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Ödén J, Eriksson K, Pavoni B, Crezee H, Kok HP. A Novel Framework for Thermoradiotherapy Treatment Planning. Int J Radiat Oncol Biol Phys 2024; 119:1530-1544. [PMID: 38387812 DOI: 10.1016/j.ijrobp.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Thermoradiotherapy combines radiation therapy with hyperthermia to increase therapeutic effectiveness. Currently, both modalities are optimized separately and in state-of-the-art research the enhanced therapeutic effect is evaluated using equivalent radiation dose in 2-Gy fractions (EQD2). This study proposes a novel thermoradiotherapy treatment planning framework with voxelwise EQD2 radiation therapy optimizing including thermal radiosensitization and direct thermal cytotoxicity. METHODS AND MATERIALS To demonstrate proof-of-concept of the planning framework, 3 strategies consisting of 20 radiation therapy fractions were planned for 4 prostate cancer cases with substantially different temperature distributions: (1) Conventional radiation therapy plan of 60 Gy combined with 4 hyperthermia sessions (RT60 + HT), (2) standalone uniform dose escalation to 68 Gy without hyperthermia (RT68), and (3) uniform target EQD2 that maximizes the tumor control probability (TCP) accounting for voxelwise thermal effects of 4 hyperthermia sessions without increasing normal tissue doses (RTHT + HT). Assessment included dose, EQD2, TCP, and rectal normal tissue complication probability (NTCP), alongside robustness analyses for TCP and NTCP against parameter uncertainties. RESULTS The estimated TCP of around 76% for RT60 without hyperthermia was increased to an average of 85.9% (range, 81.3%-90.5%) for RT60 + HT, 92.5% (92.4%-92.5%) for RT68, and 94.4% (91.7%-96.6%) for RTHT + HT. The corresponding averaged rectal NTCPs were 8.7% (7.9%-10.0%), 14.9% (13.8%-17.1%), and 8.4% (7.5%-9.7%), respectively. RT68 and RTHT + HT exhibited slightly enhanced TCP robustness against parameter uncertainties compared with RT60 + HT, and RT68 presented higher and less robust rectal NTCP values compared with the other planning strategies. CONCLUSIONS This study introduces an innovative thermoradiotherapy planning approach, integrating thermal effects into EQD2-based radiation therapy optimization. Results demonstrate an ability to achieve enhanced and uniform target EQD2 and TCP across various temperature distributions without elevating normal tissue EQD2 or NTCP compared with conventional methods. Although promising for improving clinical outcomes, realizable enhancements depend on accurate tumor- and tissue-specific data and precise quantification of hyperthermic effects, which are seamlessly integrable in the planning framework as they emerge.
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Affiliation(s)
- Jakob Ödén
- RaySearch Laboratories AB, Stockholm, Sweden.
| | | | | | - Hans Crezee
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - H Petra Kok
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Cancer Biology and Immunology, Amsterdam, The Netherlands
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Rahimi F, Nurzed B, Eigentler TW, Berangi M, Oberacker E, Kuehne A, Ghadjar P, Millward JM, Schuhmann R, Niendorf T. Helmet Radio Frequency Phased Array Applicators Enhance Thermal Magnetic Resonance of Brain Tumors. Bioengineering (Basel) 2024; 11:733. [PMID: 39061815 DOI: 10.3390/bioengineering11070733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Thermal Magnetic Resonance (ThermalMR) integrates Magnetic Resonance Imaging (MRI) diagnostics and targeted radio-frequency (RF) heating in a single theranostic device. The requirements for MRI (magnetic field) and targeted RF heating (electric field) govern the design of ThermalMR applicators. We hypothesize that helmet RF applicators (HPA) improve the efficacy of ThermalMR of brain tumors versus an annular phased RF array (APA). An HPA was designed using eight broadband self-grounded bow-tie (SGBT) antennae plus two SGBTs placed on top of the head. An APA of 10 equally spaced SGBTs was used as a reference. Electromagnetic field (EMF) simulations were performed for a test object (phantom) and a human head model. For a clinical scenario, the head model was modified with a tumor volume obtained from a patient with glioblastoma multiforme. To assess performance, we introduced multi-target evaluation (MTE) to ensure whole-brain slice accessibility. We implemented time multiplexed vector field shaping to optimize RF excitation. Our EMF and temperature simulations demonstrate that the HPA improves performance criteria critical to MRI and enhances targeted RF and temperature focusing versus the APA. Our findings are a foundation for the experimental implementation and application of a HPA en route to ThermalMR of brain tumors.
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Affiliation(s)
- Faezeh Rahimi
- Berlin Ultrahigh Field Facility, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- FG Theoretische Elektrotechnik, Technical University of Berlin, 10587 Berlin, Germany
| | - Bilguun Nurzed
- Berlin Ultrahigh Field Facility, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- Technische Universität Berlin, Chair of Medical Engineering, 10587 Berlin, Germany
- Berliner Hochschule für Technik, 13353 Berlin, Germany
| | - Thomas W Eigentler
- Technische Universität Berlin, Chair of Medical Engineering, 10587 Berlin, Germany
| | - Mostafa Berangi
- Berlin Ultrahigh Field Facility, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- MRI.TOOLS GmbH, 13125 Berlin, Germany
| | - Eva Oberacker
- Berlin Ultrahigh Field Facility, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | | | - Pirus Ghadjar
- Department Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jason M Millward
- Berlin Ultrahigh Field Facility, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Joint Cooperation between Charité Unversitätsmedizin and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Rolf Schuhmann
- FG Theoretische Elektrotechnik, Technical University of Berlin, 10587 Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- MRI.TOOLS GmbH, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Joint Cooperation between Charité Unversitätsmedizin and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
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Groen JA, Crezee J, van Laarhoven HWM, Coolen BF, Strijkers GJ, Bijlsma MF, Kok HP. Robust, planning-based targeted locoregional tumour heating in small animals. Phys Med Biol 2024; 69:085017. [PMID: 38471172 DOI: 10.1088/1361-6560/ad3324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/12/2024] [Indexed: 03/14/2024]
Abstract
Objective.To improve hyperthermia in clinical practice, pre-clinical hyperthermia research is essential to investigate hyperthermia effects and assess novel treatment strategies. Translating pre-clinical hyperthermia findings into clinically viable protocols requires laboratory animal treatment techniques similar to clinical hyperthermia techniques. The ALBA micro8 electromagnetic heating system (Med-logix SRL, Rome, Italy) has recently been developed to provide the targeted locoregional tumour heating currently lacking for pre-clinical research. This study evaluates the heat focusing properties of this device and its ability to induce robust locoregional tumour heating under realistic physiological conditions using simulations.Approach.Simulations were performed using the Plan2Heat treatment planning package (Amsterdam UMC, the Netherlands). First, the specific absorption rate (SAR) focus was characterised using a homogeneous phantom. Hereafter, a digital mouse model was used for the characterisation of heating robustness in a mouse. Device settings were optimised for treatment of a pancreas tumour and tested for varying circumstances. The impact of uncertainties in tissue property and perfusion values was evaluated using polynomial chaos expansion. Treatment quality and robustness were evaluated based on SAR and temperature distributions.Main results.The SAR distributions within the phantom are well-focused and can be adjusted to target any specific location. The focus size (full-width half-maximum) is a spheroid with diameters 9 mm (radially) and 20 mm (axially). The mouse model simulations show strong robustness against respiratory motion and intestine and stomach filling (∆T90≤0.14°C).Mouse positioning errors in the cranial-caudal direction lead to∆T90≤0.23°C. Uncertainties in tissue property and perfusion values were found to impact the treatment plan up to 0.56 °C (SD), with a variation onT90of 0.32 °C (1 SD).Significance.Our work shows that the pre-clinical phased-array system can provide adequate and robust locoregional heating of deep-seated target regions in mice. Using our software, robust treatment plans can be generated for pre-clinical hyperthermia research.
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Affiliation(s)
- Jort A Groen
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer biology and immunology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, The Netherlands
| | - Johannes Crezee
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer biology and immunology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Amsterdam, The Netherlands
| | - Bram F Coolen
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Amsterdam UMC location University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Maarten F Bijlsma
- Cancer Center Amsterdam, Cancer biology and immunology, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and biomarkers, Amsterdam, the Netherlands
- Oncode Institute, Amsterdam, The Netherlands
| | - H Petra Kok
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer biology and immunology, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, The Netherlands
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Groen JA, Crezee J, van Laarhoven HWM, Bijlsma MF, Kok HP. Quantification of tissue property and perfusion uncertainties in hyperthermia treatment planning: Multianalysis using polynomial chaos expansion. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107675. [PMID: 37339535 DOI: 10.1016/j.cmpb.2023.107675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/26/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Hyperthermia treatment planning (HTP) tools can guide treatment delivery, particularly with locoregional radiative phased array systems. Uncertainties in tissue and perfusion property values presently lead to quantitative inaccuracy of HTP, leading to sub-optimal treatment. Assessment of these uncertainties would allow for better judgement of the reliability of treatment plans and improve their value for treatment guidance. However, systematically investigating the impact of all uncertainties on treatment plans is a complex, high-dimensional problem and too computationally expensive for traditional Monte Carlo approaches. This study aims to systematically quantify the treatment-plan impact of tissue property uncertainties by investigating their individual contribution to, and combined impact on predicted temperature distributions. METHODS A novel Polynomial Chaos Expansion (PCE)-based HTP uncertainty quantification was developed and applied for locoregional hyperthermia of modelled tumours in the pancreatic head, prostate, rectum, and cervix. Patient models were based on the Duke and Ella digital human models. Using Plan2Heat, treatment plans were created to optimise tumour temperature (represented by T90) for treatment using the Alba4D system. For all 25-34 modelled tissues, the impact of tissue property uncertainties was analysed individually i.e., electrical and thermal conductivity, permittivity, density, specific heat capacity and perfusion. Next, combined analyses were performed on the top 30 uncertainties with the largest impact. RESULTS Uncertainties in thermal conductivity and heat capacity were found to have negligible impact on the predicted temperature ( < 1 × 10-10 °C), density and permittivity uncertainties had a small impact (< 0.3 °C). Uncertainties in electrical conductivity and perfusion can lead to large variations in predicted temperature. However, variations in muscle properties result in the largest impact at locations that could limit treatment quality, with a standard deviation up to almost 6 °C (pancreas) and 3.5 °C (prostate) for perfusion and electrical conductivity, respectively. The combined influence of all significant uncertainties leads to large variations with a standard deviation up to 9.0, 3.6, 3.7 and 4.1 °C for the pancreatic, prostate, rectal and cervical cases, respectively. CONCLUSION Uncertainties in tissue and perfusion property values can have a large impact on predicted temperatures from hyperthermia treatment planning. PCE-based analysis helps to identify all major uncertainties, their impact and judge the reliability of treatment plans.
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Affiliation(s)
- Jort A Groen
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer biology and immunology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, the Netherlands.
| | - Johannes Crezee
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer biology and immunology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, the Netherlands
| | - Maarten F Bijlsma
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer biology and immunology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Imaging and biomarkers, Amsterdam, the Netherlands; Oncode Institute, Amsterdam, the Netherlands
| | - H Petra Kok
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer biology and immunology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and quality of life, Amsterdam, the Netherlands
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Zanoli M, Dobšíček Trefná H. The hot-to-cold spot quotient for SAR-based treatment planning in deep microwave hyperthermia. Int J Hyperthermia 2022; 39:1421-1439. [DOI: 10.1080/02656736.2022.2136411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Massimiliano Zanoli
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Hana Dobšíček Trefná
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
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VilasBoas-Ribeiro I, Franckena M, van Rhoon GC, Hernández-Tamames JA, Paulides MM. Using MRI to measure position and anatomy changes and assess their impact on the accuracy of hyperthermia treatment planning for cervical cancer. Int J Hyperthermia 2022; 40:2151648. [PMID: 36535922 DOI: 10.1080/02656736.2022.2151648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We studied the differences between planning and treatment position, their impact on the accuracy of hyperthermia treatment planning (HTP) predictions, and the relevance of including true treatment anatomy and position in HTP based on magnetic resonance (MR) images. MATERIALS AND METHODS All volunteers were scanned with an MR-compatible hyperthermia device, including a filled waterbolus, to replicate the treatment setup. In the planning setup, the volunteers were scanned without the device to reproduce the imaging in the current HTP. First, we used rigid registration to investigate the patient position displacements between the planning and treatment setup. Second, we performed HTP for the planning anatomy at both positions and the treatment mimicking anatomy to study the effects of positioning and anatomy on the quality of the simulated hyperthermia treatment. Treatment quality was evaluated using SAR-based parameters. RESULTS We found an average displacement of 2 cm between planning and treatment positions. These displacements caused average absolute differences of ∼12% for TC25 and 10.4%-15.9% in THQ. Furthermore, we found that including the accurate treatment position and anatomy in treatment planning led to an improvement of 2% in TC25 and 4.6%-10.6% in THQ. CONCLUSIONS This study showed that precise patient position and anatomy are relevant since these affect the accuracy of HTP predictions. The major part of improved accuracy is related to implementing the correct position of the patient in the applicator. Hence, our study shows a clear incentive to accurately match the patient position in HTP with the actual treatment.
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Affiliation(s)
- Iva VilasBoas-Ribeiro
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martine Franckena
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerard C van Rhoon
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Applied Radiation and Isotopes, Reactor Institute Delft, Delft University of Technology, Delft, The Netherlands
| | - Juan A Hernández-Tamames
- Department of Radiology and Nuclear Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Margarethus M Paulides
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Care and Cure research lab (EM-4C&C) of the Electromagnetics Group, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Kok HP, Crezee J. Adapt2Heat: treatment planning-assisted locoregional hyperthermia by on-line visualization, optimization and re-optimization of SAR and temperature distributions. Int J Hyperthermia 2022; 39:265-277. [PMID: 35109742 DOI: 10.1080/02656736.2022.2032845] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Hyperthermia treatment planning is increasingly used in clinical applications and recommended in quality assurance guidelines. Assistance in phase-amplitude steering during treatment requires dedicated software for on-line visualization of SAR/temperature distributions and fast re-optimization in response to hot spots. As such software tools are not yet commercially available, we developed Adapt2Heat for on-line adaptive hyperthermia treatment planning and illustrate possible application by different relevant real patient examples. METHODS Adapt2Heat was developed as a separate module of the treatment planning software Plan2Heat. Adapt2Heat runs on a Linux operating system and was developed in C++, using the open source Qt, Qwt and VTK libraries. A graphical user interface allows interactive and flexible on-line use of hyperthermia treatment planning. Predicted SAR/temperature distributions and statistics for selected phase-amplitude settings can be visualized instantly and settings can be re-optimized manually or automatically in response to hot spots. RESULTS Pretreatment planning E-Field, SAR and temperature calculations are performed with Plan2Heat and imported in Adapt2Heat. Examples show that Adapt2Heat can be helpful in assisting with phase-amplitude steering, e.g., by suppressing indicated hot spots. The effects of phase-amplitude adjustments on the tumor and potential hot spot locations are comprehensively visualized, allowing intuitive and flexible assistance by treatment planning during locoregional hyperthermia treatments. CONCLUSION Adapt2Heat provides an intuitive and flexible treatment planning tool for on-line treatment planning-assisted hyperthermia. Extensive features for visualization and (re-)optimization during treatment allow practical use in many locoregional hyperthermia applications. This type of tools are indispensable for enhancing the quality of hyperthermia treatment delivery.
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Affiliation(s)
- H Petra Kok
- Department Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes Crezee
- Department Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Kok HP, Crezee J. Fast Adaptive Temperature-Based Re-Optimization Strategies for On-Line Hot Spot Suppression during Locoregional Hyperthermia. Cancers (Basel) 2021; 14:cancers14010133. [PMID: 35008300 PMCID: PMC8749938 DOI: 10.3390/cancers14010133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary When treatment limiting hot spots occur during locoregional hyperthermia (i.e., heating tumors to 40–44 °C for ~1 h), system settings are adjusted based on experience. In this study, we developed and evaluated treatment planning with temperature-based re-optimization and compared the predicted effectiveness to clinically applied protocol/experience-based steering. Re-optimization times were typically ~10 s; sufficiently fast for on-line use. Effective hot spot suppression was predicted, while maintaining adequate tumor heating. Inducing new hot spots was avoided. Temperature-based re-optimization to suppress treatment limiting hot spots seemed feasible to match the effectiveness of long-term clinical experience and will be further evaluated in a clinical setting. When numerical algorithms are proven to match long-term experience, the overall treatment quality within hyperthermia centers can significantly improve. Implementing these strategies would then imply that treatments become less dependent on the experience of the center/operator. Abstract Background: Experience-based adjustments in phase-amplitude settings are applied to suppress treatment limiting hot spots that occur during locoregional hyperthermia for pelvic tumors. Treatment planning could help to further optimize treatments. The aim of this research was to develop temperature-based re-optimization strategies and compare the predicted effectiveness with clinically applied protocol/experience-based steering. Methods: This study evaluated 22 hot spot suppressions in 16 cervical cancer patients (mean age 67 ± 13 year). As a first step, all potential hot spot locations were represented by a spherical region, with a user-specified diameter. For fast and robust calculations, the hot spot temperature was represented by a user-specified percentage of the voxels with the largest heating potential (HPP). Re-optimization maximized tumor T90, with constraints to suppress the hot spot and avoid any significant increase in other regions. Potential hot spot region diameter and HPP were varied and objective functions with and without penalty terms to prevent and minimize temperature increase at other potential hot spot locations were evaluated. Predicted effectiveness was compared with clinically applied steering results. Results: All strategies showed effective hot spot suppression, without affecting tumor temperatures, similar to clinical steering. To avoid the risk of inducing new hot spots, HPP should not exceed 10%. Adding a penalty term to the objective function to minimize the temperature increase at other potential hot spot locations was most effective. Re-optimization times were typically ~10 s. Conclusion: Fast on-line re-optimization to suppress treatment limiting hot spots seems feasible to match effectiveness of ~30 years clinical experience and will be further evaluated in a clinical setting.
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Paulides MM, Rodrigues DB, Bellizzi GG, Sumser K, Curto S, Neufeld E, Montanaro H, Kok HP, Dobsicek Trefna H. ESHO benchmarks for computational modeling and optimization in hyperthermia therapy. Int J Hyperthermia 2021; 38:1425-1442. [PMID: 34581246 DOI: 10.1080/02656736.2021.1979254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The success of cancer hyperthermia (HT) treatments is strongly dependent on the temperatures achieved in the tumor and healthy tissues as it correlates with treatment efficacy and safety, respectively. Hyperthermia treatment planning (HTP) simulations have become pivotal for treatment optimization due to the possibility for pretreatment planning, optimization and decision making, as well as real-time treatment guidance. MATERIALS AND METHODS The same computational methods deployed in HTP are also used for in silico studies. These are of great relevance for the development of new HT devices and treatment approaches. To aid this work, 3 D patient models have been recently developed and made available for the HT community. Unfortunately, there is no consensus regarding tissue properties, simulation settings, and benchmark applicators, which significantly influence the clinical relevance of computational outcomes. RESULTS AND DISCUSSION Herein, we propose a comprehensive set of applicator benchmarks, efficacy and safety optimization algorithms, simulation settings and clinical parameters, to establish benchmarks for method comparison and code verification, to provide guidance, and in view of the 2021 ESHO Grand Challenge (Details on the ESHO grand challenge on HTP will be provided at https://www.esho.info/). CONCLUSION We aim to establish guidelines to promote standardization within the hyperthermia community such that novel approaches can quickly prove their benefit as quickly as possible in clinically relevant simulation scenarios. This paper is primarily focused on radiofrequency and microwave hyperthermia but, since 3 D simulation studies on heating with ultrasound are now a reality, guidance as well as a benchmark for ultrasound-based hyperthermia are also included.
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Affiliation(s)
- Margarethus M Paulides
- Electromagnetics for Care & Cure Laboratory (EM4C&C), Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Radiotherapy, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Dario B Rodrigues
- Hyperthermia Therapy Program, Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, USA
| | - Gennaro G Bellizzi
- Department of Radiotherapy, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Kemal Sumser
- Department of Radiotherapy, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Sergio Curto
- Department of Radiotherapy, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Esra Neufeld
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Hazael Montanaro
- Foundation for Research on Information Technologies in Society (IT'IS), Zurich, Switzerland.,Laboratory for Acoustics/Noise control, Swiss Federal Laboratories for Materials Science and Technology (EMPA), Dubendorf, Switzerland
| | - H Petra Kok
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hana Dobsicek Trefna
- Biomedical Electromagnetics Group, Department of Electrical Engineering, Chalmers University of Technology, Göteborg, Sweden
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Zanoli M, Trefná HD. Suitability of eigenvalue beam-forming for discrete multi-frequency hyperthermia treatment planning. Med Phys 2021; 48:7410-7426. [PMID: 34529281 DOI: 10.1002/mp.15220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Thermal dose delivery in microwave hyperthermia for cancer treatment is expected to benefit from the introduction of ultra-wideband (UWB)-phased array applicators. A full exploitation of the combination of different frequencies to improve the deposition pattern is, however, a nontrivial problem. It is unclear whether the cost functions used for hyperthermia treatment planning (HTP) optimization in the single-frequency setting can be meaningfully extended to the UWB case. METHOD We discuss the ability of the eigenvalue (EV) and a novel implementation of iterative-EV (i-EV) beam-forming methods to fully exploit the available frequency spectrum when a discrete set of simultaneous operating frequencies is available for treatment. We show that the quadratic power deposition ratio solved by the methods can be maximized by only one frequency in the set, therefore rendering EV inadequate for UWB treatment planning. We further investigate whether this represents a limitation in two realistic test cases, comparing the thermal distributions resulting from EV and i-EV to those obtained by optimizing for other nonlinear cost functions that allow for multi-frequency. RESULTS The classical EV-based single-frequency HTP yields systematically lower target SAR deposition and temperature values than nonlinear HTP. In a larynx target, the proposed single-frequency i-EV scheme is able to compensate for this and reach temperatures comparable to those given by global nonlinear optimization. In a meninges target, the multi-frequency setting outperforms the single-frequency one, achieving better target coverage and 0 . 5 ∘ C higher T 90 in the tumor than single-frequency-based HTP. CONCLUSIONS Classical EV performs poorly in terms of resulting target temperatures. The proposed single-frequency i-EV scheme can be a viable option depending on the patient and tumor to be treated, as long as the proper operating frequency can be selected across a UWB range. Multi-frequency HTP can bring a considerable benefit in regions typically difficult to treat such as the brain.
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Affiliation(s)
- Massimiliano Zanoli
- Department of Electrical Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Hana Dobšíček Trefná
- Department of Electrical Engineering, Chalmers University of Technology, Göteborg, Sweden
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11
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Kok HP, van der Zee J, Guirado FN, Bakker A, Datta NR, Abdel-Rahman S, Schmidt M, Wust P, Crezee J. Treatment planning facilitates clinical decision making for hyperthermia treatments. Int J Hyperthermia 2021; 38:532-551. [PMID: 33784914 DOI: 10.1080/02656736.2021.1903583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Treatment quality is important in clinical hyperthermia. Guideline-based treatment protocols are used to determine system settings and treatment strategies to ensure effective tumor heating and prevent unwanted treatment-limiting normal tissue hot spots. Realizing both these goals can prove challenging using generic guideline-based and operator-dependent treatment strategies. Hyperthermia treatment planning (HTP) can be very useful to support treatment strategies. Although HTP is increasingly integrated into the standard clinical workflow, active clinical application is still limited to a small number of hyperthermia centers and should be further stimulated.Purpose: This paper aims to serve as a practical guide, demonstrating how HTP can be applied in clinical decision making for both superficial and locoregional hyperthermia treatments.HTP in clinical decision making: Seven problems that occur in daily clinical practice are described and we show how HTP can enhance insight to formulate an adequate treatment strategy. Examples use representative commercially available hyperthermia devices and cover all stages during the clinical workflow. Problems include selecting adequate phase settings, heating ability analysis, hot spot suppression, applicator selection, evaluation of target coverage and heating depth, and predicting possible thermal toxicity in case of an implant. Since we aim to promote a general use of HTP in daily practice, basic simulation strategies are used in these problems, avoiding a need for the application of dedicated advanced optimization routines that are not generally available.Conclusion: Even fairly basic HTP can facilitate clinical decision making, providing a meaningful and clinically relevant contribution to maintaining and improving treatment quality.
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Affiliation(s)
- H P Kok
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J van der Zee
- Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
| | - F Navarro Guirado
- Department of Medical Physics, Regional University Hospital of Málaga, Malaga, Spain
| | - A Bakker
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N R Datta
- Kantonsspital Aarau, Centre for Radiation Oncology KSA-KSB, Aarau, Switzerland
| | - S Abdel-Rahman
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
| | - M Schmidt
- Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - P Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J Crezee
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Gavazzi S, van Lier ALHMW, Zachiu C, Jansen E, Lagendijk JJW, Stalpers LJA, Crezee H, Kok HP. Advanced patient-specific hyperthermia treatment planning. Int J Hyperthermia 2021; 37:992-1007. [PMID: 32806979 DOI: 10.1080/02656736.2020.1806361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hyperthermia treatment planning (HTP) is valuable to optimize tumor heating during thermal therapy delivery. Yet, clinical hyperthermia treatment plans lack quantitative accuracy due to uncertainties in tissue properties and modeling, and report tumor absorbed power and temperature distributions which cannot be linked directly to treatment outcome. Over the last decade, considerable progress has been made to address these inaccuracies and therefore improve the reliability of hyperthermia treatment planning. Patient-specific electrical tissue conductivity derived from MR measurements has been introduced to accurately model the power deposition in the patient. Thermodynamic fluid modeling has been developed to account for the convective heat transport in fluids such as urine in the bladder. Moreover, discrete vasculature trees have been included in thermal models to account for the impact of thermally significant large blood vessels. Computationally efficient optimization strategies based on SAR and temperature distributions have been established to calculate the phase-amplitude settings that provide the best tumor thermal dose while avoiding hot spots in normal tissue. Finally, biological modeling has been developed to quantify the hyperthermic radiosensitization effect in terms of equivalent radiation dose of the combined radiotherapy and hyperthermia treatment. In this paper, we review the present status of these developments and illustrate the most relevant advanced elements within a single treatment planning example of a cervical cancer patient. The resulting advanced HTP workflow paves the way for a clinically feasible and more reliable patient-specific hyperthermia treatment planning.
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Affiliation(s)
- Soraya Gavazzi
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Cornel Zachiu
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eric Jansen
- Amsterdam UMC, Department of Radiation Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan J W Lagendijk
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas J A Stalpers
- Amsterdam UMC, Department of Radiation Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Crezee
- Amsterdam UMC, Department of Radiation Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - H Petra Kok
- Amsterdam UMC, Department of Radiation Oncology, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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13
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Kok HP, Cressman ENK, Ceelen W, Brace CL, Ivkov R, Grüll H, Ter Haar G, Wust P, Crezee J. Heating technology for malignant tumors: a review. Int J Hyperthermia 2021; 37:711-741. [PMID: 32579419 DOI: 10.1080/02656736.2020.1779357] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 °C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 °C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.
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Affiliation(s)
- H Petra Kok
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik N K Cressman
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Christopher L Brace
- Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Holger Grüll
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Gail Ter Haar
- Department of Physics, The Institute of Cancer Research, London, UK
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Han H, Oberacker E, Kuehne A, Wang S, Eigentler TW, Grass E, Niendorf T. Multi-Channel RF Supervision Module for Thermal Magnetic Resonance Based Cancer Therapy. Cancers (Basel) 2021; 13:1001. [PMID: 33670862 PMCID: PMC7957800 DOI: 10.3390/cancers13051001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 01/24/2023] Open
Abstract
Glioblastoma multiforme (GBM) is the most lethal and common brain tumor. Combining hyperthermia with chemotherapy and/or radiotherapy improves the survival of GBM patients. Thermal magnetic resonance (ThermalMR) is a hyperthermia variant that exploits radio frequency (RF)-induced heating to examine the role of temperature in biological systems and disease. The RF signals' power and phase need to be supervised to manage the formation of the energy focal point, accurate thermal dose control, and safety. Patient position during treatment also needs to be monitored to ensure the efficacy of the treatment and avoid damages to healthy tissue. This work reports on a multi-channel RF signal supervision module that is capable of monitoring and regulating RF signals and detecting patient motion. System characterization was performed for a broad range of frequencies. Monte-Carlo simulations were performed to examine the impact of power and phase errors on hyperthermia performance. The supervision module's utility was demonstrated in characterizing RF power amplifiers and being a key part of a feedback control loop regulating RF signals in heating experiments. Electromagnetic field simulations were conducted to calculate the impact of patient displacement during treatment. The supervision module was experimentally tested for detecting patient motion to a submillimeter level. To conclude, this work presents a cost-effective RF supervision module that is a key component for a hyperthermia hardware system and forms a technological basis for future ThermalMR applications.
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Affiliation(s)
- Haopeng Han
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (H.H.); (E.O.); (T.W.E.)
- Humboldt-Universität zu Berlin, Institute of Computer Science, 10099 Berlin, Germany;
| | - Eva Oberacker
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (H.H.); (E.O.); (T.W.E.)
- Department of Radiation Oncology and Radiotherapy, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | | | - Shuailin Wang
- Beijing Deepvision Technology Co., Ltd., Beijing 100085, China;
| | - Thomas Wilhelm Eigentler
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (H.H.); (E.O.); (T.W.E.)
- Technische Universität Berlin, Chair of Medical Engineering, 10623 Berlin, Germany
| | - Eckhard Grass
- Humboldt-Universität zu Berlin, Institute of Computer Science, 10099 Berlin, Germany;
- IHP–Leibniz-Institut für Innovative Mikroelektronik, 15236 Frankfurt (Oder), Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (H.H.); (E.O.); (T.W.E.)
- MRI.TOOLS GmbH, 13125 Berlin, Germany;
- Experimental and Clinical Research Center (ECRC), A Joint Cooperation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine, 13125 Berlin, Germany
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15
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van der Horst A, Kok HP, Crezee J. Effect of gastrointestinal gas on the temperature distribution in pancreatic cancer hyperthermia treatment planning. Int J Hyperthermia 2021; 38:229-240. [PMID: 33602033 DOI: 10.1080/02656736.2021.1882709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE In pancreatic cancer treatment, hyperthermia can be added to increase efficacy of chemo- and/or radiotherapy. Gas in stomach, intestines and colon is often in close proximity to the target volume. We investigated the impact of variations in gastrointestinal gas (GG) on temperature distributions during simulated hyperthermia treatment (HT). METHODS We used sets of one CT and eight cone-beam CT (CBCT) scans obtained prior to/during fractionated image-guided radiotherapy in four pancreatic cancer patients. In Plan2Heat, we simulated locoregional heating by an ALBA-4D phased array radiofrequency system and calculated temperature distributions for (i) the segmented CT (sCT), (ii) sCT with GG replaced by muscle (sCT0), (iii) sCT0 with eight different GG distributions as visible on CBCT inserted (sCTCBCT). We calculated cumulative temperature-volume histograms for the clinical target volume (CTV) for all ten temperature distributions for each patient and investigated the relationship between GG volume and change in ΔT50 (temperature increase at 50% of CTV volume). We determined location and volume of normal tissue receiving a high thermal dose. RESULTS GG volume on CBCT varied greatly (9-991 cm3). ΔT50 increased for increasing GG volume; maximum ΔT50 difference per patient was 0.4-0.6 °C. The risk for GG-associated treatment-limiting hot spots appeared low. Normal tissue high-temperature regions mostly occurred anteriorly; their volume and maximum temperature showed moderate positive correlations with GG volume, while fat-muscle interfaces were associated with higher risks for hot spots. CONCLUSIONS Considerable changes in volume and position of gastrointestinal gas can occur and are associated with clinically relevant tumor temperature differences.
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Affiliation(s)
- Astrid van der Horst
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H Petra Kok
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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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] [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] [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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18
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Schooneveldt G, Kok HP, Bakker A, Geijsen ED, Rasch CRN, Rosette JJMCHDL, Hulshof MCCM, Reijke TMD, Crezee H. Clinical validation of a novel thermophysical bladder model designed to improve the accuracy of hyperthermia treatment planning in the pelvic region. Int J Hyperthermia 2018; 35:383-397. [PMID: 30381980 DOI: 10.1080/02656736.2018.1506164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Hyperthermia treatment planning for deep locoregional hyperthermia treatment may assist in phase and amplitude steering to optimize the temperature distribution. This study aims to incorporate a physically correct description of bladder properties in treatment planning, notably the presence of convection and absence of perfusion within the bladder lumen, and to assess accuracy and clinical implications for non muscle invasive bladder cancer patients treated with locoregional hyperthermia. METHODS We implemented a convective thermophysical fluid model based on the Boussinesq approximation to the Navier-Stokes equations using the (finite element) OpenFOAM toolkit. A clinician delineated the bladder on CT scans obtained from 14 bladder cancer patients. We performed (1) conventional treatment planning with a perfused muscle-like solid bladder, (2) with bladder content properties without and (3) with flow dynamics. Finally, we compared temperature distributions predicted by the three models with temperature measurements obtained during treatment. RESULTS Much higher and more uniform bladder temperatures are predicted with physically accurate fluid modeling compared to previously employed muscle-like models. The differences reflect the homogenizing effect of convection, and the absence of perfusion. Median steady state temperatures simulated with the novel convective model (3) deviated on average -0.6 °C (-12%) from values measured during treatment, compared to -3.7 °C (-71%) and +1.5 °C (+29%) deviation for the muscle-like (1) and static (2) models, respectively. The Grashof number was 3.2 ± 1.5 × 105 (mean ± SD). CONCLUSIONS Incorporating fluid modeling in hyperthermia treatment planning yields significantly improved predictions of the temperature distribution in the bladder lumen during hyperthermia treatment.
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Affiliation(s)
- Gerben Schooneveldt
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - H Petra Kok
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - Akke Bakker
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - Elisabeth D Geijsen
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - Coen R N Rasch
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | | | - Maarten C C M Hulshof
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - Theo M de Reijke
- b Department of Urology , Academic Medical Center , Amsterdam , the Netherlands
| | - Hans Crezee
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
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Schooneveldt G, Kok HP, Bakker A, Geijsen ED, Hulshof MCCM, Reijke TMD, Crezee J. The effect of air pockets in the urinary bladder on the temperature distribution during loco-regional hyperthermia treatment of bladder cancer patients. Int J Hyperthermia 2018; 35:441-449. [PMID: 30303415 DOI: 10.1080/02656736.2018.1506890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Loco-regional hyperthermia combined with mitomycin C is used for treatment of nonmuscle invasive bladder cancer (NMIBC). Air pockets may be present in the bladder during treatment. The aim of this study is to quantify the effect of air pockets on the thermal dose of the bladder. METHODS We analysed 16 patients treated for NMIBC. Loco-regional hyperthermia was performed with the in-house developed 70 MHz AMC-4 hyperthermia device. We simulated treatments with the clinically applied device settings using Plan2Heat (developed in-house) including the air pockets delineated on CT scans made following treatment, and with the same volume filled with urine. Temperature distributions simulated with and without air pockets were compared. RESULTS The average air and fluid volumes in the bladder were 6.0 ml (range 0.8 - 19.3 ml) and 183 ml (range 47-322 ml), respectively. The effect of these air pockets varied strongly between patients. Averaged over all patients, the median bladder wall temperature (T50) remained unchanged when an air pocket was present. Temperature changes exceeded ±0.2 °C in, on average, 23% of the bladder wall volume (range 1.3-59%), in 6.0% (range 0.6-20%) changes exceeded ±0.5 °C and in 3.2% (range 0.0-7.4%) changes exceeded ±1.0 °C. There was no correlation between the differences in temperature and the air pocket or bladder volume. There was a positive correlation between air pocket surface and temperature heterogeneity. CONCLUSION Presence of air causes more heterogeneous bladder wall temperatures and lower T90, particularly for larger air pockets. The size of air pockets must therefore be minimized during bladder hyperthermia treatments.
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Affiliation(s)
- G Schooneveldt
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - H P Kok
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - A Bakker
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - E D Geijsen
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - M C C M Hulshof
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - T M de Reijke
- b Department of Urology , Academic Medical Center , Amsterdam , The Netherlands
| | - J Crezee
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
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Kok HP, Schooneveldt G, Bakker A, de Kroon-Oldenhof R, Korshuize-van Straten L, de Jong CE, Steggerda-Carvalho E, Geijsen ED, Stalpers LJA, Crezee J. Predictive value of simulated SAR and temperature for changes in measured temperature after phase-amplitude steering during locoregional hyperthermia treatments. Int J Hyperthermia 2018; 35:330-339. [DOI: 10.1080/02656736.2018.1500720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- H. P. Kok
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G. Schooneveldt
- 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
| | - L. Korshuize-van Straten
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C. E. de Jong
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E. Steggerda-Carvalho
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E. D. Geijsen
- 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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Kok HP, Navarro F, Strigari L, Cavagnaro M, Crezee J. Locoregional hyperthermia of deep-seated tumours applied with capacitive and radiative systems: a simulation study. Int J Hyperthermia 2018; 34:714-730. [PMID: 29509043 DOI: 10.1080/02656736.2018.1448119] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Locoregional hyperthermia is applied to deep-seated tumours in the pelvic region. Two very different heating techniques are often applied: capacitive and radiative heating. In this paper, numerical simulations are applied to compare the performance of both techniques in heating of deep-seated tumours. METHODS Phantom simulations were performed for small (30 × 20 × 50 cm3) and large (45 × 30 × 50 cm3), homogeneous fatless and inhomogeneous fat-muscle, tissue-equivalent phantoms with a central or eccentric target region. Radiative heating was simulated with the 70 MHz AMC-4 system and capacitive heating was simulated at 13.56 MHz. Simulations were performed for small fatless, small (i.e. fat layer typically <2 cm) and large (i.e. fat layer typically >3 cm) patients with cervix, prostate, bladder and rectum cancer. Temperature distributions were simulated using constant hyperthermic-level perfusion values with tissue constraints of 44 °C and compared for both heating techniques. RESULTS For the small homogeneous phantom, similar target heating was predicted with radiative and capacitive heating. For the large homogeneous phantom, most effective target heating was predicted with capacitive heating. For inhomogeneous phantoms, hot spots in the fat layer limit adequate capacitive heating, and simulated target temperatures with radiative heating were 2-4 °C higher. Patient simulations predicted therapeutic target temperatures with capacitive heating for fatless patients, but radiative heating was more robust for all tumour sites and patient sizes, yielding target temperatures 1-3 °C higher than those predicted for capacitive heating. CONCLUSION Generally, radiative locoregional heating yields more favourable simulated temperature distributions for deep-seated pelvic tumours, compared with capacitive heating. Therapeutic temperatures are predicted for capacitive heating in patients with (almost) no fat.
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Affiliation(s)
- H P Kok
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - F Navarro
- b Department of Medical Physics , Regional University Hospital of Málaga , Malaga , Spain
| | - L Strigari
- c Laboratory of Medical Physics and Expert Systems , Regina Elena National Cancer Institute , Rome , Italy
| | - M Cavagnaro
- d Department of Information Engineering, Electronics and Telecommunications , Sapienza University of Rome , Rome , Italy
| | - J Crezee
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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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] [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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Hallasch S, Frick S, Jung M, Hilger I. How gastrin-releasing peptide receptor (GRPR) and α vβ 3 integrin expression reflect reorganization features of tumors after hyperthermia treatments. Sci Rep 2017; 7:6916. [PMID: 28761146 PMCID: PMC5537297 DOI: 10.1038/s41598-017-06100-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/07/2017] [Indexed: 12/19/2022] Open
Abstract
The outcome of tumor treatment via hyperthermia in the clinic has been reported to be heterogeneous. Here, we assessed how the presence of gastrin-releasing peptide receptor (GRPR) and αvβ3 integrin together with the morphology of the vascularization reflects the growth behavior of tumors after hyperthermia treatment. MDA-MB-231 tumor bearing mice were treated either with high (46 °C) or low dose (42 °C) water hyperthermia for 60 min. Changes of GRPR and αvβ3 integrin expression were assessed via multiplexed optical imaging. Vascularization was reconstructed and quantified by µCT imaging after contrast agent injection. We found that high dose hyperthermia is capable of increasing the expression of GRPR, αvβ3 integrin, CD31, and Ki67 in tumors. Also the morphology of tumor vasculature changed (increased relative blood volume and small-diameter vessel density, decreased expression of α-SMA). Low dose hyperthermia induced comparatively moderate effects on the investigated protein expression pattern and vascular remodeling. We conclude that under defined circumstances, specific temperature doses affect the reorganization of tumor regrowth, which is triggered by residual "dormant" cells even though tumor volumes are transiently decreasing. Further on, GRPR, αvβ3 integrin expression are versatile tools to surveil potential tumor regrow during therapy, beyond the conventional determination of tumor volumes.
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Affiliation(s)
- Sandra Hallasch
- Department of Experimental Radiology, Institute for Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, D-07747, Jena, Germany
| | - Sindy Frick
- Department of Experimental Radiology, Institute for Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, D-07747, Jena, Germany
| | - Maximilian Jung
- Department of Experimental Radiology, Institute for Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, D-07747, Jena, Germany
- Department of Medical Engineering and Biotechnology, University of Applied Science Jena, Carl-Zeiss Promenade 2, 07745, Jena, Germany
| | - Ingrid Hilger
- Department of Experimental Radiology, Institute for Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, D-07747, Jena, Germany.
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van Rhoon GC, Paulides MM, van Holthe JML, Franckena M. Hyperthermia by electromagnetic fields to enhanced clinical results in oncology. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:359-362. [PMID: 28324929 DOI: 10.1109/embc.2016.7590714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Confining treatment to the tumor to improve therapeutic outcome and reduce toxicity, is a hot issue in cancer research. Hyperthermia is recognized as a strong sensitizer for radiotherapy and chemotherapy enhancing tumor control without increasing toxicity. Today's electromagnetic hyperthermia systems heat large tissue volumes with limited ability to selectively heat the tumor. Fortunately, tremendous improvements in 3-dimensional electromagnetic & temperature modelling provide an exciting opportunity to design advanced multi-element electromagnetic applicator systems. Together with feedback control using MR non-invasive thermometry and smart E-field sensors, this paves the way for selective tumor heating and potentially prescription of a thermal dose. A technological advanced hyperthermia system, with guaranteed delivery of high quality hyperthermia lowers the threshold for newcomers to apply hyperthermia. Combined with recent proof that hyperthermia blocks DNA repair and new, exciting, ways for controlled drug delivery using temperature sensitive liposome encapsulated drugs, this is expected to increase interest of the medical community in hyperthermia.
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Online Adaptive Hyperthermia Treatment Planning During Locoregional Heating to Suppress Treatment-Limiting Hot Spots. Int J Radiat Oncol Biol Phys 2017; 99:1039-1047. [PMID: 28870786 DOI: 10.1016/j.ijrobp.2017.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [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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Peeken JC, Vaupel P, Combs SE. Integrating Hyperthermia into Modern Radiation Oncology: What Evidence Is Necessary? Front Oncol 2017; 7:132. [PMID: 28713771 PMCID: PMC5492395 DOI: 10.3389/fonc.2017.00132] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/06/2017] [Indexed: 12/13/2022] Open
Abstract
Hyperthermia (HT) is one of the hot topics that have been discussed over decades. However, it never made its way into primetime. The basic biological rationale of heat to enhance the effect of radiation, chemotherapeutic agents, and immunotherapy is evident. Preclinical work has confirmed this effect. HT may trigger changes in perfusion and oxygenation as well as inhibition of DNA repair mechanisms. Moreover, there is evidence for immune stimulation and the induction of systemic immune responses. Despite the increasing number of solid clinical studies, only few centers have included this adjuvant treatment into their repertoire. Over the years, abundant prospective and randomized clinical data have emerged demonstrating a clear benefit of combined HT and radiotherapy for multiple entities such as superficial breast cancer recurrences, cervix carcinoma, or cancers of the head and neck. Regarding less investigated indications, the existing data are promising and more clinical trials are currently recruiting patients. How do we proceed from here? Preclinical evidence is present. Multiple indications benefit from additional HT in the clinical setting. This article summarizes the present evidence and develops ideas for future research.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Peter Vaupel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, München, Germany.,Department of Radiation Sciences (DRS), Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Neuherberg, Germany
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van Stam G, Kok HP, Hulshof MCCM, Kolff MW, van Tienhoven G, Sijbrands J, Bakker A, Zum Vörde Sive Vörding PJ, Oldenborg S, de Greef M, Rasch CRN, Crezee H. A flexible 70 MHz phase-controlled double waveguide system for hyperthermia treatment of superficial tumours with deep infiltration. Int J Hyperthermia 2017; 33:796-809. [PMID: 28540800 DOI: 10.1080/02656736.2017.1313460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Superficial tumours with deep infiltration in the upper 15 cm of the trunk cannot be treated adequately with existing hyperthermia systems. The aim of this study was to develop, characterise and evaluate a new flexible two-channel hyperthermia system (AMC-2) for tumours in this region. MATERIALS AND METHODS The two-channel AMC-2 system has two horizontally revolving and height adjustable 70 MHz waveguides. Three different interchangeable antennas with sizes 20 × 34, 15 × 34 and 8.5 × 34 cm were developed and their electrical properties were determined. The performance of the AMC-2 system was tested by measurements of the electric field distribution in a saline water filled elliptical phantom, using an electric field vector probe. Clinical feasibility was demonstrated by treatment of a melanoma in the axillary region. RESULTS Phantom measurements showed a good performance for all waveguides. The large reflection of the smallest antenna has to be compensated by increased forward power. Field patterns become asymmetrical when using smaller top antennas, necessitating phase corrections. The clinical application showed that tumours deeper than 4 cm can be heated adequately. A median tumour temperature of 42 °C can be reached up to 12 cm depth with adequate antenna positioning and phase-amplitude steering. CONCLUSIONS This 70 MHz AMC-2 waveguide system is a useful addition to existing loco-regional hyperthermia equipment as it is capable of heating axillary tumours and other tumours deeper than 4 cm.
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Affiliation(s)
- Gerard van Stam
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands.,b Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau , Aarau , Switzerland
| | - H Petra Kok
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | - Maarten C C M Hulshof
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | - M Willemijn Kolff
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | - Geertjan van Tienhoven
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | - Jan Sijbrands
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | - Akke Bakker
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | | | - Sabine Oldenborg
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | - Martijn de Greef
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | - Coen R N Rasch
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
| | - Hans Crezee
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , t he Netherlands
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Kok HP, Kotte ANTJ, Crezee J. Planning, optimisation and evaluation of hyperthermia treatments. Int J Hyperthermia 2017; 33:593-607. [PMID: 28540779 DOI: 10.1080/02656736.2017.1295323] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hyperthermia treatment planning using dedicated simulations of power and temperature distributions is very useful to assist in hyperthermia applications. This paper describes an advanced treatment planning software package for a wide variety of applications. METHODS The in-house developed C++ software package Plan2Heat runs on a Linux operating system. Modules are available to perform electric field and temperature calculations for many heating techniques. The package also contains optimisation routines, post-treatment evaluation tools and a sophisticated thermal model enabling to account for 3D vasculature based on an angiogram or generated artificially using a vessel generation algorithm. The use of the software is illustrated by a simulation of a locoregional hyperthermia treatment for a pancreatic cancer patient and a spherical tumour model heated by interstitial hyperthermia, with detailed 3D vasculature included. RESULTS The module-based set-up makes the software flexible and easy to use. The first example demonstrates that treatment planning can help to focus the heating to the tumour. After optimisation, the simulated absorbed power in the tumour increased with 50%. The second example demonstrates the impact of accurately modelling discrete vasculature. Blood at body core temperature entering the heated volume causes relatively cold tracks in the heated volume, where the temperature remains below 40 °C. CONCLUSIONS A flexible software package for hyperthermia treatment planning has been developed, which can be very useful in many hyperthermia applications. The object-oriented structure of the source code allows relatively easy extension of the software package with additional tools when necessary for future applications.
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Affiliation(s)
- H P Kok
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - A N T J Kotte
- b Department of Radiotherapy , University Medical Center Utrecht , Utrecht , The Netherlands
| | - J Crezee
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Longo TA, Gopalakrishna A, Tsivian M, Van Noord M, Rasch CR, Inman BA, Geijsen ED. A systematic review of regional hyperthermia therapy in bladder cancer. Int J Hyperthermia 2016; 32:381-9. [PMID: 27134130 DOI: 10.3109/02656736.2016.1157903] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
CONTEXT Bladder cancer therapy remains suboptimal as morbidity and mortality remain high amongst those with non-muscle-invasive and muscle-invasive disease. Regional hyperthermia therapy (RHT) is a promising adjunctive therapy being tested in multiple clinical contexts. OBJECTIVE The aim of this study was to systematically review the literature on the efficacy and toxicity of RHT. EVIDENCE ACQUISITION This systematic review was registered with the PROSPERO database (Registration number: CRD42015025780) and was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We queried PubMed, EMBASE, and Cochrane libraries. Two reviewers reviewed abstracts independently and a third reviewer arbitrated disagreements. The last search was performed on 28 August 2015. A descriptive analysis was performed and quality assessment was conducted using the Newcastle-Ottawa Quality Assessment Scale for observational studies, and the Cochrane Risk of Bias Assessment Tool for trials. EVIDENCE SYNTHESIS We identified 859 publications in the initial search, of which 24 met inclusion criteria for full-text review. Of these, we were able to obtain data on the outcomes of interest for 15 publications. CONCLUSIONS The review underscores the limited nature of the evidence; definitive conclusions are elusive. However, the promising results of RHT in the setting of intravesical chemotherapy, chemotherapy and radiotherapy show a trend towards legitimate efficacy.
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Affiliation(s)
- Thomas A Longo
- a Division of Urology , Duke University Medical Center , Durham , North Carolina
| | - Ajay Gopalakrishna
- a Division of Urology , Duke University Medical Center , Durham , North Carolina
| | - Matvey Tsivian
- a Division of Urology , Duke University Medical Center , Durham , North Carolina
| | - Megan Van Noord
- b Research and Education Services, Duke University Medical Center , Durham , North Carolina , USA
| | - Coen R Rasch
- c Academic Medical Centre , Amsterdam , the Netherlands
| | - Brant A Inman
- a Division of Urology , Duke University Medical Center , Durham , North Carolina
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Crezee J, van Leeuwen CM, Oei AL, van Heerden LE, Bel A, Stalpers LJA, Ghadjar P, Franken NAP, Kok HP. Biological modelling of the radiation dose escalation effect of regional hyperthermia in cervical cancer. Radiat Oncol 2016; 11:14. [PMID: 26831185 PMCID: PMC4735973 DOI: 10.1186/s13014-016-0592-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/20/2016] [Indexed: 12/25/2022] Open
Abstract
Background Locoregional hyperthermia combined with radiotherapy significantly improves locoregional control and overall survival for cervical tumors compared to radiotherapy alone. In this study biological modelling is applied to quantify the effect of radiosensitization for three cervical cancer patients to evaluate the improvement in equivalent dose for the combination treatment with radiotherapy and hyperthermia. Methods The Linear-Quadratic (LQ) model extended with temperature-dependent LQ-parameters α and β was used to model radiosensitization by hyperthermia and to calculate the conventional radiation dose that is equivalent in biological effect to the combined radiotherapy and hyperthermia treatment. External beam radiotherapy planning was performed based on a prescription dose of 46Gy in 23 fractions of 2Gy. Hyperthermia treatment using the AMC-4 system was simulated based on the actual optimized system settings used during treatment. Results The simulated hyperthermia treatments for the 3 patients yielded a T50 of 40.1 °C, 40.5 °C, 41.1 °C and a T90 of 39.2 °C, 39.7 °C, 40.4 °C, respectively. The combined radiotherapy and hyperthermia treatment resulted in a D95 of 52.5Gy, 55.5Gy, 56.9Gy in the GTV, a dose escalation of 7.3–11.9Gy compared to radiotherapy alone (D95 = 45.0–45.5Gy). Conclusions This study applied biological modelling to evaluate radiosensitization by hyperthermia as a radiation-dose escalation for cervical cancer patients. This model is very useful to compare the effectiveness of different treatment schedules for combined radiotherapy and hyperthermia treatments and to guide the design of clinical studies on dose escalation using hyperthermia in a multi-modality setting.
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Affiliation(s)
- J Crezee
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - C M van Leeuwen
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - A L Oei
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Laboratory for Experimental Oncology and Radiobiology (LEXOR)/Center for Experimental and Molecular Medicine, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - L E van Heerden
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - A Bel
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - L J A Stalpers
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - P Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.
| | - N A P Franken
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Laboratory for Experimental Oncology and Radiobiology (LEXOR)/Center for Experimental and Molecular Medicine, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - H P Kok
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Crezee H, van Leeuwen CM, Oei AL, Stalpers LJA, Bel A, Franken NA, Kok HP. Thermoradiotherapy planning: Integration in routine clinical practice. Int J Hyperthermia 2015; 32:41-9. [PMID: 26670625 DOI: 10.3109/02656736.2015.1110757] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Planning of combined radiotherapy and hyperthermia treatments should be performed taking the synergistic action between the two modalities into account. This work evaluates the available experimental data on cytotoxicity of combined radiotherapy and hyperthermia treatment and the requirements for integration of hyperthermia and radiotherapy treatment planning into a single planning platform. The underlying synergistic mechanisms of hyperthermia include inhibiting DNA repair, selective killing of radioresistant hypoxic tumour tissue and increased radiosensitivity by enhanced tissue perfusion. Each of these mechanisms displays different dose-effect relations, different optimal time intervals and different optimal sequences between radiotherapy and hyperthermia. Radiosensitisation can be modelled using the linear-quadratic (LQ) model to account for DNA repair inhibition by hyperthermia. In a recent study, an LQ model-based thermoradiotherapy planning (TRTP) system was used to demonstrate that dose escalation by hyperthermia is equivalent to ∼10 Gy for prostate cancer patients treated with radiotherapy. The first step for more reliable TRTP is further expansion of the data set of LQ parameters for normally oxygenated normal and tumour tissue valid over the temperature range used clinically and for the relevant time intervals between radiotherapy and hyperthermia. The next step is to model the effect of hyperthermia in hypoxic tumour cells including the physiological response to hyperthermia and the resulting reoxygenation. Thermoradiotherapy planning is feasible and a necessity for an optimal clinical application of hyperthermia combined with radiotherapy in individual patients.
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Affiliation(s)
- Hans Crezee
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and
| | | | - Arlene L Oei
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and.,b Laboratory for Experimental Oncology and Radiobiology , Academic Medical Centre , Amsterdam , The Netherlands
| | - Lukas J A Stalpers
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and
| | - Arjan Bel
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and
| | - Nicolaas A Franken
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and.,b Laboratory for Experimental Oncology and Radiobiology , Academic Medical Centre , Amsterdam , The Netherlands
| | - H Petra Kok
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and
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Geijsen ED, de Reijke TM, Koning CC, Zum Vörde Sive Vörding PJ, de la Rosette JJ, Rasch CR, van Os RM, Crezee J. Combining Mitomycin C and Regional 70 MHz Hyperthermia in Patients with Nonmuscle Invasive Bladder Cancer: A Pilot Study. J Urol 2015; 194:1202-8. [DOI: 10.1016/j.juro.2015.05.102] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Elisabeth D. Geijsen
- Departments of Radiation Oncology and Urology (TMdR, JJdlR), Academic Medical Center, Amsterdam, The Netherlands
| | - Theo M. de Reijke
- Departments of Radiation Oncology and Urology (TMdR, JJdlR), Academic Medical Center, Amsterdam, The Netherlands
| | - Caro C. Koning
- Departments of Radiation Oncology and Urology (TMdR, JJdlR), Academic Medical Center, Amsterdam, The Netherlands
| | | | - Jean J. de la Rosette
- Departments of Radiation Oncology and Urology (TMdR, JJdlR), Academic Medical Center, Amsterdam, The Netherlands
| | - Coen R. Rasch
- Departments of Radiation Oncology and Urology (TMdR, JJdlR), Academic Medical Center, Amsterdam, The Netherlands
| | - Rob M. van Os
- Departments of Radiation Oncology and Urology (TMdR, JJdlR), Academic Medical Center, Amsterdam, The Netherlands
| | - Johannes Crezee
- Departments of Radiation Oncology and Urology (TMdR, JJdlR), Academic Medical Center, Amsterdam, The Netherlands
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Kok HP, Wust P, Stauffer PR, Bardati F, van Rhoon GC, Crezee J. Current state of the art of regional hyperthermia treatment planning: a review. Radiat Oncol 2015; 10:196. [PMID: 26383087 PMCID: PMC4574087 DOI: 10.1186/s13014-015-0503-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/08/2015] [Indexed: 01/15/2023] Open
Abstract
Locoregional hyperthermia, i.e. increasing the tumor temperature to 40–45 °C using an external heating device, is a very effective radio and chemosensitizer, which significantly improves clinical outcome. There is a clear thermal dose-effect relation, but the pursued optimal thermal dose of 43 °C for 1 h can often not be realized due to treatment limiting hot spots in normal tissue. Modern heating devices have a large number of independent antennas, which provides flexible power steering to optimize tumor heating and minimize hot spots, but manual selection of optimal settings is difficult. Treatment planning is a very valuable tool to improve locoregional heating. This paper reviews the developments in treatment planning software for tissue segmentation, electromagnetic field calculations, thermal modeling and optimization techniques. Over the last decade, simulation tools have become more advanced. On-line use has become possible by implementing algorithms on the graphical processing unit, which allows real-time computations. The number of applications using treatment planning is increasing rapidly and moving on from retrospective analyses towards assisting prospective clinical treatment strategies. Some clinically relevant applications will be discussed.
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Affiliation(s)
- H P Kok
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - P Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - P R Stauffer
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - F Bardati
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata, Rome, Italy.
| | - G C van Rhoon
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - J Crezee
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, 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: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [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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