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Fig 1.

Consort participant flow diagram.

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Fig 2.

Specific time of immunotherapy.

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Table 1.

Patients’ characteristics and baseline demographics.

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Table 2.

Supplementary baseline for clinical characteristics of patients with liver metastases.

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Fig 3.

The real-time ultrasound image obtained from two patients with liver metastases.

(A) shows the overall grayscale change: the gradient grayscale increases; (B) shows the Massive grayscale change: the area around the focal point quickly and noticeably grays and brightens grayscale We categorized grayscale changes into two types: overall grayscale changes and massive grayscale changes [1]. Overall grayscale change refers to a gradual increase in grayscale around the focal point, while massive grayscale change indicates an immediate and significant diffuse increase in grayscale in the focal area. However, there is no standard for grayscale changes in HIFU treatment for malignant tumors. Clinically, grayscale changes for malignant tumors are typically assessed based on the standard of grayscale changes in HIFU treatment for uterine fibroids.

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Table 3.

Workflow for HIFU treatment of liver metastases.

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Table 4.

Adverse events (definitely, possibly, or probably) associated with HIFU treatment and immunotherapy (n = 14).

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Table 5.

Recording of pain scores.

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Fig 4.

Waterfall plot for the optimal percentage change in all target lesions.

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Table 6.

Assessment of best overall response following HIFU ablation combined with immunotherapy according to RESIST 1.1.

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