Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is a prevalent type of primary liver cancer and one of the leading causes of cancer-related mortality worldwide. Antivascular Ultrasound (AVUS) is a novel therapy approach that utilizes the mechanical and thermal interactions between ultrasound and microbubbles to disrupt tumor vasculature or potentiate effects of chemotherapy or radiation therapy in a dose-dependent fashion. In this review, we aim to illustrate the mechanisms of AVUS, focusing on the preclinical and clinical evidence of AVUS applications in HCC. METHODS: Peer-reviewed publications pertaining to the use of AVUS in HCC were collected and analyzed. RESULTS: 12 preclinical studies and 1 clinical trial were analyzed. At lower energy levels, AVUS can enhance tumor perfusion, facilitating the delivery of chemotherapy agents and resulting in improved therapeutic outcomes. Conversely, at higher energy levels, AVUS can disrupt tumor perfusion, leading to ischemic damage of the tumors. Combining AVUS with other therapeutic approaches, such as chemotherapy, radiation therapy, and transarterial radioembolization (TARE), can synergistically enhance therapeutic outcomes. CONCLUSIONS: AVUS is a promising novel treatment modality for HCC. Current evidence suggests that AVUS exhibits a dose-dependent nature, making it a versatile approach that can be effectively combined with other therapeutic regimens. Further clinical studies and long-term follow-ups are needed to establish the optimal clinical protocol and safety profile of AVUS.