Focused tandem shock waves in water and their potential application in cancer treatment

The generator of two focused successive (tandem) shock waves (FTSW) in water produced by underwater multichannel electrical discharges at two composite electrodes, with a time delay between the first and second shock waves of 10  $\upmu $ s, was developed. It produces, at the focus, a strong shock wave with a peak positive pressure of up to 80 MPa, followed by a tensile wave with a peak negative pressure of up to $-80$  MPa, thus generating at the focus a large amount of cavitation. Biological effects of FTSW were demonstrated in vitro on hemolysis of erythrocytes and cell viability of human acute lymphoblastic leukemia cells as well as on tumor growth delay ex vivo and in vivo experiments performed with B16 melanoma, T-lymphoma, and R5-28 sarcoma cell lines. It was demonstrated in vivo that FTSW can enhance antitumor effects of chemotherapeutic drugs, such as cisplatin, most likely due to increased permeability of the membrane of cancer cells induced by FTSW. Synergetic cytotoxicity of FTSW with sonosensitive porphyrin-based drug Photosan on tumor growth was observed, possibly due to the cavitation-induced sonodynamic effect of FTSW.