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Clinical Evidence for Thermometric Parameters to Guide Hyperthermia Treatment. Cancers (Basel) 2022; 14:cancers14030625. [PMID: 35158893 PMCID: PMC8833668 DOI: 10.3390/cancers14030625] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 01/01/2023] Open
Abstract
Hyperthermia (HT) is a cancer treatment modality which targets malignant tissues by heating to 40-43 °C. In addition to its direct antitumor effects, HT potently sensitizes the tumor to radiotherapy (RT) and chemotherapy (CT), thereby enabling complete eradication of some tumor entities as shown in randomized clinical trials. Despite the proven efficacy of HT in combination with classic cancer treatments, there are limited international standards for the delivery of HT in the clinical setting. Consequently, there is a large variability in reported data on thermometric parameters, including the temperature obtained from multiple reference points, heating duration, thermal dose, time interval, and sequence between HT and other treatment modalities. Evidence from some clinical trials indicates that thermal dose, which correlates with heating time and temperature achieved, could be used as a predictive marker for treatment efficacy in future studies. Similarly, other thermometric parameters when chosen optimally are associated with increased antitumor efficacy. This review summarizes the existing clinical evidence for the prognostic and predictive role of the most important thermometric parameters to guide the combined treatment of RT and CT with HT. In conclusion, we call for the standardization of thermometric parameters and stress the importance for their validation in future prospective clinical studies.
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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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van Leeuwen CM, Crezee J, Oei AL, Franken NAP, Stalpers LJA, Bel A, Kok HP. The effect of time interval between radiotherapy and hyperthermia on planned equivalent radiation dose. Int J Hyperthermia 2018; 34:901-909. [PMID: 29749270 DOI: 10.1080/02656736.2018.1468930] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Thermoradiotherapy is an effective treatment for locally advanced cervical cancer. However, the optimal time interval between radiotherapy and hyperthermia, resulting in the highest therapeutic gain, remains unclear. This study aims to evaluate the effect of time interval on the therapeutic gain using biological treatment planning. METHODS Radiotherapy and hyperthermia treatment plans were created for 15 cervical cancer patients. Biological modeling was used to calculate the equivalent radiation dose, that is, the radiation dose that results in the same biological effect as the thermoradiotherapy treatment, for different time intervals ranging from 0-4 h. Subsequently, the thermal enhancement ratio (TER, i.e. the ratio of the dose for the thermoradiotherapy and the radiotherapy-only plan) was calculated for the gross tumor volume (GTV) and the organs at risk (OARs: bladder, rectum, bowel), for each time interval. Finally, the therapeutic gain factor (TGF, i.e. TERGTV/TEROAR) was calculated for each OAR. RESULTS The median TERGTV ranged from 1.05 to 1.16 for 4 h and 0 h time interval, respectively. Similarly, for bladder, rectum and bowel, TEROARs ranged from 1-1.03, 1-1.04 and 1-1.03, respectively. Radiosensitization in the OARs was much less than in the GTV, because temperatures were lower, fractionation sensitivity was higher (lower α/β) and direct cytotoxicity was assumed negligible in normal tissue. TGFs for the three OARs were similar, and were highest (around 1.12) at 0 h time interval. CONCLUSION This planning study indicates that the largest therapeutic gain for thermoradiotherapy in cervical cancer patients can be obtained when hyperthermia is delivered immediately before or after radiotherapy.
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Affiliation(s)
- C M van Leeuwen
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
| | - J Crezee
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
| | - A L Oei
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands.,b Laboratory for Experimental Oncology and Radiobiology (LEXOR)/Center for Experimental Molecular Medicine , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
| | - N A P Franken
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands.,b Laboratory for Experimental Oncology and Radiobiology (LEXOR)/Center for Experimental Molecular Medicine , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
| | - L J A Stalpers
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
| | - A Bel
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands
| | - H P Kok
- a 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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van Leeuwen CM, Crezee J, Oei AL, Franken NAP, Stalpers LJA, Bel A, Kok HP. 3D radiobiological evaluation of combined radiotherapy and hyperthermia treatments. Int J Hyperthermia 2016; 33:160-169. [PMID: 27744728 DOI: 10.1080/02656736.2016.1241431] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Currently, clinical decisions regarding thermoradiotherapy treatments are based on clinical experience. Quantification of the radiosensitising effect of hyperthermia allows comparison of different treatment strategies, and can support clinical decision-making regarding the optimal treatment. The software presented here enables biological evaluation of thermoradiotherapy plans through calculation of equivalent 3D dose distributions. METHODS Our in-house developed software (X-Term) uses an extended version of the linear-quadratic model to calculate equivalent radiation dose, i.e. the radiation dose yielding the same effect as the thermoradiotherapy treatment. Separate sets of model parameters can be assigned to each delineated structure, allowing tissue specific modelling of hyperthermic radiosensitisation. After calculation, the equivalent radiation dose can be evaluated according to conventional radiotherapy planning criteria. The procedure is illustrated using two realistic examples. First, for a previously irradiated patient, normal tissue dose for a radiotherapy and thermoradiotherapy plan (with equal predicted tumour control) is compared. Second, tumour control probability (TCP) is assessed for two (otherwise identical) thermoradiotherapy schedules with different time intervals between radiotherapy and hyperthermia. RESULTS The examples demonstrate that our software can be used for individualised treatment decisions (first example) and treatment optimisation (second example) in thermoradiotherapy. In the first example, clinically acceptable doses to the bowel were exceeded for the conventional plan, and a substantial reduction of this excess was predicted for the thermoradiotherapy plan. In the second example, the thermoradiotherapy schedule with long time interval was shown to result in a substantially lower TCP. CONCLUSIONS Using biological modelling, our software can facilitate the evaluation of thermoradiotherapy plans and support individualised treatment decisions.
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Affiliation(s)
- C M van Leeuwen
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - J Crezee
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - A L Oei
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,b Laboratory for Experimental Oncology and Radiobiology (LEXOR)/Center for Experimental Molecular Medicine , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - N A P Franken
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands.,b Laboratory for Experimental Oncology and Radiobiology (LEXOR)/Center for Experimental Molecular Medicine , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - L J A Stalpers
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - A Bel
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - H P Kok
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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Shi Y, Zhang F, Bai Z, Wang J, Qiu L, Li Y, Meng Y, Valji K, Yang X. Orthotopic Esophageal Cancers: Intraesophageal Hyperthermia-enhanced Direct Chemotherapy in Rats. Radiology 2016; 282:103-112. [PMID: 27404050 DOI: 10.1148/radiol.2016152281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Yaoping Shi
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
| | - Feng Zhang
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
| | - Zhibin Bai
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
| | - Jianfeng Wang
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
| | - Longhua Qiu
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
| | - Yonggang Li
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
| | - Yanfeng Meng
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
| | - Karim Valji
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
| | - Xiaoming Yang
- From the Image-guided Biomolecular Intervention Research and Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington School of Medicine, Campus Box 358056, 850 Republican St, Room S470, Seattle, WA 98109
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Nelson DA, Curran AR, Nyberg HA, Marttila EA, Mason PA, Ziriax JM. High-resolution simulations of the thermophysiological effects of human exposure to 100 MHz RF energy. Phys Med Biol 2013; 58:1947-68. [DOI: 10.1088/0031-9155/58/6/1947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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De Greef M, Kok HP, Bel A, Crezee J. 3D versus 2D steering in patient anatomies: A comparison using hyperthermia treatment planning. Int J Hyperthermia 2011; 27:74-85. [DOI: 10.3109/02656736.2010.531882] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ohguri T, Yahara K, Moon SD, Yamaguchi S, Imada H, Terashima H, Korogi Y. Deep regional hyperthermia for the whole thoracic region using 8 MHz radiofrequency-capacitive heating device: Relationship between the radiofrequency-output power and the intra-oesophageal temperature and predictive factors for a good heating in 59 patients. Int J Hyperthermia 2010; 27:20-6. [DOI: 10.3109/02656736.2010.500644] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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