with just sound.

valcron1000 2 hours ago||
I'm unfortunately on the same situation. We made a consultation with people from Baptist Health Miami and it seems like there are several non trivial requirements for such treatment (histotripsy), like the number and location of mets. Hope that this improves in the mear future.
chiph 8 hours ago|||
I finished treatment for prostate cancer this summer. Most of my time in the x-ray machine was spent getting the alignment right. They'd take a CT scan, do some image analysis and other computations, then adjust the table some small amount before turning the beam on.

I'm curious how they do the alignment with the histotripsy machine. I would think that they could obviously do an ultrasound scan to get the gross alignment correct. But perhaps there is a CT scan afterwards that lets them make the fine alignment. It probably also helps that the liver is a much larger gland so aiming is less critical?

cogman10 7 hours ago||
I'm not sure how they do it exactly. I know just the nature of the machine is that it has a massive array of ultrasound emitters and sensors.
dr_dshiv 2 hours ago|||
> When I first learned about this, I thought it was pseudo-science BS. It's crazy what can be done with just sound.

I think we were all thinking that. Acoustic Cavitation has also been proposed as a mechanism for enabling cold fusion. https://www.science.org/doi/10.1126/science.1067589

pointbob 3 hours ago|||
Cool
doctorpangloss 3 hours ago||
Pretty pricey, yes. HistoSonics is a microcosm of the truth of healthcare spending: it is an amazing technology made by possible by deep and sophisticated capital markets. But, better health technology seems to explain more than 50% of the growth of healthcare spending since medicare (1965), meaning all of the faster-than-GDP growth people gripe about. When people talk about slowing health spending to something manageable, they are talking about not just govt not paying for things like histotrispy - not paying is a shell game, nobody chooses to not pay to save their life, and hence faster than GDP healthcare spending growth is observed everywhere in the West, not just the US. They are talking about somehow making the technology not happen altogether.
aitchnyu 2 hours ago|
Will this be applicable to belly/visceral fat? It could be wildly popular.
throwup238 1 hour ago|
Yes. There are several methods like high-intensity focused ultrasound (UltraShape and Liposonix) and the ultrasonic cavitation found in medspas.

The former is somewhat effective but based on early research shares the same problems as other active fat loss treatments: lysing the fat cells causes all the relevant hormones to get released into the bloodstream, causing reabsorption by other fat cells. It’s a very gradual process and quite expensive.

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