{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:36:08Z","timestamp":1787027768438,"version":"build-2736575974"},"reference-count":64,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal malignancy due to late presentation, limited resectability, therapeutic resistance, and a dense desmoplastic immunosuppressive tumor microenvironment that impairs drug penetration and antitumor immunity. Focused ultrasound (FUS) is an emerging non-invasive, image-guided therapeutic platform capable of delivering spatially confined acoustic energy to induce tumor ablation, disrupt stromal barriers, and enhance delivery of drugs, nanoparticles, and nucleic acids. Depending on acoustic parameters, FUS can produce thermal effects resulting in coagulative necrosis or non-thermal mechanical effects, including cavitation, sonoporation, and histotripsy which remodel extracellular matrix architecture, increase vascular and cellular permeability, and facilitate tumor debulking. In addition, FUS-induced cell injury can promote immunogenic cell death and release tumor-associated antigens and danger signals, providing a rationale for combination strategies with chemotherapy, radiation, and immunotherapy. This review synthesizes the mechanistic foundations, preclinical modeling advances, and emerging clinical applications of FUS in PDAC, with emphasis on treatment integration, patient selection, real-time monitoring, and acoustic parameter optimization, while acknowledging current safety considerations and limited clinical toxicity data. Key limitations, translational challenges, and priority knowledge gaps are also discussed to define the role of FUS in multimodal PDAC care.<\/jats:p>","DOI":"10.3390\/cancers18040574","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T09:16:08Z","timestamp":1770801368000},"page":"574","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Focused Ultrasound in Pancreatic Ductal Adenocarcinoma: Mechanisms, Preclinical Evidence, and Emerging Clinical Applications"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9987-7563","authenticated-orcid":false,"given":"Olivia","family":"Sears","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22904, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7704-4365","authenticated-orcid":false,"given":"Hongji","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22904, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Blatz","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22904, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22904, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Tsung","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22904, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1001\/jama.2021.13027","article-title":"Pancreatic Cancer: A Review","volume":"326","author":"Park","year":"2021","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/S0140-6736(25)00261-2","article-title":"Pancreatic cancer","volume":"405","author":"Stoop","year":"2025","journal-title":"Lancet"},{"key":"ref_3","first-page":"e70035","article-title":"Advances in pancreatic cancer early diagnosis, prevention, and treatment: The past, the present, and the future","volume":"76","author":"Mannucci","year":"2025","journal-title":"CA Cancer J. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.molmed.2023.03.002","article-title":"Fibroblasts in pancreatic cancer: Molecular and clinical perspectives","volume":"29","author":"Rebelo","year":"2023","journal-title":"Trends Mol. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"De Grandis, M.C., Ascenti, V., Lanza, C., Di Paolo, G., Galassi, B., Ierardi, A.M., Carrafiello, G., Facciorusso, A., and Ghidini, M. (2023). Locoregional Therapies and Remodeling of Tumor Microenvironment in Pancreatic Cancer. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241612681"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3748\/wjg.v29.i2.223","article-title":"Irreversible electroporation for the management of pancreatic cancer: Current data and future directions","volume":"29","author":"Spiliopoulos","year":"2023","journal-title":"World J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1200\/JCO.2016.67.5561","article-title":"Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline","volume":"34","author":"Balaban","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.pan.2023.11.013","article-title":"Novel treatment system using endoscopic ultrasound-guided high-intensity focused ultrasound: A proof-of-concept study","volume":"24","author":"Ashida","year":"2024","journal-title":"Pancreatology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"904","DOI":"10.3748\/wjg.v26.i9.904","article-title":"Magnetic resonance imaging biomarkers for pulsed focused ultrasound treatment of pancreatic ductal adenocarcinoma","volume":"26","author":"Maloney","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Farmer, W., Hannon, G., Ghosh, S., and Prina-Mello, A. (2022). Thermal ablation in pancreatic cancer: A scoping review of clinical studies. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.1066990"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1016\/j.ultrasmedbio.2024.06.013","article-title":"High-Intensity Focused Ultrasound Ablation Combined With Pharmacogenomic-Guided Chemotherapy for Advanced Pancreatic Cancer: Initial Experience","volume":"50","author":"Ran","year":"2024","journal-title":"Ultrasound Med. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2987","DOI":"10.1109\/TUFFC.2021.3078094","article-title":"Histotripsy Ablation Alters the Tumor Microenvironment and Promotes Immune System Activation in a Subcutaneous Model of Pancreatic Cancer","volume":"68","author":"Sereno","year":"2021","journal-title":"IEEE Trans. Ultrason. Ferroelectr. Freq. Control"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"8532","DOI":"10.1038\/s41598-024-54432-y","article-title":"Power-Doppler-based NH002 microbubble sonoporation with chemotherapy relieves hypoxia and enhances the efficacy of chemotherapy and immunotherapy for pancreatic tumors","volume":"14","author":"Wu","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2247187","DOI":"10.1080\/02656736.2023.2247187","article-title":"Ultrasound-guided noninvasive pancreas ablation using histotripsy: Feasibility study in an in vivo porcine model","volume":"40","author":"Gannon","year":"2023","journal-title":"Int. J. Hyperth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.4049\/jimmunol.1901430","article-title":"Focused Ultrasound for Immunomodulation of the Tumor Microenvironment","volume":"205","author":"Joiner","year":"2020","journal-title":"J. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"7884","DOI":"10.7150\/thno.73218","article-title":"Multiomic analysis for optimization of combined focal and immunotherapy protocols in murine pancreatic cancer","volume":"12","author":"Wang","year":"2022","journal-title":"Theranostics"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"16480","DOI":"10.3748\/wjg.v20.i44.16480","article-title":"High intensity focused ultrasound: A noninvasive therapy for locally advanced pancreatic cancer","volume":"20","author":"Wu","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2295812","DOI":"10.1080\/02656736.2023.2295812","article-title":"US-guided high-intensity focused ultrasound in pancreatic cancer treatment: A consensus initiative between Chinese and European HIFU centers","volume":"41","author":"Zhou","year":"2024","journal-title":"Int. J. Hyperth."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2250586","DOI":"10.1080\/02656736.2023.2250586","article-title":"Analysis of the results of high-intensity focused ultrasound for patients with advanced pancreatic cancer","volume":"40","author":"Qian","year":"2023","journal-title":"Int. J. Hyperth."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Marinova, M., Khouri, D.-A., K\u00fcppers, J., Ramig, O., Strunk, H.M., Breuers, J., Fazaal, J., Fuhrmann, C., Coenen, M., and M\u00f6hring, C. (2024). Study Protocol of a Randomized, Two-Arm, Phase I\/II Trial Investigating the Feasibility, Safety, and Efficacy of Local Treatment with US-Guided High-Intensity Focused Ultrasound in Combination with Palliative Chemotherapy in Inoperable Pancreatic Cancer. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133717"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1080\/02656736.2021.1962550","article-title":"Systematic review and trial sequential analysis of high-intensity focused ultrasound combined with chemotherapy versus chemotherapy in the treatment of unresectable pancreatic ductal adenocarcinoma","volume":"38","author":"Guo","year":"2021","journal-title":"Int. J. Hyperth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.3748\/wjg.v28.i13.1288","article-title":"Locoregional therapies and their effects on the tumoral microenvironment of pancreatic ductal adenocarcinoma","volume":"28","author":"Lambin","year":"2022","journal-title":"World J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Mouratidis, P.X.E., and Ter Haar, G. (2022). Latest Advances in the Use of Therapeutic Focused Ultrasound in the Treatment of Pancreatic Cancer. Cancers, 14.","DOI":"10.3390\/cancers14030638"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1002\/mp.16622","article-title":"Sound speed and attenuation of human pancreas and pancreatic tumors and their influence on focused ultrasound thermal and mechanical therapies","volume":"51","author":"Gray","year":"2024","journal-title":"Med. Phys."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lafond, M., Lambin, T., Drainville, R.A., Dupr\u00e9, A., Pioche, M., Melodelima, D., and Lafon, C. (2022). Pancreatic Ductal Adenocarcinoma: Current and Emerging Therapeutic Uses of Focused Ultrasound. Cancers, 14.","DOI":"10.3390\/cancers14112577"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"18916","DOI":"10.1038\/s41598-019-55388-0","article-title":"Ultrasound-induced Cavitation enhances the efficacy of Chemotherapy in a 3D Model of Pancreatic Ductal Adenocarcinoma with its microenvironment","volume":"9","author":"Leenhardt","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3738","DOI":"10.1158\/0008-5472.CAN-15-0296","article-title":"Pulsed High-Intensity Focused Ultrasound Enhances Delivery of Doxorubicin in a Preclinical Model of Pancreatic Cancer","volume":"75","author":"Li","year":"2015","journal-title":"Cancer Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ultrasmedbio.2025.07.026","article-title":"Non-Invasive Pancreas Ablation Using Histotripsy: Pre-clinical Safety Study in an In Vivo Porcine Model","volume":"52","author":"Gannon","year":"2026","journal-title":"Ultrasound Med. Biol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"107861","DOI":"10.1016\/j.ultras.2025.107861","article-title":"Comparison of mechanical and thermal effects of focused ultrasound on drug delivery efficiency and toxicity for pancreatic cancer treatment","volume":"159","author":"Kim","year":"2025","journal-title":"Ultrasonics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1109\/TUFFC.2025.3596530","article-title":"Development of an Endoscopic Ultrasound Device for Delivering Microbubble-Mediated Cavitation in the Pancreas: Characterization and Preclinical In-Vivo Results","volume":"72","author":"Rohfritsch","year":"2025","journal-title":"IEEE Trans. Ultrason. Ferroelectr. Freq. Control"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1016\/j.ultrasmedbio.2014.01.007","article-title":"Passive Cavitation Detection during Pulsed HIFU Exposures of Ex Vivo Tissues and In Vivo Mouse Pancreatic Tumors","volume":"40","author":"Li","year":"2014","journal-title":"Ultrasound Med. Biol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3046","DOI":"10.1016\/j.ultrasmedbio.2020.07.019","article-title":"Synergistic Effects of Pulsed Focused Ultrasound and a Doxorubicin-Loaded Microparticle\u2013Microbubble Complex in a Pancreatic Cancer Xenograft Mouse Model","volume":"46","author":"Kang","year":"2020","journal-title":"Ultrasound Med. Biol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3710","DOI":"10.1007\/s00330-018-5355-9","article-title":"In vivo study of enhanced chemotherapy combined with ultrasound image-guided focused ultrasound (USgFUS) treatment for pancreatic cancer in a xenograft mouse model","volume":"28","author":"Park","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e202507388","DOI":"10.1002\/anie.202507388","article-title":"Ultrasound-Responsive Lipid Nanosonosensitizers with Size Reduction and NO Release: Synergistic Sonodynamic-Chemo-Immunotherapy for Pancreatic Tumors","volume":"64","author":"Fang","year":"2025","journal-title":"Angew. Chem. Int. Ed."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"11873","DOI":"10.1021\/acsami.4c21975","article-title":"Acoustically Driven Hybrid Nanocrystals for In Vivo Pancreatic Cancer Treatment","volume":"17","author":"Conte","year":"2025","journal-title":"ACS Appl. Mater. Interfaces"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"TPS777","DOI":"10.1200\/JCO.2023.41.4_suppl.TPS777","article-title":"Sonoporation for disrupting the pancreatic cancer microenvironment to enhance chemotherapy delivery and improve outcomes","volume":"41","author":"Posey","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e34684","DOI":"10.1097\/MD.0000000000034684","article-title":"The dose of focused ultrasound ablation surgery (FUAS) for unresectable pancreatic cancer is predictable: A multicenter retrospective study","volume":"102","author":"Yang","year":"2023","journal-title":"Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2620","DOI":"10.1007\/s00330-022-09271-8","article-title":"Combination of chemotherapy and focused ultrasound for the treatment of unresectable pancreatic cancer: A proof-of-concept study","volume":"33","author":"Lee","year":"2022","journal-title":"Eur. Radiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"106993","DOI":"10.1016\/j.ultras.2023.106993","article-title":"Chronic effects of pulsed high intensity focused ultrasound aided delivery of gemcitabine in a mouse model of pancreatic cancer","volume":"132","author":"Khokhlova","year":"2023","journal-title":"Ultrasonics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1080\/15384047.2021.1881026","article-title":"Selecting the optimal parameters for sonoporation of pancreatic cancer in a pre-clinical model","volume":"22","author":"Schultz","year":"2021","journal-title":"Cancer Biol. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/978-1-4939-9798-5_9","article-title":"Sonoporation for Augmenting Chemotherapy of Pancreatic Ductal Adenocarcinoma","volume":"Volume 2059","author":"Castle","year":"2020","journal-title":"Drug Delivery Systems"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"20210266","DOI":"10.1098\/rsif.2021.0266","article-title":"Pulsed focused ultrasound can improve the anti-cancer effects of immune checkpoint inhibitors in murine pancreatic cancer","volume":"18","author":"Mouratidis","year":"2021","journal-title":"J. R. Soc. Interface"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e003717","DOI":"10.1136\/jitc-2021-003717","article-title":"Combination of ultrasound-based mechanical disruption of tumor with immune checkpoint blockade modifies tumor microenvironment and augments systemic antitumor immunity","volume":"10","author":"Abe","year":"2022","journal-title":"J. Immunother. Cancer"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"112842","DOI":"10.1016\/j.jphotobiol.2024.112842","article-title":"Evaluation of the cytotoxic and immunomodulatory effects of sonodynamic therapy in human pancreatic cancer spheroids","volume":"251","author":"Foglietta","year":"2024","journal-title":"J. Photochem. Photobiol. B"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Coppola, A., Grasso, D., Fontana, F., Piacentino, F., Minici, R., Lagan\u00e0, D., Ierardi, A.M., Carrafiello, G., D\u2019Angelo, F., and Carcano, G. (2023). Innovative Experimental Ultrasound and US-Related Techniques Using the Murine Model in Pancreatic Ductal Adenocarcinoma: A Systematic Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12247677"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s00261-021-03334-y","article-title":"A meta-analysis evaluating the role of high-intensity focused ultrasound (HIFU) as a fourth treatment modality for patients with locally advanced pancreatic cancer","volume":"47","author":"Fergadi","year":"2022","journal-title":"Abdom. Radiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e23922","DOI":"10.1097\/MD.0000000000023922","article-title":"Stent insertion with high-intensity focused ultrasound ablation for malignant biliary obstruction: A protocol of systematic review and meta-analysis","volume":"100","author":"Cai","year":"2021","journal-title":"Medicine"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1097\/SLE.0000000000000327","article-title":"Combined Stent Insertion and High-intensity Focused Ultrasound Ablation for Patients With Malignant Obstructive Jaundice","volume":"26","author":"Niu","year":"2016","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1002\/cncr.32756","article-title":"Conventionally fractionated radiation therapy versus stereotactic body radiation therapy for locally advanced pancreatic cancer (CRiSP): An international systematic review and meta-analysis","volume":"126","author":"Tchelebi","year":"2020","journal-title":"Cancer"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1245\/s10434-019-07261-7","article-title":"Systematic Review of Surgical and Percutaneous Irreversible Electroporation in the Treatment of Locally Advanced Pancreatic Cancer","volume":"26","author":"Moris","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00464-024-11450-1","article-title":"Radiofrequency ablation (RFA) in unresectable pancreatic adenocarcinoma: Meta-analysis & systematic review","volume":"39","author":"Birrer","year":"2025","journal-title":"Surg. Endosc."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1097\/RLI.0000000000000080","article-title":"Magnetic Resonance\u2013Guided High-Intensity Focused Ultrasound Treatment of Locally Advanced Pancreatic Adenocarcinoma: Preliminary Experience for Pain Palliation and Local Tumor Control","volume":"49","author":"Anzidei","year":"2014","journal-title":"Investig. Radiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1080\/02656736.2020.1782999","article-title":"Feasibility study of MR-guided pancreas ablation using high-intensity focused ultrasound in a healthy swine model","volume":"37","author":"Sebeke","year":"2020","journal-title":"Int. J. Hyperth."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Dahiya, D.S., Chandan, S., Ali, H., Pinnam, B.S.M., Gangwani, M.K., Al Bunni, H.A., Canakis, A., Gopakumar, H., Vohra, I., and Bapaye, J. (2023). Role of Therapeutic Endoscopic Ultrasound in Management of Pancreatic Cancer: An Endoscopic Oncologist Perspective. Cancers, 15.","DOI":"10.3390\/cancers15123235"},{"key":"ref_55","first-page":"3839","article-title":"Effects of high-intensity focused ultrasound treatment on peripancreatic arterial and venous blood vessels in pancreatic cancer","volume":"19","author":"Guo","year":"2020","journal-title":"Oncol. Lett."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Cilleros, C., Dupr\u00e9, A., Chen, Y., Vincenot, J., Rivoire, M., and Melodelima, D. (2021). Intraoperative HIFU Ablation of the Pancreas Using a Toroidal Transducer in a Porcine Model. The First Step towards a Clinical Treatment of Locally Advanced Pancreatic Cancer. Cancers, 13.","DOI":"10.3390\/cancers13246381"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1002\/jum.16181","article-title":"High Intensity Focused Ultrasound Ablation for Patients With Locally Advanced Pancreatic Adenocarcinoma: A Propensity Score-Matching Analysis","volume":"42","author":"Ning","year":"2023","journal-title":"J. Ultrasound Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1097\/SLE.0000000000000918","article-title":"Stent Insertion With High Intensity\u2013Focused Ultrasound Ablation for Biliary Obstruction Caused by Pancreatic Carcinoma: A Randomized Controlled Trial","volume":"31","author":"Zhang","year":"2021","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e19099","DOI":"10.1097\/MD.0000000000019099","article-title":"Stent insertion with high-intensity focused ultrasound ablation for distal biliary obstruction secondary to pancreatic carcinoma","volume":"99","author":"Yang","year":"2020","journal-title":"Medicine"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"540","DOI":"10.7150\/thno.49517","article-title":"Boiling histotripsy and in-situ CD40 stimulation improve the checkpoint blockade therapy of poorly immunogenic tumors","volume":"11","author":"Singh","year":"2021","journal-title":"Theranostics"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"5773","DOI":"10.1038\/s41467-025-60927-7","article-title":"Engineering STING Nanoadjuvants for spatiotemporally-tailored innate immunity stimulation and cancer vaccination therapy","volume":"16","author":"Chen","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1093\/jnci\/djt305","article-title":"Enhanced tumor uptake and penetration of virotherapy using polymer stealthing and focused ultrasound","volume":"105","author":"Carlisle","year":"2013","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1016\/j.ultrasmedbio.2025.03.010","article-title":"Ultrasound and Microbubble Mediated Delivery of Virus-Sensitizing Drugs Improves In Vitro Oncolytic Virotherapy Against Breast Cancer Cells","volume":"51","author":"Italiya","year":"2025","journal-title":"Ultrasound Med. Biol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"104076","DOI":"10.1016\/j.jtherbio.2025.104076","article-title":"Optimizing thermal dose prediction in nanoparticle-mediated photothermal therapy using a convolutional neural network-based model","volume":"128","author":"Shirisha","year":"2025","journal-title":"J. Therm. Biol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/4\/574\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T09:35:43Z","timestamp":1770802543000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/4\/574"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":64,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["cancers18040574"],"URL":"https:\/\/doi.org\/10.3390\/cancers18040574","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]}}}