In vivo study of enhanced chemotherapy combined with ultrasound image-guided focused ultrasound (USgFUS) treatment for pancreatic cancer in a xenograft mouse model

Objectives This study was designed to investigate whether focused ultrasound (FUS) treatment with a higher mechanical index (MI) can enhance the effects of combined chemotherapy more than with a lower MI, and to evaluate the feasibility of the chemotherapy combined with FUS at a higher MI as an alternative treatment protocol. Methods Mice in the first study were divided into six groups: control, chemotherapy only (GEM), two groups treated with FUS only at two different MIs, and two groups treated with chemotherapy and FUS (GEM + FUS). Mice were treated with a single-session treatment; one session consisted of three weekly treatments and 1 week of follow-up monitoring. In the second study, mice were assigned to two groups (GEM, GEM + FUS) and treated with four treatment sessions. Results In the single-session treatment, tumor growth was most effectively suppressed in GEM + FUS group with a higher MI. Tumor growth rate was significantly lower in GEM + FUS group than in GEM group for multiple-session treatment. Specifically, three of ten mice in GEM + FUS group showed complete remission. Conclusions This study demonstrated that FUS at a higher MI can enhance chemotherapy outcomes more than at a lower MI and demonstrated the potential of FUS in combination with chemotherapy as a new cancer treatment protocol. Key points • Combined treatment of chemotherapy and focused ultrasound can effectively suppress tumor growth. • For the focused ultrasound treatment conditions used in this study, focused ultrasound with relatively higher mechanical index shows more enhanced therapeutic outcomes than with the lower mechanical index. • Combination therapy shows the possibility as a new cancer treatment protocol.