Tumor Treating Fields (TTFields)—A Novel Cancer Treatment Modality: Translating Preclinical Evidence and Engineering Into a Survival Benefit with Delayed Decline in Quality of Life

Effects of Intermediate Frequency (150 kHz) Electromagnetic Radiation on the Vital Organs of Female Sprague Dawley Rats

Exposure to electromagnetic radiation (EMR) from intermediate frequency sources has increased exponentially in recent years. The consequences of this exposure on biological systems are prompting scientists to study the effects on human health. This current study aimed to determine the effects of intermediate frequency (150 kHz) EMR exposure on the vital organs of female Sprague Dawley rats. The EMR group (n = 10 animals) was exposed to a frequency of 150 kHz with an intensity of 65 ± 15 μW/cm2 for two months. The control group (n = 10 animals) was exposed to an intensity of 35 ± 15 nW/cm2. Haematological, histochemical, gross, and histopathological profiles of all major organs of all animals were then performed using standard procedures. All major organs generally showed no significant detectable effects in either the control or EMR groups. However, gross and histopathological examinations revealed the effects of EMR on the liver and lungs, which showed inflammatory changes without significant biochemical/haematological manifestations. In addition, a significant increase in serum sodium level and a decrease in serum urea level were also observed in the EMR group. It can be concluded that the current frequency and duration of exposure trigger the changes in the liver and lungs but are not sufficient to cause clinical and functional manifestations. Therefore, a long-term exposure study might be helpful to determine the effects of 150 kHz IF EMR on these organs.

Effects of 150 kHz intermediate frequency electromagnetic radiation on fertility indicators in male rats

Background

The present study aimed to evaluate the effects of whole-body exposure to 150 kHz Intermediate-frequency electromagnetic radiation (IF EMR) on fertility indicators of male rats since human exposure to this frequency has increased in recent years. Fourteen adult male Sprague-Dawley rats were used in this study. The rats were randomly divided into a control and an EMR group (n = 7/group). The EMR group was continuously irradiated with 150 kHz EMR for 8 weeks. Male fertility indicators, body mass, testicular mass, rectal temperature, testicular histology, histometry, sperm analysis, and serum gonadotrophic hormone levels were evaluated.

Results

The study showed no negative effect on body mass (grams) (323.78 ± 37.09 to 305.09 ± 26.36; p = 0.72), rectal temperature (Control: 34.5 °C-35.8 °C; EMR: 34.4 °C-36.1 °C; p < 0.05), and testicular histology. There were significant reductions in left and right testicular mass (1.04 ± 0.10 to 0.96 ± 0.32: p = 0.03 and 1.02 ± 0.08 to 0.96 ± 0.35 p = 0.04, respectively), interstitial cell count/1000 μm² (5.33 ± 0.56 to 4.47 ± 0.48; p = 0.01), sperm motility trajectories (p = 0.05) and sperm distal cytoplasmic droplet (%) (2.27 ± 2.28 to 6.84 ± 5.01; p = 0.05). A significant increase in follicle-stimulating hormone levels was observed (13.44 ± 6.38 IU/ml to 26.96 ± 8.07 IU/ml; p = 0.01).

Conclusions

Most male fertility parameters of rats in the present study were not affected by 8 weeks of whole-body exposure to 150 kHz EMR. However, significant decreases in testicular mass, interstitial cell count/1000 μm², sperm motility trajectories, and distal cytoplasmic droplets were observed, as well as an increase in FSH level.

Polycystic ovary rat model exposure to 150 kHz intermediate frequency: hypothalamic-pituitary-ovarian axis at the receptor, cellular, tissue, and hormone levels

INTRODUCTION

The hypothalamic-pituitary-ovarian (HPO) axis is the principal regulator of the reproductive system. The neurons in the arcuate nucleus of the hypothalamus signal the basophilic cells of the anterior pituitary to release luteinizing hormone (LH) and follicle stimulating hormone (FSH), which bind to the granulosa and theca cells of a follicle in the ovary to promote healthy follicular development. Disruption of this process at any time can lead to polycystic ovaries and, if left untreated, can lead to Polycystic Ovarian Syndrome (PCOS), one of the leading causes of infertility. A novel treatment option using 150 kHz Intermediate Frequency (IF) Electromagnetic Radiation (EMR) has been proposed to monitor the effect of this frequency during cystic development.

METHODS

To prove this, an experiment was conducted to study the effect of whole-body exposure to 150 kHz EMR for 8 weeks at receptor, cellular, tissue and hormonal levels on the HPO axis of 25 young cyclic female rats.

RESULTS

The results showed that 150 kHz EMR did not affect the histoarchitecture of neurons of arcuate nucleus of the hypothalamus of PCO-induced rats. It was also found that the number of basophilic cells of the pituitary gland was increased and the immunoreactivity of LH and FSH secretion increased. This EMR field also decreased the development of follicular cysts in the ovary and possibly increased the immunoreactivity of the LH and FSH receptors as well on the theca and granulosa cells of follicles in the ovary.

CONCLUSION

There are still many limitations to this study. If properly evaluated, the results of this experiment could help develop a new non-invasive treatment option for women with PCOS in the near future.

Patient Reported Outcome (PRO) Among High-Grade Glioma Patients Receiving TTFields Treatment: A Two Center Observational Study

Study design: A two center, observational study. Introduction: Patient reported outcome (PRO) plays an increasingly important role in the evaluation of novel therapies for tumor patients. It has been shown that tumor treating fields (TTFields) in combination with standard therapy prolong survival in high-grade glioma (hgG) patients. But critics claim that TTFields significantly impacts patients' everyday life due to side effects and average daily time on therapy (18 h) in a patient population with very limited life expectancy and high symptom burden. However, very limited data exist on PRO for TTFields treatment. Methods: This two center, observational study describes PRO of 30 hgG patients receiving TTFields in combination with chemotherapy. We introduced a device-specific questionnaire (DSQ) addressing device-specific restrictions and impact on daily live after 2 months of therapy. Additionally following questionnaires were used: EORTC (European Organization for Research and Treatment of Cancer), QLQ-30 (Quality of life of cancer patients), QLQ BN20 (Quality of life brain cancer module), QLQ FA13 (Cancer-related fatigue), and SSUK-8 (social support). Results: Surveys have been completed by 91% of enrolled patients. EORTC QLQ-30 revealed better physical, emotional, and cognitive function than social and role function of study cohort. TTFields users reported frequently on positive social support and a low level of detrimental interactions. Seventy one percent of patients felt affected in daily life due to TTFields at least 2-3 times per week up to several times per day while maintaining high therapy compliance. Most frequent device-specific restrictions were duration of therapy (74%), size (66%), and weight (70%) of the device and changing time and bonding of the transducer arrays (66%, mean duration: 43.6 min). Restrictions on exercise of hobbies/work (63%/61%), body care (71%), and sexuality/relationship (64%) were most relevant. Seventy percent would recommend TTFields to others and 67% would reuse TTFields treatment again based on their current experience. Conclusion: The study shows that although TTFields treatment frequently affects everyday life in all aspects, therapy compliance was high and 67% of patients would reconsider TTFields for themselves. We propose that findings of PRO be taken into account for medical consultation about TTFields and in future device development to deliver high-value patient-centered care.

Effects of tumor treating fields (TTFields) on glioblastoma cells are augmented by mitotic checkpoint inhibition

Tumor treating fields (TTFields) are approved for glioblastoma (GBM) therapy. TTFields disrupt cell division by inhibiting spindle fiber formation. Spindle assembly checkpoint (SAC) inhibition combined with antimitotic drugs synergistically decreases glioma cell growth in cell culture and mice. We hypothesized that SAC inhibition will increase TTFields efficacy. Human GBM cells (U-87 MG, GaMG) were treated with TTFields (200 kHz, 1.7 V/cm) and/or the SAC inhibitor MPS1-IN-3 (IN-3, 4 µM). Cells were counted after 24, 48, and 72 h of treatment and at 24 and 72 h after end of treatment (EOT). Flow cytometry, immunofluorescence microscopy, Annexin-V staining and TUNEL assay were used to detect alterations in cell cycle and apoptosis after 72 h of treatment. The TTFields/IN-3 combination decreased cell proliferation after 72 h compared to either treatment alone (−78.6% vs. TTFields, P = 0.0337; −52.6% vs. IN-3, P = 0.0205), and reduced the number of viable cells (62% less than seeded). There was a significant cell cycle shift from G1 to G2/M phase (P < 0.0001). The apoptotic rate increased to 44% (TTFields 14%, P = 0.0002; IN-3 4%, P < 0.0001). Cell growth recovered 24 h after EOT with TTFields and IN-3 alone, but the combination led to further decrease by 92% at 72 h EOT if IN-3 treatment was continued (P = 0.0288). The combination of TTFields and SAC inhibition led to earlier and prolonged effects that significantly augmented the efficacy of TTFields and highlights a potential new targeted multimodal treatment for GBM.