Specific absorption rate and tissue temperature in local hyperthermia

Comparative analysis of energy transfer mechanisms for neural implants

As neural implant technologies advance rapidly, a nuanced understanding of their powering mechanisms becomes indispensable, especially given the long-term biocompatibility risks like oxidative stress and inflammation, which can be aggravated by recurrent surgeries, including battery replacements. This review delves into a comprehensive analysis, starting with biocompatibility considerations for both energy storage units and transfer methods. The review focuses on four main mechanisms for powering neural implants: Electromagnetic, Acoustic, Optical, and Direct Connection to the Body. Among these, Electromagnetic Methods include techniques such as Near-Field Communication (RF). Acoustic methods using high-frequency ultrasound offer advantages in power transmission efficiency and multi-node interrogation capabilities. Optical methods, although still in early development, show promising energy transmission efficiencies using Near-Infrared (NIR) light while avoiding electromagnetic interference. Direct connections, while efficient, pose substantial safety risks, including infection and micromotion disturbances within neural tissue. The review employs key metrics such as specific absorption rate (SAR) and energy transfer efficiency for a nuanced evaluation of these methods. It also discusses recent innovations like the Sectored-Multi Ring Ultrasonic Transducer (S-MRUT), Stentrode, and Neural Dust. Ultimately, this review aims to help researchers, clinicians, and engineers better understand the challenges of and potentially create new solutions for powering neural implants.

Heterogeneous Heat Absorption Is Complementary to Radiotherapy

Simple Summary

This review shows the advantages of heterogeneous heating of selected malignant cells in harmonic synergy with radiotherapy. The main clinical achievement of this complementary therapy is its extreme safety and minimal adverse effects. Combining the two methods opens a bright perspective, transforming the local radiotherapy to the antitumoral impact on the whole body, destroying the distant metastases by “teaching” the immune system about the overall danger of malignancy.

Abstract

(1) Background: Hyperthermia in oncology conventionally seeks the homogeneous heating of the tumor mass. The expected isothermal condition is the basis of the dose calculation in clinical practice. My objective is to study and apply a heterogenic temperature pattern during the heating process and show how it supports radiotherapy. (2) Methods: The targeted tissue’s natural electric and thermal heterogeneity is used for the selective heating of the cancer cells. The amplitude-modulated radiofrequency current focuses the energy absorption on the membrane rafts of the malignant cells. The energy partly “nonthermally” excites and partly heats the absorbing protein complexes. (3) Results: The excitation of the transmembrane proteins induces an extrinsic caspase-dependent apoptotic pathway, while the heat stress promotes the intrinsic caspase-dependent and independent apoptotic signals generated by mitochondria. The molecular changes synergize the method with radiotherapy and promote the abscopal effect. The mild average temperature (39–41 °C) intensifies the blood flow for promoting oxygenation in combination with radiotherapy. The preclinical experiences verify, and the clinical studies validate the method. (4) Conclusions: The heterogenic, molecular targeting has similarities with DNA strand-breaking in radiotherapy. The controlled energy absorption allows using a similar energy dose to radiotherapy (J/kg). The two therapies are synergistically combined.

Exhaustion of Protective Heat Shock Response Induces Significant Tumor Damage by Apoptosis after Modulated Electro-Hyperthermia Treatment of Triple Negative Breast Cancer Isografts in Mice

Simple Summary

Breast cancer is one of the most frequent cancer types among women worldwide. Triple-negative breast cancer is a highly aggressive breast cancer type with very poor survival due to the lack of targeted therapy. Modulated electro-hyperthermia (mEHT) is a newly emerging form of adjuvant, electromagnetic cancer-treatment. Capacitive energy delivery and frequency modulation enable the application of non-thermal effects. Furthermore, selective energy absorption by the tumor (as demonstrated in our present paper) enables 2.5 °C selective heating of the tumor. In the present study, we demonstrate in an in vivo syngeneic Balb/c TNBC mouse model that mEHT caused a remarkable reduction in the number of viable tumor cells accompanied by significant cleaved caspase-3-related apoptotic tumor tissue destruction and a transitional heat shock response. Furthermore, we demonstrated in vitro that the tumor cell killing effect of mEHT was amplified by inhibitors of the protective heat shock response such as Quercetin and KRIBB11.

Abstract

Modulated electro-hyperthermia (mEHT) is a complementary antitumor therapy applying capacitive radiofrequency at 13.56 MHz. Here we tested the efficiency of mEHT treatment in a BALB/c mouse isograft model using the firefly luciferase-transfected triple-negative breast cancer cell line, 4T1. Tumors inoculated orthotopically were treated twice using a novel ergonomic pole electrode and an improved mEHT device (LabEHY 200) at 0.7 ± 0.3 W for 30 min. Tumors were treated one, two, or three times every 48 h. Tumor growth was followed by IVIS, caliper, and ultrasound. Tumor destruction histology and molecular changes using immunohistochemistry and RT-qPCR were also revealed. In vivo, mEHT treatment transitionally elevated Hsp70 expression in surviving cells indicating heat shock-related cell stress, while IVIS fluorescence showed a significant reduction of viable tumor cell numbers. Treated tumor centers displayed significant microscopic tumor damage with prominent signs of apoptosis, and major upregulation of cleaved/activated caspase-3-positive tumor cells. Serial sampling demonstrated substantial elevation of heat shock (Hsp70) response twelve hours after the treatment which was exhausted by twenty-four hours after treatment. Heat shock inhibitors Quercetin or KRIBB11 could synergistically amplify mEHT-induced tumor apoptosis in vitro. In conclusion, modulated electro-hyperthermia exerted a protective heat shock response as a clear sign of tumor cell stress. Exhaustion of the HSR manifested in caspase-dependent apoptotic tumor cell death and tissue damage of triple-negative breast cancer after mEHT monotherapy. Inhibiting the HSR synergistically increased the effect of mEHT. This finding has great translational potential.

Temperature and SAR measurements in deep-body hyperthermia with thermocouple thermometry

Multisensor (7-14) thermocouple thermometry is used at our department for temperature measurement with our 'Coaxial TEM' regional hyperthermia system. A special design of the thermometry system with high resolution (0.005 degrees C) and fast data-acquisition (all channels within 320 ms) together with a pulsed power technique allows assessment of specific absorption rate (SAR) information in patients along catheter tracks. A disadvantage of thermocouple thermometry, EM interference, is almost entirely eliminated by application of absorbing ferrite beads around the probe leads. We investigated the effect of remaining disturbance on the temperature decay after power-off, both experimentally in phantoms and in the clinic, and with numerical simulations. Probe and tissue characteristics influence the response time tau dist of the decay of the disturbance. In our clinical practice a normal pulse sequence is 50 s power-on, 10 s power-off: a response time longer than the power-off time results in a deflection of the temperature course at the start. Based on analysis of temperature decays correction of temperature is possible. A double-pulse technique is introduced to provide an initial correction of temperature, and fast information about accuracy. Sometimes disturbance with a relatively long response time occurs, probably due to a bad contact between probe, catheter and/or tissue. Thermocouple thermometry proved to be suitable to measure the SAR along a catheter track. This is used to optimize the SAR distribution by patient positioning before treatment. A clinical example illustrates this.

The local tissue cooling coefficient: a unified approach to thermal washout and steady-state 'perfusion' calculations

Several investigators have attempted to utilize either transient 'thermal washout' and/or steady-state temperature data from standard hyperthermia thermometry to obtain information regarding both tumour and normal tissue perfusions, and transient data to measure SAR distributions. This paper reviews that literature, presents a unified theoretical basis for all of the temporal 'perfusion' approaches, and shows that both the steady-state and the 'washout' techniques actually measure the same quantity, which is related to, but not equal to, the tissue perfusion. A new nomenclature for the quantity measured by these techniques is proposed, the local tissue cooling coefficient, a name which avoids any use of the term 'perfusion', in order to avoid unwarranted inferences regarding this quantity. The requirements for relating this quantity to the true tissue perfusion are presented, and possible applications of the local tissue cooling coefficient are reviewed. Finally, the techniques used by various investigators for normalizing SAR data are summarized and discussed, and a standard approach suggested.

Perfusion analyses in advanced breast carcinoma during hyperthermia

Blood flow in tumours and healthy tissue determines the ability of obtaining satisfactory temperature distributions in clinical hyperthermia, as well as the success of hyperthermia and radiation treatment. During the hyperthermia treatment, diagnostic data related to tissue blood flow can be determined by analysing the relationship between the amount of power absorbed in the tissue and the resulting temperature rise. The interpretation of the perfusion data (PERF) is highly complicated by the lack of an adequate theory to describe the heat transport in vascularized tissues. In vascularized breast tissues about 10 times as much power is needed to maintain therapeutic temperatures as is necessary in a stationary breast phantom. This large difference in maintenance power levels indicates the extreme importance of blood flow in tissue heat transport. PERF has been determined in 23 patients with advanced breast tumours. In this series (a) perfusion typically did not change during the stationary part of the individual hyperthermic sessions, (b) minimum tumour PERF was not related to tumour volume, and (c) there was no relation between tumour PERF and the ability to heat tumours. PERF can both increase and decrease after successful hyperthermia.

Applied potential tomography for non-invasive temperature mapping in hyperthermia

In the field of hyperthermia for cancer treatment, much effort is being put into the development of non-invasive temperature monitoring so that the trauma of implanting thermocouple or thermistor probes in the patient can be avoided. Preliminary studies investigating the use of applied potential tomography (APT) for this purpose have been reported. APT has the advantages over other tomographic methods that the instrumentation is inexpensive, transportable, and could easily be accommodated in a hyperthermia treatment environment. Moreover, the temperature coefficient of electrical conductivity is large (2% degrees C-1) compared, for example, with the corresponding quantity in CT, the x-ray attenuation coefficient, which changes by only 0.04% degrees C-1. In our experimental system, 16 electrodes were fixed around a cylindrical block of agar simulating a human thigh. The system was driven with 5 mA at 50 kHz. The agar was heated using the 13.56 MHz capacitive system currently in clinical use in this hospital. By relating data sets recorded at different times during heating to a set recorded before heating, images of the temperature change in the agar with time were computed and are presented. The experiment was then repeated in vivo on the thigh of a volunteer.