Reliability of temperature and SAR measurements at oesophageal tumour locations

Orthotopic Esophageal Cancers: Intraesophageal Hyperthermia-enhanced Direct Chemotherapy in Rats

Purpose To determine the feasibility of using intraesophageal radiofrequency (RF) hyperthermia to enhance local chemotherapy in a rat model with orthotopic esophageal squamous cancers. Materials and Methods The animal protocol was approved by the institutional animal care and use committee and the institutional review board. Human esophageal squamous cancer cells were transduced with luciferase lentiviral particles. Cancer cells, mice with subcutaneous cancer esophageal xenografts, and nude rats with orthotopic esophageal cancers in four study groups of six animals per group were treated with (a) combination therapy of magnetic resonance imaging heating guidewire-mediated RF hyperthermia (42°C) plus local chemotherapy (cisplatin and 5-fluorouracil), (b) chemotherapy alone, (c) RF hyperthermia alone, and (d) phosphate-buffered saline. Bioluminescent optical imaging and transcutaneous ultrasonographic imaging were used to observe bioluminescence signal and changes in tumor size among the groups over 2 weeks, which were correlated with subsequent histologic results. The nonparametric Mann-Whitney U test was used for comparisons of variables. Results Compared with chemotherapy alone, RF hyperthermia alone, and phosphate-buffered saline, combination therapy with RF hyperthermia and chemotherapy induced the lowest cell proliferation (relative absorbance of formazan: 23.4% ± 7, 44.6% ± 7.5, 95.8% ± 2, 100%, respectively; P < .0001), rendered the smallest relative tumor volume (0.65 mm³ ± 0.15, P < .0001) and relative bioluminescence optical imaging photon signal (0.57 × 10⁷ photons per second per square millimeter ± 0.15, P < .001) of mice with esophageal cancer xenografts, as well as the smallest relative tumor volume (0.68 mm³ ± 0.13, P < .05) and relative photon signal (0.56 × 10⁷ photons per second per square millimeter ± 0.11. P < .001) of rat orthotopic esophageal cancers. Conclusion Intraesophageal RF hyperthermia can enhance the effect of chemotherapy on esophageal squamous cell cancers. ^© RSNA, 2016.

On verification of hyperthermia treatment planning for cervical carcinoma patients

PURPOSE

The aim of this study was to verify hyperthermia treatment planning calculations by means of measurements performed during hyperthermia treatments. The calculated specific absorption rate (SAR(calc)) was compared with clinically measured SAR values, during 11 treatments in seven cervical carcinoma patients.

METHODS

Hyperthermia treatments were performed using the 70 MHz AMC-4 waveguide system. Temperatures were measured using multisensor thermocouple probes. One invasive thermometry catheter in the cervical tumour and two non-invasive catheters in the vagina were used. For optimal tissue contact and fixation of the catheters, a gynaecological tampon was inserted, moisturized with distilled water (4 treatments), or saline (6 treatments) for better thermal contact. During one treatment no tampon was used. At the start of treatment the temperature rise (DeltaT(meas)) after a short power pulse was measured, which is proportional to SAR(meas). The SAR(calc) along the catheter tracks was extracted from the calculated SAR distribution and compared with the DeltaT(meas)-profiles.

RESULTS

The correlation between DeltaT(meas) and SAR(calc) was on average R = 0.56 +/- 0.28, but appeared highly dependent on the wetness of the tampon (preferably with saline) and the tissue contact of the catheters. Correlations were strong (R approximately 0.85-0.93) when thermal contact was good, but much weaker (R approximately 0.14-0.48) for cases with poor thermal contact.

CONCLUSION

Good correlations between measurements and calculations were found when tissue contact of the catheters was good. The main difficulties for accurate verification were of clinical nature, arising from improper use of the gynaecological tampon. Poor thermal contact between thermocouples and tissue caused measurement artefacts that were difficult to correlate with calculations.

Current status of antivascular therapy and targeted treatment in the clinic

Antivascular and targeted therapy are now an integrated part of the treatment of myelogenous leukemias, GIST tumours, B-cell lymphomas and breast cancer. In various malignancies improved responses and prolongation of survival for several months is regularly reported. The progress in this field is relevant for hyperthermia. Heat has among other effects documented antivascular effects, and can be considered as one of the established methods in the field based on several randomised phase III studies. Hyperthermia should be considered for combination with other antiangiogenic agents.

Artefacts in intracavitary temperature measurements during regional hyperthermia

For adequate hyperthermia treatments, reliable temperature information during treatment is essential. During regional hyperthermia, temperature information is preferably obtained non-invasively from intracavitary or intraluminal measurements to avoid implant risks for the patient. However, for intracavitary or intraluminal thermometry optimal tissue contact is less natural as for invasive thermometry. In this study, the reliability of intraluminal/intracavitary measurements was examined in phantom experiments and in a numerical model for various extents of thermal contact between thermometry and the surroundings. Both thermocouple probes and fibre optic probes were investigated. Temperature rises after a 30 s power pulse of the 70 MHz AMC-4 hyperthermia system were measured in a tissue-equivalent phantom using a multisensor thermocouple probe placed centrally in a hollow tube. The tube was filled with (1) air, (2) distilled water or (3) saline solution that mimics the properties of tissue, simulating situations with (1) bad thermal contact and no power dissipation in the tube, (2) good thermal contact but no power dissipation or (3) good thermal contact and tissue representative power dissipation. For numerical simulations, a cylindrical symmetric model of a thermocouple probe or a fibre optic probe in a cavity was developed. The cavity was modelled as air, distilled water or saline solution. A generalised E-Field distribution was assumed, resulting in a power deposition. With this power deposition, the temperature rise after a 30 s power pulse was calculated. When thermal contact was bad (1), both phantom measurements and simulations with a thermocouple probe showed very high temperature rises (>0.5 degrees C), which are artefacts due to self-heating of the thermocouple probe, since no power is dissipated in air. Simulations with a fibre optic probe showed almost no temperature rise when the cavity was filled with air. When thermal contact was good, but no power was dissipated in the tube (2), artefacts due to self-heating were not significant and the observed temperature rises were very low ( approximately 0-0.1 degrees C). For the situation, with tissue representative power dissipation (3), a temperature rise of approximately 0.23 degrees C was observed for both measurements and simulations. A clinical example of a regional hyperthermia treatment of a patient with a cervix uteri carcinoma showed that the artefacts observed in the case of bad thermal contact also affect the steady-state temperature measurements. Good tissue contact must be assured for reliable intraluminal or intracavitary measurements.