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Brummelhuis ISG, Crezee J, Witjes JA. Evaluation of thermal dose effect in radiofrequency-induced hyperthermia with intravesical chemotherapy for nonmuscle invasive bladder cancer. Int J Hyperthermia 2023; 40:2157498. [PMID: 36755433 DOI: 10.1080/02656736.2022.2157498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
PURPOSE In nonmuscle invasive bladder cancer (NMIBC) patients who fail standard intravesical treatment and are unfit or unwilling to undergo a radical cystectomy, radiofrequency (RF)-induced hyperthermia combined with intravesical chemotherapy (RF-CHT) has shown promising results. We studied whether higher thermal dose improves clinical NMIBC outcome. METHODS AND MATERIALS The cohort comprised 108 patients who started with RF-CHT between November 2013 and December 2019. Patients received intravesical mitomycin-C or epirubicin. Bladder hyperthermia was accomplished with an intravesical 915 MHz RF device guided by intravesical thermometry. We assessed the association between thermal dose parameters (including median temperature and Cumulative Equivalent Minutes of T50 at 43 °C [CEM43T50]) and complete response (CR) at six months for patients with (concomitant) carcinoma in situ (CIS), and recurrence-free survival (RFS) for patients with papillary disease. RESULTS Median temperature and CEM43T50 per treatment were 40.9 (IQR 40.8-41.1) °C and 3.1 (IQR 0.9-2.4) minutes, respectively. Analyses showed no association between any thermal dose parameter and CR or RFS (p > 0.05). Less bladder spasms during treatment sessions was associated with increased median temperature and CEM43T50 (adjusted OR 0.01 and 0.34, both p < 0.001). CONCLUSIONS No significant association between thermal dose and NMIBC outcome was found. Possibly thermal dose effect in patients of the current cohort exceeds a certain threshold value. On the other hand, occurrence of bladder spasms had a thermal dose limiting effect. We advise to treat patients with temperatures >40.5 °C for at least 45 min while respecting individual tolerability, including occurrence of bladder spasms.
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Affiliation(s)
- Iris S G Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johannes Crezee
- Department of Radiotherapy, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Ademaj A, Veltsista DP, Ghadjar P, Marder D, Oberacker E, Ott OJ, Wust P, Puric E, Hälg RA, Rogers S, Bodis S, Fietkau R, Crezee H, Riesterer O. Clinical Evidence for Thermometric Parameters to Guide Hyperthermia Treatment. Cancers (Basel) 2022; 14:625. [PMID: 35158893 DOI: 10.3390/cancers14030625] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/01/2023] Open
Abstract
Hyperthermia (HT) is a cancer treatment modality which targets malignant tissues by heating to 40-43 °C. In addition to its direct antitumor effects, HT potently sensitizes the tumor to radiotherapy (RT) and chemotherapy (CT), thereby enabling complete eradication of some tumor entities as shown in randomized clinical trials. Despite the proven efficacy of HT in combination with classic cancer treatments, there are limited international standards for the delivery of HT in the clinical setting. Consequently, there is a large variability in reported data on thermometric parameters, including the temperature obtained from multiple reference points, heating duration, thermal dose, time interval, and sequence between HT and other treatment modalities. Evidence from some clinical trials indicates that thermal dose, which correlates with heating time and temperature achieved, could be used as a predictive marker for treatment efficacy in future studies. Similarly, other thermometric parameters when chosen optimally are associated with increased antitumor efficacy. This review summarizes the existing clinical evidence for the prognostic and predictive role of the most important thermometric parameters to guide the combined treatment of RT and CT with HT. In conclusion, we call for the standardization of thermometric parameters and stress the importance for their validation in future prospective clinical studies.
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VilasBoas-Ribeiro I, Curto S, van Rhoon GC, Franckena M, Paulides MM. MR Thermometry Accuracy and Prospective Imaging-Based Patient Selection in MR-Guided Hyperthermia Treatment for Locally Advanced Cervical Cancer. Cancers (Basel) 2021; 13:cancers13143503. [PMID: 34298716 PMCID: PMC8303939 DOI: 10.3390/cancers13143503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Monitoring and controlling the temperature distribution combined with precise energy delivery are key components for hyperthermia treatment success. Magnetic resonance (MR) imaging is used clinically to monitor the temperature of the treated volume non-invasively. However, there are no comprehensive systematic studies on MR thermometry accuracy during deep pelvic hyperthermia, and the few investigational studies suffer from a high probability of bias due to lacking objective criteria for data inclusion. This study presents the first systematic analysis and defines an imaging-based criterion for prospective patient selection to standardize clinical MR thermometry accuracy assessments. Abstract The efficacy of a hyperthermia treatment depends on the delivery of well-controlled heating; hence, accurate temperature monitoring is essential for ensuring effective treatment. For deep pelvic hyperthermia, there are no comprehensive and systematic reports on MR thermometry. Moreover, data inclusion generally lacks objective selection criteria leading to a high probability of bias when comparing results. Herein, we studied whether imaging-based data inclusion predicts accuracy and could serve as a tool for prospective patient selection. The accuracy of the MR thermometry in patients with locally advanced cervical cancer was benchmarked against intraluminal temperature. We found that gastrointestinal air motion at the start of the treatment, quantified by the Jaccard similarity coefficient, was a good predictor for MR thermometry accuracy. The results for the group that was selected for low gastrointestinal air motion improved compared to the results for all patients by 50% (accuracy), 26% (precision), and 80% (bias). We found an average MR thermometry accuracy of 2.0 °C when all patients were considered and 1.0 °C for the selected group. These results serve as the basis for comprehensive benchmarking of novel technologies. The Jaccard similarity coefficient also has good potential to prospectively determine in which patients the MR thermometry will be valuable.
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Affiliation(s)
- Iva VilasBoas-Ribeiro
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
- Correspondence:
| | - Sergio Curto
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
| | - Gerard C. van Rhoon
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
- Department of Radiation Science and Technology, Faculty of Applied Sciences, Delft University of Technology, 2629 JB Delft, The Netherlands
| | - Martine Franckena
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
| | - Margarethus M. Paulides
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (S.C.); (G.C.v.R.); (M.F.); (M.M.P.)
- Center for Care and Cure Technologies Eindhoven (C3Te), Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
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Nadobny J, Lim A, Seifert G, Sullivan D, Chrzon B, Weihrauch M, Zschaeck S, Herz E, Moczynska A, Pellicer-Guridi R, Wust P, Beck M, Ghadjar P. Improved patient-specific hyperthermia planning based on parametrized electromagnetic and thermal models for the SIGMA-30 applicator. Int J Hyperthermia 2021; 38:663-678. [PMID: 33899658 DOI: 10.1080/02656736.2021.1909757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To create an improved planning method for pediatric regional hyperthermia (RHT) using the SIGMA-30 applicator (SIGMA-30). MATERIALS AND METHODS An electromagnetic model of SIGMA-30 was generated for use with the finite-difference time-domain (FDTD) method. Applying special MATLAB-based algorithms, voxel models of a pediatric patient with pelvic rhabdomyosarcoma were created from Computed-Tomography (CT) contours for use with the FDTD method and the finite-difference (FD) method capable of using either temperature-independent or temperature-dependent perfusion models for solving the Bioheat Transfer Equation (BHTE). Patient models were parametrized regarding, first, the positioning in the applicator, second, the absorbed power range and, third, different perfusion models, resulting in the so-called Parametrized Treatment Models (PTMs). A novel dedicated optimization procedure was developed based on quantitative comparison of numerical calculations against temperature and power measurements from two RHT therapies. RESULTS Using measured data, a realistic absorbed power range in the patient model was estimated. Within this range, several FDTD and BHTE runs were performed and, applying the aforementioned optimization scheme, the best PTMs and perfusion models were identified for each therapy via a retrospective comparison with measurements in 14 temperature sensor positions: 5 in the tumor, 8 in rectum and one in bladder. CONCLUSION A novel dedicated optimization procedure for identification of suitable patient-specific electromagnetic and thermal models, which can be used for improved patient planning, was developed and evaluated by comparison with treatment-derived measurements using SIGMA-30. The optimization procedure can be extended to other hyperthermia applicators and to other patient types, including adults.
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Affiliation(s)
- Jacek Nadobny
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Amanda Lim
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg Seifert
- Department of Paediatric Oncology/Haematology, Otto-Heubner Centre for Paediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dennis Sullivan
- Department of Electrical and Computer Engineering, University of Idaho, Moscow, ID, USA
| | - Benjamin Chrzon
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mirko Weihrauch
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Enrico Herz
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Aleksandra Moczynska
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ruben Pellicer-Guridi
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Wust
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Datta NR, Marder D, Datta S, Meister A, Puric E, Stutz E, Rogers S, Eberle B, Timm O, Staruch M, Riesterer O, Bodis S. Quantification of thermal dose in moderate clinical hyperthermia with radiotherapy: a relook using temperature-time area under the curve (AUC). Int J Hyperthermia 2021; 38:296-307. [PMID: 33627018 DOI: 10.1080/02656736.2021.1875060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Thermal dose in clinical hyperthermia reported as cumulative equivalent minutes (CEM) at 43 °C (CEM43) and its variants are based on direct thermal cytotoxicity assuming Arrhenius 'break' at 43 °C. An alternative method centered on the actual time-temperature plot during each hyperthermia session and its prognostic feasibility is explored. METHODS AND MATERIALS Patients with bladder cancer treated with weekly deep hyperthermia followed by radiotherapy were evaluated. From intravesical temperature (T) recordings obtained every 10 secs, the area under the curve (AUC) was computed for each session for T > 37 °C (AUC > 37 °C) and T ≥ 39 °C (AUC ≥ 39 °C). These along with CEM43, CEM43(>37 °C), CEM43(≥39 °C), Tmean, Tmin and Tmax were evaluated for bladder tumor control. RESULTS Seventy-four hyperthermia sessions were delivered in 18 patients (median: 4 sessions/patient). Two patients failed in the bladder. For both individual and summated hyperthermia sessions, the Tmean, CEM43, CEM43(>37 °C), CEM43(≥39 °C), AUC > 37 °C and AUC ≥ 39 °C were significantly lower in patients who had a local relapse. Individual AUC ≥ 39 °C for patients with/without local bladder failure were 105.9 ± 58.3 °C-min and 177.9 ± 58.0 °C-min, respectively (p = 0.01). Corresponding summated AUC ≥ 39 °C were 423.7 ± 27.8 °C-min vs. 734.1 ± 194.6 °C-min (p < 0.001), respectively. The median AUC ≥ 39 °C for each hyperthermia session in patients with bladder tumor control was 190 °C-min. CONCLUSION AUC ≥ 39 °C for each hyperthermia session represents the cumulative time-temperature distribution at clinically defined moderate hyperthermia in the range of 39 °C to 45 °C. It is a simple, mathematically computable parameter without any prior assumptions and appears to predict treatment outcome as evident from this study. However, its predictive ability as a thermal dose parameter merits further evaluation in a larger patient cohort.
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Affiliation(s)
- Niloy R Datta
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Dietmar Marder
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Sneha Datta
- Animal Production and Health Laboratory, Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Andreas Meister
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Emsad Puric
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Stutz
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Rogers
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Brigitte Eberle
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Olaf Timm
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Michal Staruch
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Switzerland
| | - Stephan Bodis
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Switzerland
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Abstract
Time-reversal (TR) is a known wideband array beam-forming technique that has been suggested as a treatment planning alternative in deep microwave hyperthermia for cancer treatment. While the aim in classic TR is to focus the energy at a specific point within the target, no assumptions are made on secondary lobes that might arise in the healthy tissues. These secondary lobes, together with tissue heterogeneity, may result in hot-spots (HSs), which are known to limit the efficiency of the thermal dose delivery to the tumor. This paper proposes a novel wideband TR focusing method that iteratively shifts the focus away from HSs and towards cold-spots from an initial TR solution, a procedure that improves tumor coverage and reduces HSs. We verify this method on two different applicator topologies and several target volume configurations. The algorithm is deterministic and runs within seconds, enabling its use for real-time applications. At the same time, it yields results comparable to those obtained with global stochastic optimizers such as Particle Swarm.
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Affiliation(s)
- Massimiliano Zanoli
- Dept. Electrical Engineering, Chalmers University of Technology, Gothenburg, SE, Sweden
| | - Hana Dobšíček Trefná
- Dept. Electrical Engineering, Chalmers University of Technology, Gothenburg, SE, Sweden
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VilasBoas-Ribeiro I, van Rhoon GC, Drizdal T, Franckena M, Paulides MM. Impact of Number of Segmented Tissues on SAR Prediction Accuracy in Deep Pelvic Hyperthermia Treatment Planning. Cancers (Basel) 2020; 12:cancers12092646. [PMID: 32947939 PMCID: PMC7563220 DOI: 10.3390/cancers12092646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Hyperthermia treatment planning is the process of optimizing treatment quality using pre-treatment simulations. Although it has become a powerful tool, prediction accuracy is strongly dependent on the patient model. For deep hyperthermia in the pelvis, it is common that only four tissue categories are discriminated (bone, fat, muscle-like, and tumor). For the head and neck region, more tissues have been shown to be required for good prediction accuracy. Delineating is a labor-intensive and difficult process. Hence, it is important to find the optimum between accuracy and labor, but for deep pelvic hyperthermia, there are no published studies showing the impact of the number of tissues. We studied the trade-off between the segmentation detail needed and segmentation feasibility. Our findings indicate that including high water content tissues can impact simulation accuracy. Although our results, in general, underline the suitability of our current clinical protocol, they help to prioritize improvements for specific cases. Abstract In hyperthermia, the general opinion is that pre-treatment optimization of treatment settings requires a patient-specific model. For deep pelvic hyperthermia treatment planning (HTP), tissue models comprising four tissue categories are currently discriminated. For head and neck HTP, we found that more tissues are required for increasing accuracy. In this work, we evaluated the impact of the number of segmented tissues on the predicted specific absorption rate (SAR) for the pelvic region. Highly detailed anatomical models of five healthy volunteers were selected from a virtual database. For each model, seven lists with varying levels of segmentation detail were defined and used as an input for a modeling study. SAR changes were quantified using the change in target-to-hotspot-quotient and maximum SAR relative differences, with respect to the most detailed patient model. The main finding of this study was that the inclusion of high water content tissues in the segmentation may result in a clinically relevant impact on the SAR distribution and on the predicted hyperthermia treatment quality when considering our pre-established thresholds. In general, our results underline the current clinical segmentation protocol and help to prioritize any improvements.
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Affiliation(s)
- Iva VilasBoas-Ribeiro
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (G.C.v.R.); (M.F.); (M.M.P.)
- Correspondence:
| | - Gerard C. van Rhoon
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (G.C.v.R.); (M.F.); (M.M.P.)
- Department of Radiation Science and Technology, Faculty of Applied Sciences, Delft University of Technology, 2629 JB Delft, The Netherlands
| | - Tomas Drizdal
- Department of Biomedical Technology, Czech Technical University in Prague, nam. Sitna 3105, 272 01 Kladno, Czech Republic;
| | - Martine Franckena
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (G.C.v.R.); (M.F.); (M.M.P.)
| | - Margarethus M. Paulides
- Department of Radiation Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (G.C.v.R.); (M.F.); (M.M.P.)
- Electromagnetics for Care & Cure (EM-4C&C) Laboratory, Center for Care and Cure Technologies Eindhoven (C3Te), Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
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Datta NR, Kok HP, Crezee H, Gaipl US, Bodis S. Integrating Loco-Regional Hyperthermia Into the Current Oncology Practice: SWOT and TOWS Analyses. Front Oncol 2020; 10:819. [PMID: 32596144 PMCID: PMC7303270 DOI: 10.3389/fonc.2020.00819] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Moderate hyperthermia at temperatures between 40 and 44°C is a multifaceted therapeutic modality. It is a potent radiosensitizer, interacts favorably with a host of chemotherapeutic agents, and, in combination with radiotherapy, enforces immunomodulation akin to “in situ tumor vaccination.” By sensitizing hypoxic tumor cells and inhibiting repair of radiotherapy-induced DNA damage, the properties of hyperthermia delivered together with photons might provide a tumor-selective therapeutic advantage analogous to high linear energy transfer (LET) neutrons, but with less normal tissue toxicity. Furthermore, the high LET attributes of hyperthermia thermoradiobiologically are likely to enhance low LET protons; thus, proton thermoradiotherapy would mimic 12C ion therapy. Hyperthermia with radiotherapy and/or chemotherapy substantially improves therapeutic outcomes without enhancing normal tissue morbidities, yielding level I evidence reported in several randomized clinical trials, systematic reviews, and meta-analyses for various tumor sites. Technological advancements in hyperthermia delivery, advancements in hyperthermia treatment planning, online invasive and non-invasive MR-guided thermometry, and adherence to quality assurance guidelines have ensured safe and effective delivery of hyperthermia to the target region. Novel biological modeling permits integration of hyperthermia and radiotherapy treatment plans. Further, hyperthermia along with immune checkpoint inhibitors and DNA damage repair inhibitors could further augment the therapeutic efficacy resulting in synthetic lethality. Additionally, hyperthermia induced by magnetic nanoparticles coupled to selective payloads, namely, tumor-specific radiotheranostics (for both tumor imaging and radionuclide therapy), chemotherapeutic drugs, immunotherapeutic agents, and gene silencing, could provide a comprehensive tumor-specific theranostic modality akin to “magic (nano)bullets.” To get a realistic overview of the strength (S), weakness (W), opportunities (O), and threats (T) of hyperthermia, a SWOT analysis has been undertaken. Additionally, a TOWS analysis categorizes future strategies to facilitate further integration of hyperthermia with the current treatment modalities. These could gainfully accomplish a safe, versatile, and cost-effective enhancement of the existing therapeutic armamentarium to improve outcomes in clinical oncology.
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Affiliation(s)
- Niloy R Datta
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - H Petra Kok
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hans Crezee
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Udo S Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Bodis
- Centre for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
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Unsoeld M, Lamprecht U, Traub F, Hermes B, Scharpf M, Potkrajcic V, Zips D, Paulsen F, Eckert F. MR Thermometry Data Correlate with Pathological Response for Soft Tissue Sarcoma of the Lower Extremity in a Single Center Analysis of Prospectively Registered Patients. Cancers (Basel) 2020; 12:E959. [PMID: 32295076 DOI: 10.3390/cancers12040959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: There is a strong biologic rationale for using locoregional hyperthermia in soft tissue sarcoma and a randomized trial reported significant improvements with hyperthermia. The aim of this study was to describe the opportunities of magnetic resonance (MR)-based thermometry in a cohort of soft tissue sarcoma patients undergoing combined radiotherapy and locoregional hyperthermia. Patients and Methods: For eleven evaluable patients, tumor volume (VTu) and a separate volume for temperature analysis with reliable temperature distribution (Vtherm) were contoured for every hyperthermia treatment (103 therapies). Temperature data were recorded for all tumors and were correlated with clinical features and pathologic response data. Results: Of 48 patients with high-risk soft tissue sarcomas treated with radio(chemo)therapy and locoregional hyperthermia, MR thermometry was possible in 11 (23%) patients. For all patients, the temperature superseded by 90% of VTu (T90(VTu)) and T90 (Vtherm) were in the range of 37–43 °C and 40–45 °C, respectively. Larger tumors tended to reach higher temperatures. For tumors showing a pathologic response in the resection specimen after preoperative treatment, temperature (T90 (Vtherm)) was significantly higher than in tumors without pathologic response. Conclusion: Lower extremity sarcomas undergoing preoperative treatment with locoregional hyperthermia are especially suitable for MR thermometry. MR thermometry is a promising non-invasive way for temperature measurement during locoregional hyperthermia, showing a positive dose-response relationship.
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Kroesen M, Mulder HT, van Holthe JML, Aangeenbrug AA, Mens JWM, van Doorn HC, Paulides MM, Oomen-de Hoop E, Vernhout RM, Lutgens LC, van Rhoon GC, Franckena M. Confirmation of thermal dose as a predictor of local control in cervical carcinoma patients treated with state-of-the-art radiation therapy and hyperthermia. Radiother Oncol 2019; 140:150-158. [PMID: 31302345 DOI: 10.1016/j.radonc.2019.06.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Addition of deep hyperthermia results in improved local control (LC) and overall survival (OS) compared to radiotherapy alone in patients with cervical carcinoma. Previously, we showed that the thermal dose of hyperthermia significantly correlates with LC and disease specific survival (DSS). Over the last decade, new radiation techniques were introduced resulting in improved LC. AIM To validate the effect of thermal dose in a more recent cohort of patients treated with modern radiotherapy techniques, including image guided brachytherapy (IGBT). METHODS We analyzed primary cervical carcinoma patients treated with a combination of radiotherapy and deep hyperthermia between 2005 and 2016 at our institute. Data on patient, tumor and treatment were collected including the thermal dose parameters TRISE and CEM43T90. Follow-up data on LC, disease free survival, DSS, OS as well as late toxicity data were collected. Data were analyzed using the Cox proportional hazard and Kaplan-Meier analyses. RESULTS 227 patients were included. In multivariate analysis, histology, FIGO stage, lymphadenopathy, TRISE, CEM43T90 and IGBT had a significant effect on LC. In the patients treated with IGBT, the thermal dose parameter TRISE remained to have a significant effect on LC in univariate analysis. CONCLUSIONS The positive association between thermal dose and clinical outcome is replicated in an independent, recent cohort of cervical carcinoma patients. Importantly, in patients receiving IGBT, the effect of thermal dose on clinical outcome is still observed.
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Affiliation(s)
- Michiel Kroesen
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Hendrik T Mulder
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Jeanette M L van Holthe
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Aleida A Aangeenbrug
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Jan Willem M Mens
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Helena C van Doorn
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynaecology, The Netherlands
| | - Margarethus M Paulides
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands; Eindhoven University of Technology, Department of Electrical Engineering, The Netherlands
| | - Esther Oomen-de Hoop
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Rene M Vernhout
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Ludy C Lutgens
- University Medical Centre Maastricht, Department of Radiation Oncology (MAASTRO), Maastricht, The Netherlands
| | - Gerard C van Rhoon
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands
| | - Martine Franckena
- Erasmus MC, University Medical Center Rotterdam, Department of Radiation Oncology, The Netherlands.
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Mulder HT, Curto S, Paulides MM, Franckena M, van Rhoon GC. Systematic quality assurance of the BSD2000-3D MR-compatible hyperthermia applicator performance using MR temperature imaging. Int J Hyperthermia 2018; 35:305-313. [PMID: 30204006 DOI: 10.1080/02656736.2018.1497209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Radiofrequency (RF) mild hyperthermia (40 °C-44 °C for 60 minutes) is an effective adjuvant treatment for several types of cancer. To ensure treatment efficacy, quality assurance (QA) is necessary. This study presents the first systematic 3D characterisation of the heating performance of the commonly used Pyrexar BSD2000-3D MR-compatible hyperthermia applicator using magnetic resonance temperature imaging (MRTI). METHODS A reproducibly positioned phantom was heated with a power of 1000 watts during the 12.4 min needed to measure eight temperature distributions using MRTI. The target heating location was systematically varied between experiments. We analysed focus shape characteristics, steering accuracy, focus deformation due to steering, presence of off-target heating and reproducibility. RESULTS The mean maximum temperature increase was 5.9 ± 0.4 °C. The mean full width half maximum (FWHM) was 14.4 ± 0.5 cm in the XY plane and 24.5 ± 0.8 cm in Z-direction. The mean steering error was 0.4 ± 0.2 cm. The focus shape slightly varied between experiments, depending on steering distance in Y-direction. Off-target heating was not detected. Reproducibility of the focus amplitude and shape was determined by comparing the mean deviation from the mean temperature in the central slice was 0.3 ± 0.2 °C. CONCLUSION The Pyrexar BSD2000-3D MR-compatible applicator provides robust and reproducible heating. The upper boundary of the 95% confidence interval of the spatial steering accuracy is 0.9 cm, i.e. sufficient to fulfil the criterion of ≤0.2 °C temperature variation due to positioning errors as defined by Canters et al.
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Affiliation(s)
- Hendrik Thijmen Mulder
- a Radiation Oncology, Erasmus Medical Centre Cancer Institute , Rotterdam , The Netherlands
| | - Sergio Curto
- a Radiation Oncology, Erasmus Medical Centre Cancer Institute , Rotterdam , The Netherlands
| | | | - Martine Franckena
- a Radiation Oncology, Erasmus Medical Centre Cancer Institute , Rotterdam , The Netherlands
| | - Gerard C van Rhoon
- a Radiation Oncology, Erasmus Medical Centre Cancer Institute , Rotterdam , The Netherlands
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Cappiello G, Drizdal T, Mc Ginley B, O’Halloran M, Glavin M, van Rhoon GC, Jones E, Paulides MM. The potential of time-multiplexed steering in phased array microwave hyperthermia for head and neck cancer treatment. ACTA ACUST UNITED AC 2018; 63:135023. [DOI: 10.1088/1361-6560/aaca10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Verduijn GM, de Wee EM, Rijnen Z, Togni P, Hardillo JAU, Ten Hove I, Franckena M, van Rhoon GC, Paulides MM. Deep hyperthermia with the HYPERcollar system combined with irradiation for advanced head and neck carcinoma - a feasibility study. Int J Hyperthermia 2018; 34:994-1001. [PMID: 29747544 DOI: 10.1080/02656736.2018.1454610] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
PURPOSE Radiotherapy (RT) treatment of locally-advanced and recurrent head and neck carcinoma (HNC) results in disappointing outcomes. Combination of RT with cisplatin or cetuximab improves survival but the increased toxicity and patient's comorbidity warrant the need for a less-toxic radiosensitizer. Stimulated by several randomized studies demonstrating the radio-sensitizing effect of hyperthermia, we developed the HYPERcollar. Here, we report early experience and toxicity in patients with advanced HNC. METHODS AND MATERIALS 119 hyperthermia treatments given to 27 patients were analyzed. Hyperthermia was applied once a week by the HYPERcollar aimed at achieving 39-43 °C in the target area, up to patients' tolerance. Pre-treatment planning was used to optimize treatment settings. When possible, invasive thermometry catheters were placed. RESULTS Mean power applied during the 119 hyperthermia treatments ranged from 120 to 1007 W (median 543 W). 15 (13%) hyperthermia treatments were not fully completed due to: pain allocated to hyperthermia (6/15), dyspnea from sticky saliva associated with irradiation (2/15) and unknown reasons (7/15). No severe complications or enhanced thermal or mucosal toxicities were observed. Excluding post-operative treatment, response rates after 3 months were 46% (complete) and 7% (partial). CONCLUSION Hyperthermia with the HYPERcollar proved to be safe and feasible with good compliance and promising outcome.
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Affiliation(s)
- G M Verduijn
- a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , Netherlands
| | - E M de Wee
- a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , Netherlands
| | - Z Rijnen
- a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , Netherlands
| | - P Togni
- a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , Netherlands
| | - J A U Hardillo
- b Department of Otorhinolaryngology-Head and neck surgery , Erasmus MC Cancer Institute , Rotterdam , Netherlands
| | - I Ten Hove
- c Department of Oral and Maxillofacial Surgery-Head and Neck Surgery , Erasmus MC Cancer Institute , Rotterdam , Netherlands
| | - M Franckena
- a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , Netherlands
| | - G C van Rhoon
- a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , Netherlands
| | - M M Paulides
- a Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , Netherlands
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Tomura K, Ohguri T, Mulder HT, Murakami M, Nakahara S, Yahara K, Korogi Y. The usefulness of mobile insulator sheets for the optimisation of deep heating area for regional hyperthermia using a capacitively coupled heating method: phantom, simulation and clinical prospective studies. Int J Hyperthermia 2017; 34:1092-1103. [PMID: 29108446 DOI: 10.1080/02656736.2017.1402130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To evaluate the feasibility and efficacy of deep regional hyperthermia with the use of mobile insulator sheets in a capacitively coupled heating device. MATERIALS AND METHODS The heat was applied using an 8-MHz radiofrequency-capacitive device. The insulator sheet was inserted between the regular bolus and cooled overlay bolus in each of upper and lower side of the electrode. Several settings using the insulator sheets were investigated in an experimental study using an agar phantom to evaluate the temperature distributions. The specific absorption rate (SAR) distributions in several organs were also computed for the three-dimensional patient model. In a clinical prospective study, a total of five heating sessions were scheduled for the pelvic tumours, to assess the thermal parameters. The conventional setting was used during the first, third and fifth treatment sessions, and insulator sheets were used during the second and fourth treatment sessions. RESULTS In the phantom study, the higher heating area improved towards the centre when the mobile insulator sheets were used. The subcutaneous fat/target ratios for the averaged SARs in the setting with the mobile insulator (median, 2.5) were significantly improved compared with those in the conventional setting (median, 3.4). In the clinical study, the thermal dose parameters of CEM43°CT90 in the sessions with the mobile insulator sheets (median, 1.9 min) were significantly better than those in the sessions using a conventional setting (median, 1.0 min). CONCLUSIONS Our novel heating method using mobile insulator sheets was thus found to improve the thermal dose parameters. Further investigations are expected.
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Affiliation(s)
- Kyosuke Tomura
- a Department of Radiology , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Takayuki Ohguri
- a Department of Radiology , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Hendrik Thijmen Mulder
- b Department of Radiation Oncology, Hyperthermia unit , Erasmus MC Cancer Institute , Rotterdam , the Netherlands
| | - Motohiro Murakami
- c Department of Medical Electronics , University Hospital of Occupational and Environmental Health , Kitakyushu , Japan
| | - Sota Nakahara
- a Department of Radiology , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Katsuya Yahara
- a Department of Radiology , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Yukunori Korogi
- a Department of Radiology , University of Occupational and Environmental Health , Kitakyushu , Japan
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Kok HP, Korshuize-van Straten L, Bakker A, de Kroon – Oldenhof R, Westerveld GH, Versteijne E, Stalpers LJA, Crezee J. Feasibility of on-line temperature-based hyperthermia treatment planning to improve tumour temperatures during locoregional hyperthermia. Int J Hyperthermia 2017; 34:1082-1091. [DOI: 10.1080/02656736.2017.1400120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- H. P. Kok
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - L. Korshuize-van Straten
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Bakker
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R. de Kroon – Oldenhof
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G. H. Westerveld
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E. Versteijne
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - L. J. A. Stalpers
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J. Crezee
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Cappiello G, McGinley B, Elahi MA, Drizdal T, Paulides MM, Glavin M, O'Halloran M, Jones E. Differential Evolution Optimization of the SAR Distribution for Head and Neck Hyperthermia. IEEE Trans Biomed Eng 2017; 64:1875-1885. [DOI: 10.1109/tbme.2016.2627941] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ohguri T, Harima Y, Imada H, Sakurai H, Ohno T, Hiraki Y, Tuji K, Tanaka M, Terashima H. Relationships between thermal dose parameters and the efficacy of definitive chemoradiotherapy plus regional hyperthermia in the treatment of locally advanced cervical cancer: data from a multicentre randomised clinical trial. Int J Hyperthermia 2017; 34:461-468. [DOI: 10.1080/02656736.2017.1352105] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Takayuki Ohguri
- Department of Radiology, University of Occupational and Environmental Health, Kitakyusyu City, Japan
| | - Yoko Harima
- Department of Radiology, Kansai Medical University, Moriguchi City, Japan
| | - Hajime Imada
- Cancer Therapy Centre, Tobata Kyoritsu Hospital, Kitakyusyu City, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba City, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Heavy Ion Medical Centre, Maehashi City, Japan
| | - Yoshiyuki Hiraki
- Department of Radiology, National Hospital Organization Kagoshima Medical Centre, Kagoshima City, Japan
| | - Koh Tuji
- Department of Radiology, National Hospital Organization Minami Wakayama Medical Centre, Tanabe City, Japan
| | - Masahiro Tanaka
- Department of Radiation Oncology, Osaka City General Hospital, Osaka City, Japan
| | - Hiromi Terashima
- Department of Radiology, Harasanshin Hospital, Fukuoka City, Japan
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18
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Kok HP, Korshuize-van Straten L, Bakker A, de Kroon-Oldenhof R, Geijsen ED, Stalpers LJA, Crezee J. Online Adaptive Hyperthermia Treatment Planning During Locoregional Heating to Suppress Treatment-Limiting Hot Spots. Int J Radiat Oncol Biol Phys 2017; 99:1039-47. [PMID: 28870786 DOI: 10.1016/j.ijrobp.2017.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adequate tumor temperatures during hyperthermia are essential for good clinical response, but excessive heating of normal tissue should be avoided. This makes locoregional heating using phased array systems technically challenging. Online application of hyperthermia treatment planning could help to improve the heating quality. The aim of this study was to evaluate the clinical benefit of online treatment planning during treatment of pelvic tumors heated with the AMC-8 locoregional hyperthermia system. METHODS For online adaptive hyperthermia treatment planning, a graphical user interface was developed. Electric fields were calculated in a preprocessing step using our in-house-developed finite-difference-based treatment planning system. This allows instant calculation of the temperature distribution for user-selected phase-amplitude settings during treatment and projection onto the patient's computed tomographic scan for online visualization. Online treatment planning was used for 14 treatment sessions in 8 patients to reduce the patients' reports of hot spots while maintaining the same level of tumor heating. The predicted decrease in hot spot temperature should be at least 0.5°C, and the tumor temperature should decrease less than 0.2°C. These predictions were compared with clinical data: patient feedback about the hot spot and temperature measurements in the tumor region. RESULTS In total, 17 hot spot reports occurred during the 14 sessions, and the alternative settings predicted the hot spot temperature to decrease by at least 0.5°C, which was confirmed by the disappearance of all 17 hot spot reports. At the same time, the average tumor temperature was predicted to change on average -0.01°C (range, -0.19°C to 0.34°C). The measured tumor temperature change was on average only -0.02°C (range, -0.26°C to 0.31°C). In only 2 cases the temperature decrease was slightly larger than 0.2°C, but at most it was 0.26°C. CONCLUSIONS Online application of hyperthermia treatment planning is reliable and very useful to reduce hot spots without affecting tumor temperatures.
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Schooneveldt G, Bakker A, Balidemaj E, Chopra R, Crezee J, Geijsen ED, Hartmann J, Hulshof MC, Kok HP, Paulides MM, Sousa-Escandon A, Stauffer PR, Maccarini PF. Thermal dosimetry for bladder hyperthermia treatment. An overview. Int J Hyperthermia 2016; 32:417-33. [DOI: 10.3109/02656736.2016.1156170] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Abstract
Moderate temperature hyperthermia (40-45°C for 1 h) is emerging as an effective treatment to enhance best available chemotherapy strategies for bladder cancer. A rapidly increasing number of clinical trials have investigated the feasibility and efficacy of treating bladder cancer with combined intravesical chemotherapy and moderate temperature hyperthermia. To date, most studies have concerned treatment of non-muscle-invasive bladder cancer (NMIBC) limited to the interior wall of the bladder. Following the promising results of initial clinical trials, investigators are now considering protocols for treatment of muscle-invasive bladder cancer (MIBC). This paper provides a brief overview of the devices and techniques used for heating bladder cancer. Systems are described for thermal conduction heating of the bladder wall via circulation of hot fluid, intravesical microwave antenna heating, capacitively coupled radio-frequency current heating, and radiofrequency phased array deep regional heating of the pelvis. Relative heating characteristics of the available technologies are compared based on published feasibility studies, and the systems correlated with clinical requirements for effective treatment of MIBC and NMIBC.
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Affiliation(s)
- Paul R Stauffer
- a Department of Radiation Oncology , Thomas Jefferson University , Philadelphia , Pennsylvana , USA and
| | - Gerard C van Rhoon
- b Department of Radiation Oncology , Erasmus Medical Centre Cancer Institute , Rotterdam , The Netherlands
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Abstract
The benefit of hyperthermia as a potent modifier of radiotherapy has been well established and more recently also the combination with chemotherapy was shown beneficial. Also for head and neck cancer, the impact of hyperthermia has been clinically demonstrated by a number of clinical trials. Unfortunately, the technology applied in these studies provided only limited thermal dose control, and the devices used only allowed treatment of target regions close to the skin. Over the last decade, we developed the technology for deep and controlled hyperthermia that allows treatment of the entire head and neck region. Our strategy involves focused microwave heating combined with 3D patient-specific electromagnetic and thermal simulations for conformal, reproducible and adaptive hyperthermia application. Validation of our strategy has been performed by 3D thermal dose assessment based on invasively placed temperature sensors combined with the 3D patient specific simulations. In this paper, we review the phase III clinical evidence for hyperthermia in head and neck tumors, as well as the heating and dosimetry technology applied in these studies. Next, we describe the development, clinical implementation and validation of 3D guided deep hyperthermia with the HYPERcollar, and its second generation, i.e. the HYPERcollar3D. Lastly, we discuss early clinical results and provide an outlook for this technology.
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Affiliation(s)
| | - Gerda M Verduijn
- Erasmus MC Cancer Institute, Box 5201, 3008AE, Rotterdam, The Netherlands.
| | - Netteke Van Holthe
- Erasmus MC Cancer Institute, Box 5201, 3008AE, Rotterdam, The Netherlands.
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Datta NR, Ordóñez SG, Gaipl US, Paulides MM, Crezee H, Gellermann J, Marder D, Puric E, Bodis S. Local hyperthermia combined with radiotherapy and-/or chemotherapy: recent advances and promises for the future. Cancer Treat Rev 2015; 41:742-53. [PMID: 26051911 DOI: 10.1016/j.ctrv.2015.05.009] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/16/2015] [Accepted: 05/20/2015] [Indexed: 02/08/2023]
Abstract
Hyperthermia, one of the oldest forms of cancer treatment involves selective heating of tumor tissues to temperatures ranging between 39 and 45°C. Recent developments based on the thermoradiobiological rationale of hyperthermia indicate it to be a potent radio- and chemosensitizer. This has been further corroborated through positive clinical outcomes in various tumor sites using thermoradiotherapy or thermoradiochemotherapy approaches. Moreover, being devoid of any additional significant toxicity, hyperthermia has been safely used with low or moderate doses of reirradiation for retreatment of previously treated and recurrent tumors, resulting in significant tumor regression. Recent in vitro and in vivo studies also indicate a unique immunomodulating prospect of hyperthermia, especially when combined with radiotherapy. In addition, the technological advances over the last decade both in hardware and software have led to potent and even safer loco-regional hyperthermia treatment delivery, thermal treatment planning, thermal dose monitoring through noninvasive thermometry and online adaptive temperature modulation. The review summarizes the outcomes from various clinical studies (both randomized and nonrandomized) where hyperthermia is used as a thermal sensitizer of radiotherapy and-/or chemotherapy in various solid tumors and presents an overview of the progresses in loco-regional hyperthermia. These recent developments, supported by positive clinical outcomes should merit hyperthermia to be incorporated in the therapeutic armamentarium as a safe and an effective addendum to the existing oncological treatment modalities.
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Affiliation(s)
- N R Datta
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - S Gómez Ordóñez
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - U S Gaipl
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
| | - M M Paulides
- Department of Radiation Oncology, Hyperthermia Unit, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - H Crezee
- Department of Radiation Oncology, Academic Medical Centre, University of Amsterdam, The Netherlands.
| | - J Gellermann
- Praxis/Zentrum für Strahlentherapie und Radioonkologie, Janusz-Korczak-Str. 12, 12627 Berlin, Germany.
| | - D Marder
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - E Puric
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.
| | - S Bodis
- Centre of Radiation Oncology, KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Switzerland.
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Noh JM, Kim HY, Park HC, Lee SH, Kim YS, Hong SB, Park JH, Jung SH, Han Y. In vivo verification of regional hyperthermia in the liver. Radiat Oncol J 2014; 32:256-61. [PMID: 25568854 PMCID: PMC4283000 DOI: 10.3857/roj.2014.32.4.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/21/2014] [Accepted: 09/11/2014] [Indexed: 12/13/2022] Open
Abstract
PURPOSE We performed invasive thermometry to verify the elevation of local temperature in the liver during hyperthermia. MATERIALS AND METHODS Three 40-kg pigs were used for the experiments. Under general anesthesia with ultrasonography guidance, two glass fiber-optic sensors were placed in the liver, and one was placed in the peritoneal cavity in front of the liver. Another sensor was placed on the skin surface to assess superficial cooling. Six sessions of hyperthermia were delivered using the Celsius TCS electro-hyperthermia system. The energy delivered was increased from 240 kJ to 507 kJ during the 60-minute sessions. The inter-session cooling periods were at least 30 minutes. The temperature was recorded every 5 minutes by the four sensors during hyperthermia, and the increased temperatures recorded during the consecutive sessions were analyzed. RESULTS As the animals were anesthetized, the baseline temperature at the start of each session decreased by 1.3℃ to 2.8℃ (median, 2.1℃). The mean increases in temperature measured by the intrahepatic sensors were 2.42℃ (95% confidence interval [CI], 1.70-3.13) and 2.67℃ (95% CI, 2.05-3.28) during the fifth and sixth sessions, respectively. The corresponding values for the intraperitoneal sensor were 2.10℃ (95% CI, 0.71-3.49) and 2.87℃ (1.13-4.43), respectively. Conversely, the skin temperature was not increased but rather decreased according to application of the cooling system. CONCLUSION We observed mean 2.67℃ and 2.87℃ increases in temperature at the liver and peritoneal cavity, respectively, during hyperthermia. In vivo real-time thermometry is useful for directly measuring internal temperature during hyperthermia.
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Affiliation(s)
- Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Young Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Hyang Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Sun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Saet-Byul Hong
- Laboratory Animal Research Center, Samsung Biomedical Research Institute, Seoul, Korea
| | - Ji Hyun Park
- Laboratory Animal Research Center, Samsung Biomedical Research Institute, Seoul, Korea
| | - Sang Hoon Jung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Roesch M, Mueller-Huebenthal B. Review: the role of hyperthermia in treating pancreatic tumors. Indian J Surg Oncol 2014; 6:75-81. [PMID: 25937768 DOI: 10.1007/s13193-014-0316-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/13/2014] [Indexed: 12/18/2022] Open
Abstract
There is only marginal improvement in outcome of treating pancreatic cancer in the last two decades. Time to open up and have a fresh look at complementary adjuvant treatment options. Hyperthermia may be one such option. Hyperthermic intraperitoneal chemotherapy (HIPEC) predominantly as a intrasurgical procedure has already proved its justification. Non-invasive loco regional hyperthermia as complement to either chemo or radiation has not yet reached a comparable status of evidence. However the potential to eventually grow into such evidence is already clearly observable. This review presents the various methodologies available for hyperthermia, covers the initial clinical data that has been published and gives an outlook to what can be expected in the next 2-3 years to come. Hyperthermia has the potential to significantly prolong life expectancies and this while maintaining a satisfying quality of life!
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Affiliation(s)
- Martin Roesch
- Research & Development Celsius42+, Mannheim, Germany
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Paulides MM, Stauffer PR, Neufeld E, Maccarini PF, Kyriakou A, Canters RAM, Diederich CJ, Bakker JF, Van Rhoon GC. Simulation techniques in hyperthermia treatment planning. Int J Hyperthermia 2013; 29:346-57. [PMID: 23672453 PMCID: PMC3711016 DOI: 10.3109/02656736.2013.790092] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract Clinical trials have shown that hyperthermia (HT), i.e. an increase of tissue temperature to 39-44 °C, significantly enhance radiotherapy and chemotherapy effectiveness [1]. Driven by the developments in computational techniques and computing power, personalised hyperthermia treatment planning (HTP) has matured and has become a powerful tool for optimising treatment quality. Electromagnetic, ultrasound, and thermal simulations using realistic clinical set-ups are now being performed to achieve patient-specific treatment optimisation. In addition, extensive studies aimed to properly implement novel HT tools and techniques, and to assess the quality of HT, are becoming more common. In this paper, we review the simulation tools and techniques developed for clinical hyperthermia, and evaluate their current status on the path from 'model' to 'clinic'. In addition, we illustrate the major techniques employed for validation and optimisation. HTP has become an essential tool for improvement, control, and assessment of HT treatment quality. As such, it plays a pivotal role in the quest to establish HT as an efficacious addition to multi-modality treatment of cancer.
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Affiliation(s)
- Margarethus M Paulides
- Hyperthermia Unit, Department of Radiation Oncology, Daniel den Hoed Cancer Centre, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Bruggmoser G, Bauchowitz S, Canters R, Crezee H, Ehmann M, Gellermann J, Lamprecht U, Lomax N, Messmer M, Ott O, Abdel-Rahman S, Schmidt M, Sauer R, Thomsen A, Wessalowski R, van Rhoon G. Guideline for the clinical application, documentation and analysis of clinical studies for regional deep hyperthermia. Strahlenther Onkol 2012; 188 Suppl 2:198-211. [DOI: 10.1007/s00066-012-0176-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
The hyperthermia effect is based on its thermal influence on tumours. Therefore a controlled heating of the tumours must be achieved. In order to guarantee this, two points must be fulfilled at least: First, the hyperthermia equipment must have the necessary power and steering capability. Second, the distribution of the 'hyperthermic drug', the heat, has to be measured and controlled over the whole treatment time. To reach this aim both a sophisticated technique and a staff trained in hyperthermia are required. In treating patients such as those with cervical cancer, the volume to be exposed and the dosage must be clarified. This means that very special technical and medical conditions must be fulfilled in hyperthermia. To reach and maintain a certain level of quality, hyperthermia is embedded in a framework of procedures. These procedures are defined in the modules of quality management. Therefore quality management must contain specific guidelines for each application, i.e. coordinated standards have to be defined. When adapting these standards in hyperthermia, comparable and comprehensible results of the treatment are guaranteed. Furthermore, an analysis of the treatments under a scientific point of view will be possible and finally result in improvements of this method.
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Affiliation(s)
- Gregor Bruggmoser
- Department of Radiotherapy, University Hospital of Freiburg, Freiburg, Germany.
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Ishikawa T, Kokura S, Sakamoto N, Ando T, Imamoto E, Hattori T, Oyamada H, Yoshinami N, Sakamoto M, Kitagawa K, Okumura Y, Yoshida N, Kamada K, Katada K, Uchiyama K, Handa O, Takagi T, Yasuda H, Sakagami J, Konishi H, Yagi N, Naito Y, Yoshikawa T. Phase II trial of combined regional hyperthermia and gemcitabine for locally advanced or metastatic pancreatic cancer. Int J Hyperthermia 2012; 28:597-604. [PMID: 22838644 DOI: 10.3109/02656736.2012.695428] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Despite advances in cancer therapy, treating pancreatic cancer remains one of the major challenges in the field of medical oncology. We conducted this phase II study to evaluate the efficacy and safety of regional hyperthermia combined with gemcitabine for the treatment of unresectable advanced pancreatic cancer. METHODS Eligibility criteria included histologically proven, locally advanced or metastatic pancreatic cancer. Gemcitabine was administered intravenously at a dose of 1000 mg/m(2) on days 1, 8, and 15 every 4 weeks. Regional hyperthermia was performed once weekly, 1 day preceding or following gemcitabine administration. The primary end point was the 1-year survival rate. Secondary objectives were determination of tumour response and safety. RESULTS We enrolled 18 patients with advanced pancreatic cancer between November 2008 and May 2010. The major grade 3-4 adverse events were neutropenia and anaemia; however, there were no episodes of infection. The objective response rate (ORR) and disease control rate (ORR + stable disease) were 11.1% and 61.1%, respectively. Median overall survival (OS) was 8 months, and the 1-year survival rate was 33.3%. Median OS of patients with locally advanced pancreatic cancer was 17.7 months. CONCLUSIONS Regional hyperthermia combined with gemcitabine is well tolerated and active in patients with locally advanced pancreatic cancer.
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Affiliation(s)
- Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Bruggmoser G, Bauchowitz S, Canters R, Crezee H, Ehmann M, Gellermann J, Lamprecht U, Lomax N, Messmer MB, Ott O, Abdel-Rahman S, Sauer R, Schmidt M, Thomsen A, Wessalowski R, van Rhoon G. Quality assurance for clinical studies in regional deep hyperthermia. Strahlenther Onkol 2011; 187:605-10. [DOI: 10.1007/s00066-011-1145-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 07/04/2011] [Indexed: 10/17/2022]
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Wootton JH, Hsu ICJ, Diederich CJ. Endocervical ultrasound applicator for integrated hyperthermia and HDR brachytherapy in the treatment of locally advanced cervical carcinoma. Med Phys 2011; 38:598-611. [PMID: 21452697 DOI: 10.1118/1.3512803] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The clinical success of hyperthermia adjunct to radiotherapy depends on adequate temperature elevation in the tumor with minimal temperature rise in organs at risk. Existing technologies for thermal treatment of the cervix have limited spatial control or rapid energy falloff. The objective of this work is to develop an endocervical applicator using a linear array of multisectored tubular ultrasound transducers to provide 3-D conformal, locally targeted hyperthermia concomitant to radiotherapy in the uterine cervix. The catheter-based device is integrated within a HDR brachytherapy applicator to facilitate sequential and potentially simultaneous heat and radiation delivery. METHODS Treatment planning images from 35 patients who underwent HDR brachytherapy for locally advanced cervical cancer were inspected to assess the dimensions of radiation clinical target volumes (CTVs) and gross tumor volumes (GTVs) surrounding the cervix and the proximity of organs at risk. Biothermal simulation was used to identify applicator and catheter material parameters to adequately heat the cervix with minimal thermal dose accumulation in nontargeted structures. A family of ultrasound applicators was fabricated with two to three tubular transducers operating at 6.6-7.4 MHz that are unsectored (360 degrees), bisectored (2 x 180 degrees), or trisectored (3 x 120 degrees) for control of energy deposition in angle and along the device length in order to satisfy anatomical constraints. The device is housed in a 6 mm diameter PET catheter with cooling water flow for endocervical implantation. Devices were characterized by measuring acoustic efficiencies, rotational acoustic intensity distributions, and rotational temperature distributions in phantom. RESULTS The CTV in HDR brachytherapy plans extends 20.5 +/- 5.0 mm from the endocervical tandem with the rectum and bladder typically <8 mm from the target boundary. The GTV extends 19.4 +/- 7.3 mm from the tandem. Simulations indicate that for 60 min treatments the applicator can heat to 41 degrees C and deliver > 5EM(43 degrees C) over 4-5 cm diameter with Tmax < 45 degrees C and 1 kg m(-3) s(-1) blood perfusion. The 41 degrees C contour diameter is reduced to 3-4 cm at 3 kg m(-3) s(-1) perfusion. Differential power control to transducer elements and sectors demonstrates tailoring of heating along the device length and in angle. Sector cuts are associated with a 14-47 degrees acoustic dead zone, depending on cut width, resulting in a approximately 2-4 degrees C temperature reduction within the dead zone below Tmax. Dead zones can be oriented for thermal protection of the rectum and bladder. Fabricated devices have acoustic efficiencies of 33.4%-51.8% with acoustic output that is well collimated in length, reflects the sectoring strategy, and is strongly correlated with temperature distributions. CONCLUSIONS A catheter-based ultrasound applicator was developed for endocervical implantation with locally targeted, 3-D conformal thermal delivery to the uterine cervix. Feasibility of heating clinically relevant target volumes was demonstrated with power control along the device length and in angle to treat the cervix with minimal thermal dose delivery to the rectum and bladder.
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Affiliation(s)
- Jeffery H Wootton
- Thermal Therapy Research Group, Department of Radiation Oncology, University of California, San Francisco, California 94115, USA
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Ohguri T, Yahara K, Moon SD, Yamaguchi S, Imada H, Terashima H, Korogi Y. Deep regional hyperthermia for the whole thoracic region using 8 MHz radiofrequency-capacitive heating device: Relationship between the radiofrequency-output power and the intra-oesophageal temperature and predictive factors for a good heating in 59 patients. Int J Hyperthermia 2010; 27:20-6. [DOI: 10.3109/02656736.2010.500644] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Paulides MM, Bakker JF, Linthorst M, van der Zee J, Rijnen Z, Neufeld E, Pattynama PMT, Jansen PP, Levendag PC, van Rhoon GC. The clinical feasibility of deep hyperthermia treatment in the head and neck: new challenges for positioning and temperature measurement. Phys Med Biol 2010; 55:2465-80. [PMID: 20371911 DOI: 10.1088/0031-9155/55/9/003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To apply high-quality hyperthermia treatment to tumours at deep locations in the head and neck (H&N), we have designed and built a site-specific phased-array applicator. Earlier, we demonstrated its features in parameter studies, validated those by phantom measurements and clinically introduced the system. In this paper we will critically review our first clinical experiences and demonstrate the pivotal role of hyperthermia treatment planning (HTP). Three representative patient cases (thyroid, oropharynx and nasal cavity) are selected and discussed. Treatment planning, the treatment, interstitially measured temperatures and their interrelation are analysed from a physics point of view. Treatments lasting 1 h were feasible and well tolerated and no acute treatment-related toxicity has been observed. Maximum temperatures measured are in the range of those obtained during deep hyperthermia treatments in the pelvic region but mean temperatures are still to be improved. Further, we found that simulated power absorption correlated well with measured temperatures illustrating the validity of our treatment approach of using energy profile optimizations to arrive at higher temperatures. This is the first data proving that focussed heating of tumours in the H&N is feasible. Further, HTP proved a valuable tool in treatment optimization. Items to improve are (1) the transfer of HTP settings into the clinic and (2) the registration of the thermal dose, i.e. dosimetry.
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Affiliation(s)
- M M Paulides
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
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Franckena M, Canters R, Termorshuizen F, Van Der Zee J, Van Rhoon G. Clinical implementation of hyperthermia treatment planning guided steering: A cross over trial to assess its current contribution to treatment quality. Int J Hyperthermia 2010; 26:145-57. [DOI: 10.3109/02656730903453538] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Andocs G, Renner H, Balogh L, Fonyad L, Jakab C, Szasz A. Strong synergy of heat and modulated electromagnetic field in tumor cell killing. Strahlenther Onkol 2009; 185:120-6. [PMID: 19240999 DOI: 10.1007/s00066-009-1903-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 10/13/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Hyperthermia is an emerging complementary method in radiooncology. Despite many positive studies and comprehensive reviews, the method is not widely accepted as a combination to radiotherapy. Modulated electrohyperthermia (mEHT; capacitive, electric field modulated, 13.56 MHz) has been used in clinical practice for almost 2 decades in Germany, Austria and Hungary. This in vivo study in nude mice xenograft tumors compares mEHT with "classic" radiative hyperthermia (radHT). MATERIAL AND METHODS Nude mice were xenografted with HT29 human colorectal carcinoma cells. 28 mice in four groups with seven animals each and two tumors per animal (totally 56 tumors) were included in the present study: group 1 as untreated control; group 2 treated with radHT at 42 degrees C; group 3 treated with mEHT at identical 42 degrees C; group 4 treated with mEHT at 38 degrees C (by intensively cooling down the tumor). 24 h after treatment, animals were sacrificed and the tumor cross sections studied by precise morphological methods for the respective relative amount of "dead" tumor cells. RESULTS The effect of mEHT established a double effect as a synergy between the purely thermal (temperature-dependent) and nonthermal (not directly temperature-dependent) effects. The solely thermal enhancement ratio (TER) of cell killing was shown to be 2.9. The field enhancement ratio (FER) at a constant temperature of 42 degrees C was measured as 3.2. Their complex application significantly increased the therapeutic enhancement to 9.4. CONCLUSION mEHT had a remarkable cancer cell-killing effect in a nude mice xenograft model.
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Affiliation(s)
- Gabor Andocs
- "Frederic Joliot Curie" National Research Institute for Radiobiology and Radiohygiene, Budapest, Hungary
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Ohguri T, Imada H, Yahara K, Morioka T, Nakano K, Terashima H, Korogi Y. Radiotherapy With 8-MHz Radiofrequency-Capacitive Regional Hyperthermia for Stage III Non–Small-Cell Lung Cancer: The Radiofrequency-Output Power Correlates With the Intraesophageal Temperature and Clinical Outcomes. Int J Radiat Oncol Biol Phys 2009; 73:128-35. [DOI: 10.1016/j.ijrobp.2008.03.059] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 01/17/2008] [Accepted: 03/24/2008] [Indexed: 01/02/2023]
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