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Kok HP, Crezee J. Validation of the implementation of phased-array heating systems in Plan2Heat. Strahlenther Onkol 2024:10.1007/s00066-024-02264-0. [PMID: 39143400 DOI: 10.1007/s00066-024-02264-0] [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: 02/07/2024] [Accepted: 06/28/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Hyperthermia treatment planning can be supportive to ensure treatment quality, provided reliable prediction of the heating characteristics (i.e., focus size and effects of phase-amplitude and frequency steering) of the device concerned is possible. This study validates the predictions made by the treatment planning system Plan2Heat for various clinically used phased-array systems. METHODS The evaluated heating systems were AMC-2, AMC-4/ALBA-4D (Med-Logix srl, Rome, Italy), BSD Sigma-30, and Sigma-60 (Pyrexar Medical, Salt Lake City, UT, USA). Plan2Heat was used for specific absorption rate (SAR) simulations in phantoms representing measurement set-ups reported in the literature. SAR profiles from published measurement data based on E‑field or temperature rise were used to compare the device-specific heating characteristics predicted by Plan2Heat. RESULTS Plan2Heat is able to predict the correct location and size of the SAR focus, as determined by phase-amplitude settings and operating frequency. Measured effects of phase-amplitude steering on focus shifts (i.e., local SAR minima or maxima) were also correctly reflected in treatment planning predictions. Deviations between measurements and simulations were typically < 10-20%, which is within the range of experimental uncertainty for such phased-array measurements. CONCLUSION Plan2Heat is capable of adequately predicting the heating characteristics of the AMC‑2, AMC-4/ALBA-4D, BSD Sigma-30, and Sigma-60 phased-array systems routinely used in clinical hyperthermia.
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Affiliation(s)
- H P Kok
- Amsterdam UMC, University of Amsterdam, Dept. Radiation Oncology, Cancer Center Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Treatment and quality of life, Cancer biology and immunology, Amsterdam, The Netherlands.
| | - J Crezee
- Amsterdam UMC, University of Amsterdam, Dept. Radiation Oncology, Cancer Center Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and quality of life, Cancer biology and immunology, Amsterdam, The Netherlands
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2
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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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Carlton H, Arepally N, Healy S, Sharma A, Ptashnik S, Schickel M, Newgren M, Goodwill P, Attaluri A, Ivkov R. Magnetic Particle Imaging-Guided Thermal Simulations for Magnetic Particle Hyperthermia. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:1059. [PMID: 38921935 PMCID: PMC11206764 DOI: 10.3390/nano14121059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024]
Abstract
Magnetic particle hyperthermia (MPH) enables the direct heating of solid tumors with alternating magnetic fields (AMFs). One challenge with MPH is the unknown particle distribution in tissue after injection. Magnetic particle imaging (MPI) can measure the nanoparticle content and distribution in tissue after delivery. The objective of this study was to develop a clinically translatable protocol that incorporates MPI data into finite element calculations for simulating tissue temperatures during MPH. To verify the protocol, we conducted MPH experiments in tumor-bearing mouse cadavers. Five 8-10-week-old female BALB/c mice bearing subcutaneous 4T1 tumors were anesthetized and received intratumor injections of Synomag®-S90 nanoparticles. Immediately following injection, the mice were euthanized and imaged, and the tumors were heated with an AMF. We used the Mimics Innovation Suite to create a 3D mesh of the tumor from micro-computerized tomography data and spatial index MPI to generate a scaled heating function for the heat transfer calculations. The processed imaging data were incorporated into a finite element solver, COMSOL Multiphysics®. The upper and lower bounds of the simulated tumor temperatures for all five cadavers demonstrated agreement with the experimental temperature measurements, thus verifying the protocol. These results demonstrate the utility of MPI to guide predictive thermal calculations for MPH treatment planning.
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Affiliation(s)
- Hayden Carlton
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (S.H.); (A.S.)
| | - Nageshwar Arepally
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University—Harrisburg, Middletown, PA 17057, USA; (N.A.); (A.A.)
| | - Sean Healy
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (S.H.); (A.S.)
| | - Anirudh Sharma
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (S.H.); (A.S.)
| | | | | | - Matt Newgren
- Magnetic Insight Inc., Alameda, CA 94502, USA; (M.N.); (P.G.)
| | | | - Anilchandra Attaluri
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University—Harrisburg, Middletown, PA 17057, USA; (N.A.); (A.A.)
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (H.C.); (S.H.); (A.S.)
- Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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Fan F, Chen L, Zhou Y, Duan H. Multiscale Transfer Printing via Shape Memory Polymer with High Adhesion and Modulus Switchability. ACS APPLIED MATERIALS & INTERFACES 2024; 16:26824-26832. [PMID: 38733385 DOI: 10.1021/acsami.4c05828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
Flexible electronics have gained significant attention as an innovative solution to meet the growing need for information collection from the human body and the environment. However, a critical challenge lies in the need for a transfer printing technique that can fabricate rigid and brittle devices on flexible organic substrates. Here, we develop a multiscale transfer printing technique using an ultraviolet-curable shape memory polymer (SMP) that serves as both the stamp and the receiver substrate. The SMP demonstrates exceptional mechanical performance with toughness at room temperature and remarkable flexibility near its glass transition temperature. The SMP material exhibits an impressive shape recovery ratio and remarkable adhesion switchability. We demonstrate robust transfer printing of diverse objects with different materials and morphologies and in situ transfer of multiscale metallic structures. In addition, the in situ fabricated transparent hyperthermia patches with embedded metal grids are demonstrated, offering potential application in the field of sensors, wearable devices, and electronic skin.
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Affiliation(s)
- Fu Fan
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha 410082, PR China
- Greater Bay Area Institute for Innovation, Hunan University, Guangzhou 511300, PR China
| | - Lei Chen
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha 410082, PR China
- Greater Bay Area Institute for Innovation, Hunan University, Guangzhou 511300, PR China
| | - Yu Zhou
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha 410082, PR China
- Greater Bay Area Institute for Innovation, Hunan University, Guangzhou 511300, PR China
| | - Huigao Duan
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha 410082, PR China
- Greater Bay Area Institute for Innovation, Hunan University, Guangzhou 511300, PR China
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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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VilasBoas-Ribeiro I, Sumser K, Nouwens S, Feddersen T, Heemels W, van Rhoon GC, Paulides MM. Adapting Temperature Predictions to MR Imaging in Treatment Position to Improve Simulation-Guided Hyperthermia for Cervical Cancer. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 5:99-106. [PMID: 38445240 PMCID: PMC10914156 DOI: 10.1109/ojemb.2023.3321990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/13/2023] [Accepted: 09/21/2023] [Indexed: 03/07/2024] Open
Abstract
Hyperthermia treatment consists of elevating the temperature of the tumor to increase the effectiveness of radiotherapy and chemotherapy. Hyperthermia treatment planning (HTP) is an important tool to optimize treatment quality using pre-treatment temperature predictions. The accuracy of these predictions depends on modeling uncertainties such as tissue properties and positioning. In this study, we evaluated if HTP accuracy improves when the patient is imaged inside the applicator at the start of treatment. Because perfusion is a major uncertainty source, the importance of accurate treatment position and anatomy was evaluated using different perfusion values. Volunteers were scanned using MR imaging without ("planning setup") and with the MR-compatible hyperthermia device ("treatment setup"). Temperature-based quality indicators were used to assess the differences between the standard, apparent and the optimized hyperthermia dose. We conclude that pre-treatment imaging can improve HTP predictions accuracy but also, that tissue perfusion modelling is crucial if temperature-based optimization is applied.
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Affiliation(s)
- Iva VilasBoas-Ribeiro
- Department of Radiotherapy, Erasmus MC Cancer InstituteUniversity Medical Center Rotterdam3015GDRotterdamThe Netherlands
| | - Kemal Sumser
- Care and Cure research lab (EM-4C&C) of the Electromagnetics Group, Department of Electrical EngineeringEindhoven University of Technology5600 MBEindhovenThe Netherlands
| | - Sven Nouwens
- Control System Technology Group, Department of Mechanical EngineeringEindhoven University of Technology5600 MBEindhovenThe Netherlands
| | - Theresa Feddersen
- Department of Radiology & Nuclear Medicine, Erasmus MCUniversity Medical Center Rotterdam3015GDRotterdamThe Netherlands
| | - W.P.M.H. Heemels
- Control System Technology Group, Department of Mechanical EngineeringEindhoven University of Technology5600 MBEindhovenThe Netherlands
| | - Gerard C. van Rhoon
- Department of Radiotherapy, Erasmus MC Cancer InstituteUniversity Medical Center Rotterdam3015GDRotterdamThe Netherlands
- Department of Applied Radiation and Isotopes, Reactor Institute DelftDelft University of Technology2629JBDelftThe Netherlands
| | - Margarethus M. Paulides
- Care and Cure research lab (EM-4C&C) of the Electromagnetics Group, Department of Electrical EngineeringEindhoven University of Technology5600 MBEindhovenThe Netherlands
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7
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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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Saha N, Kuehne A, Millward JM, Eigentler TW, Starke L, Waiczies S, Niendorf T. Advanced Radio Frequency Applicators for Thermal Magnetic Resonance Theranostics of Brain Tumors. Cancers (Basel) 2023; 15:cancers15082303. [PMID: 37190232 DOI: 10.3390/cancers15082303] [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: 03/06/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Thermal Magnetic Resonance (ThermalMR) is a theranostic concept that combines diagnostic magnetic resonance imaging (MRI) with targeted thermal therapy in the hyperthermia (HT) range using a radiofrequency (RF) applicator in an integrated system. ThermalMR adds a therapeutic dimension to a diagnostic MRI device. Focused, targeted RF heating of deep-seated brain tumors, accurate non-invasive temperature monitoring and high-resolution MRI are specific requirements of ThermalMR that can be addressed with novel concepts in RF applicator design. This work examines hybrid RF applicator arrays combining loop and self-grounded bow-tie (SGBT) dipole antennas for ThermalMR of brain tumors, at magnetic field strengths of 7.0 T, 9.4 T and 10.5 T. These high-density RF arrays improve the feasible transmission channel count, and provide additional degrees of freedom for RF shimming not afforded by using dipole antennas only, for superior thermal therapy and MRI diagnostics. These improvements are especially relevant for ThermalMR theranostics of deep-seated brain tumors because of the small surface area of the head. ThermalMR RF applicators with the hybrid loop+SGBT dipole design outperformed applicators using dipole-only and loop-only designs, with superior MRI performance and targeted RF heating. Array variants with a horse-shoe configuration covering an arc (270°) around the head avoiding the eyes performed better than designs with 360° coverage, with a 1.3 °C higher temperature rise inside the tumor while sparing healthy tissue. Our EMF and temperature simulations performed on a virtual patient with a clinically realistic intracranial tumor provide a technical foundation for implementation of advanced RF applicators tailored for ThermalMR theranostics of brain tumors.
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Affiliation(s)
- Nandita Saha
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Experimental and Clinical Research Center (ECRC), A Joint Cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Andre Kuehne
- MRI.TOOLS GmbH, 13125 Berlin, Germany
- Brightmind.AI GmbH, 1010 Vienna, Austria
| | - Jason M Millward
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Experimental and Clinical Research Center (ECRC), A Joint Cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Thomas Wilhelm Eigentler
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
| | - Ludger Starke
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Hasso Plattner Institute for Digital Engineering, University of Potsdam, 14482 Potsdam, Germany
| | - Sonia Waiczies
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Experimental and Clinical Research Center (ECRC), A Joint Cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
| | - Thoralf Niendorf
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin Ultrahigh Field Facility (B.U.F.F.), 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Experimental and Clinical Research Center (ECRC), A Joint Cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, 13125 Berlin, Germany
- MRI.TOOLS GmbH, 13125 Berlin, Germany
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Alves D, Araújo JC, Fangueiro R, Ferreira DP. Localized Therapeutic Approaches Based on Micro/Nanofibers for Cancer Treatment. Molecules 2023; 28:molecules28073053. [PMID: 37049815 PMCID: PMC10096407 DOI: 10.3390/molecules28073053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Cancer remains one of the most challenging health problems worldwide, and localized therapeutic approaches based on micro/nanofibers have shown potential for its treatment. Micro/nanofibers offer several advantages as a drug delivery system, such as high surface area, tunable pore size, and sustained release properties, which can improve drug efficacy and reduce side effects. In addition, functionalization of these fibers with nanoparticles can enhance their targeting and therapeutic capabilities. Localized delivery of drugs and/or other therapeutic agents via micro/nanofibers can also help to overcome the limitations of systemic administration, such as poor bioavailability and off-target effects. Several studies have shown promising results in preclinical models of cancer, including inhibition of tumor growth and improved survival rates. However, more research is needed to overcome technical and regulatory challenges to bring these approaches to clinical use. Localized therapeutic approaches based on micro/nanofibers hold great promise for the future of cancer treatment, providing a targeted, effective, and minimally invasive alternative to traditional treatments. The main focus of this review is to explore the current treatments utilizing micro/nanofibers, as well as localized drug delivery systems that rely on fibrous structures to deliver and release drugs for the treatment of cancer in a specific area.
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Kok HP, Herrera TD, Crezee J. The Relevance of High Temperatures and Short Time Intervals Between Radiation Therapy and Hyperthermia: Insights in Terms of Predicted Equivalent Enhanced Radiation Dose. Int J Radiat Oncol Biol Phys 2023; 115:994-1003. [PMID: 36288756 DOI: 10.1016/j.ijrobp.2022.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE The radiosensitization effect of hyperthermia can be considered and quantified as an enhanced equivalent radiation dose (EQDRT), that is, the dose needed to achieve the same effect without hyperthermia. EQDRT can be predicted using an extended linear quadratic model, with temperature-dependent parameters. Clinical data show that both the achieved temperature and time interval between radiation therapy and hyperthermia correlate with clinical outcome, but their effect on expected EQDRT is unknown and was therefore evaluated in this study. METHODS AND MATERIALS Biological modeling was performed using our in-house developed software (X-Term), considering a 23- × 2-Gy external beam radiation scheme, as applied for patients with locally advanced cervical cancer. First, the EQDRT was calculated for homogeneous temperature levels, evaluating time intervals between 0 and 4 hours. Next, realistic heterogeneous hyperthermia treatment plans were combined with radiation therapy plans and the EQDRT was calculated for 10 patients. Furthermore, the effect of achieving 0.5°C to 1°C lower or higher temperatures was evaluated. RESULTS EQDRT increases substantially with both increasing temperature and decreasing time interval. The effect of the time interval is most pronounced at higher temperatures (>41°C). At a typical hyperthermic temperature level of 41.5°C, an enhancement of ∼10 Gy can be realized with a 0-hour time interval, which is decreased to only ∼4 Gy enhancement with a 4-hour time interval. Most enhancement is already lost after 1 hour. Evaluation in patients predicted an average additional EQDRT (D95%) of 2.2 and 6.3 Gy for 4- and 0-hour time intervals, respectively. The effect of 0.5°C to 1°C lower or higher temperatures is most pronounced at high temperature levels and short time intervals. The additional EQDRT (D95%) ranged between 1.5 and 3.3 Gy and between 4.5 and 8.5 Gy for 4- and 0-hour time intervals, respectively. CONCLUSIONS Biological modeling provides relevant insight into the relationship between treatment parameters and expected EQDRT. Both high temperatures and short time intervals are essential to maximize EQDRT.
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Affiliation(s)
- H Petra Kok
- Amsterdam UMC Location University of Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Cancer Biology and Immunology, Amsterdam, The Netherlands.
| | - Timoteo D Herrera
- Amsterdam UMC Location University of Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Johannes Crezee
- Amsterdam UMC Location University of Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Cancer Biology and Immunology, Amsterdam, The Netherlands
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11
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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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12
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Bakker A, Zweije R, Kok HP, Stalpers LJA, Westerveld GH, Hinnen KA, van Tienhoven G, Kolff MW, Crezee H. Comparison of the clinical performance of a hybrid Alba 4D and the AMC-4 locoregional hyperthermia systems. Int J Hyperthermia 2022; 39:1408-1414. [DOI: 10.1080/02656736.2022.2140841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Akke Bakker
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Remko Zweije
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - H. Petra Kok
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Lukas J. A. Stalpers
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - G. Henrike Westerveld
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
| | - Karel A. Hinnen
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Geertjan van Tienhoven
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - M. Willemijn Kolff
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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13
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Nandhini G, Shobana MK. Influence of phytochemicals with iron oxide nanoparticles for biomedical applications: a review. Polym Bull (Berl) 2022. [DOI: 10.1007/s00289-022-04648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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14
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Kok HP, Crezee J. Validation and practical use of Plan2Heat hyperthermia treatment planning for capacitive heating. Int J Hyperthermia 2022; 39:952-966. [PMID: 35853733 DOI: 10.1080/02656736.2022.2093996] [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: 10/17/2022] Open
Abstract
BACKGROUND Capacitive devices are used for hyperthermia delivery, initially mainly in Asia, but nowadays also increasingly in Europe. Treatment planning can be very useful to determine the most effective patient-specific treatment set-up. This paper provides a validation of GPU-based simulations using Plan2Heat for capacitive hyperthermia devices. METHODS Validation was first performed by comparing simulations with an analytical solution for a spherical object placed inside a uniform electric field. Resolution was 5, 2.5 or 1 mm. Next, simulations for homogeneous and inhomogeneous phantom setups were performed for Thermotron RF8 and Celsius TCS capacitive heating devices at 2.5 mm resolution. Also different combinations of electrode sizes were evaluated. Normalized SAR profiles were compared to phantom measurements from the literature. Possible clinical use of treatment planning was demonstrated for an anal cancer patient, evaluating different treatment set-ups in prone and supine position. RESULTS Numerical and analytical solutions showed excellent agreement. At the center of the sphere, the error was 5.1%, 2.9% and 0.2% for a resolution of 5, 2.5 and 1 mm, respectively. Comparison of measurements and simulations for both Thermotron RF8 and Celsius TCS showed very good agreement within 5% for all phantom set-ups. Simulations were capable of accurately predicting the penetration depth; a very relevant parameter for clinical application. The patient case illustrated that planning can provide insight by comparing effectiveness of different treatment strategies. CONCLUSION Plan2Heat can rapidly and accurately predict heating patterns generated by capacitive devices. Thus, Plan2Heat is suitable for patient-specific treatment planning for capacitive hyperthermia.
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Affiliation(s)
- H P Kok
- Amsterdam UMC Location University of Amsterdam, Radiation Oncology, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Treatment and Quality of Life, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - J Crezee
- Amsterdam UMC Location University of Amsterdam, Radiation Oncology, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Treatment and Quality of Life, Cancer Biology and Immunology, Amsterdam, The Netherlands
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15
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The Role of Hyperthermia in the Treatment of Peritoneal Surface Malignancies. Curr Oncol Rep 2022; 24:875-887. [PMID: 35325402 DOI: 10.1007/s11912-022-01275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Hyperthermia is used to treat peritoneal surface malignancies (PSM), particularly during hyperthermic intraperitoneal chemotherapy (HIPEC). This manuscript provides a focused update of hyperthermia in the treatment of PSM. RECENT FINDINGS The heterogeneous response to hyperthermia in PSM can be explained by tumor and treatment conditions. PSM tumors may resist hyperthermia via metabolic and immunologic adaptation. The thermodynamics of HIPEC are complex and require computational fluid dynamics (CFD). The clinical evidence supporting the benefit of hyperthermia is largely observational. Continued research will allow clinicians to characterize and predict the individual response of PSM to hyperthermia. The application of hyperthermia in current HIPEC protocols is mostly empirical. Thus, modeling heat transfer with CFD is a necessary task if we are to achieve consistent and reproducible hyperthermia. Although observational evidence suggests a survival benefit of hyperthermia, no clinical trial has tested the individual role of hyperthermia in PSM.
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A Novel Framework for the Optimization of Simultaneous ThermoBrachyTherapy. Cancers (Basel) 2022; 14:cancers14061425. [PMID: 35326574 PMCID: PMC8946271 DOI: 10.3390/cancers14061425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022] Open
Abstract
In high-dose-rate brachytherapy (HDR-BT) for prostate cancer treatment, interstitial hyperthermia (IHT) is applied to sensitize the tumor to the radiation (RT) dose, aiming at a more efficient treatment. Simultaneous application of HDR-BT and IHT is anticipated to provide maximum radiosensitization of the tumor. With this rationale, the ThermoBrachyTherapy applicators have been designed and developed, enabling simultaneous irradiation and heating. In this research, we present a method to optimize the three-dimensional temperature distribution for simultaneous HDR-BT and IHT based on the resulting equivalent physical dose (EQDphys) of the combined treatment. First, the temperature resulting from each electrode is precomputed. Then, for a given set of electrode settings and a precomputed radiation dose, the EQDphys is calculated based on the temperature-dependent linear-quadratic model. Finally, the optimum set of electrode settings is found through an optimization algorithm. The method is applied on implant geometries and anatomical data of 10 previously irradiated patients, using reported thermoradiobiological parameters and physical doses. We found that an equal equivalent dose coverage of the target can be achieved with a physical RT dose reduction of 20% together with a significantly lower EQDphys to the organs at risk (p-value < 0.001), even in the least favorable scenarios. As a result, simultaneous ThermoBrachyTherapy could lead to a relevant therapeutic benefit for patients with prostate cancer.
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17
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Simultaneous ThermoBrachytherapy: Electromagnetic Simulation Methods for Fast and Accurate Adaptive Treatment Planning. SENSORS 2022; 22:s22041328. [PMID: 35214230 PMCID: PMC8963063 DOI: 10.3390/s22041328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 12/18/2022]
Abstract
The combination of interstitial hyperthermia treatment (IHT) with high dose rate brachytherapy (HDR-BT) can improve clinical outcomes since it highly enhances the efficiency of cell kill, especially when applied simultaneously. Therefore, we have developed the ThermoBrachy applicators. To effectively apply optimal targeted IHT, treatment planning is considered essential. However, treatment planning in IHT is rarely applied as it is regarded as difficult to accurately calculate the deposited energy in the tissue in a short enough time for clinical practice. In this study, we investigated various time-efficient methods for fast computation of the electromagnetic (EM) energy deposition resulting from the ThermoBrachy applicators. Initially, we investigated the use of an electro-quasistatic solver. Next, we extended our investigation to the application of geometric simplifications. Furthermore, we investigated the validity of the superpositioning principle, which can enable adaptive treatment plan optimization without the need for continuous recomputation of the EM field. Finally, we evaluated the accuracy of the methods by comparing them to the golden standard Finite-Difference Time-Domain calculation method using gamma-index analysis. The simplifications considerably reduced the computation time needed, improving from >12 h to a few seconds. All investigated methods showed excellent agreement with the golden standard by showing a >99% passing rate with 1%/0.5 mm Dose Difference and Distance-to-Agreement criteria. These results allow the proposed electromagnetic simulation method to be used for fast and accurate adaptive treatment planning.
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18
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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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19
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Improving Prediction of the Potential Distribution Induced by Cylindrical Electrodes within a Homogeneous Rectangular Grid during Irreversible Electroporation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Irreversible electroporation (IRE) is an ablation technique based on the application of short, high-voltage pulses between needle electrodes (diameter: ~1.0 × 10−3 m). A Finite Difference-based software simulating IRE treatment generally uses rectangular grids, yielding discretization issues when modeling cylindrical electrodes and potentially affecting the validity of treatment planning simulations. Aim: Develop an Electric-Potential Estimation (EPE) method for accurate prediction of the electric-potential distribution in the vicinity of cylindrical electrodes. Methods: The electric-potential values in the voxels neighboring the cylindrical electrode voxels were corrected based on analytical solutions derived for coaxial/cylindrical electrodes. Simulations at varying grid resolutions were validated using analytical models. Low-resolution heterogeneous simulations at 2.0 × 10−3 m excluding/including EPE were compared with high-resolution results at 0.25 × 10−3 m. Results: EPE significantly reduced maximal errors compared to analytical results for the electric-potential distributions (26.6–71.8%→0.4%) and for the electrical resistance (30%→1–6%) at 3.0 × 10−3 m voxel-size. EPE significantly improved the mean-deviation (43.1–52.8%→13.0–24.3%) and the calculation-time gain (>15,000×) of low-resolution compared to high-resolution heterogeneous simulations. Conclusions: EPE can accurately predict the potential distribution of neighboring cylindrical electrodes, regardless of size, position, and orientation in a rectangular grid. The simulation time of treatment planning can therefore be shortened by using large voxel-sized models without affecting accuracy of the electric-field distribution, enabling real-time clinical IRE treatment planning.
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20
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IJff M, Crezee J, Oei AL, Stalpers LJA, Westerveld H. The role of hyperthermia in the treatment of locally advanced cervical cancer: a comprehensive review. Int J Gynecol Cancer 2022; 32:288-296. [PMID: 35046082 PMCID: PMC8921566 DOI: 10.1136/ijgc-2021-002473] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/14/2021] [Indexed: 01/02/2023] Open
Abstract
Radiotherapy with cisplatin (chemoradiation) is the standard treatment for women with locally advanced cervical cancer. Radiotherapy with deep hyperthermia (thermoradiation) is a well established alternative, but is rarely offered as an alternative to chemoradiation, particularly for patients in whom cisplatin is contraindicated. The scope of this review is to provide an overview of the biological rationale of hyperthermia treatment delivery, including patient workflow, and the clinical effectiveness of hyperthermia as a radiosensitizer in the treatment of cervical cancer. Hyperthermia is especially effective in hypoxic and nutrient deprived areas of the tumor where radiotherapy is less effective. Its radiosensitizing effectiveness depends on the temperature level, duration of treatment, and the time interval between radiotherapy and hyperthermia. High quality hyperthermia treatment requires an experienced team, adequate online adaptive treatment planning, and is preferably performed using a phased array radiative locoregional hyperthermia device to achieve the optimal thermal dose effect. Hyperthermia is well tolerated and generally leads to only mild toxicity, such as patient discomfort. Patients in whom cisplatin is contraindicated should therefore be referred to a hyperthermia center for thermoradiation.
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Affiliation(s)
- Marloes IJff
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Experimental Oncology and Radiobiology (LEXOR), Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Experimental Oncology and Radiobiology (LEXOR), Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Experimental Oncology and Radiobiology (LEXOR), Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Henrike Westerveld
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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21
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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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22
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Androulakis I, Mestrom RMC, Christianen MEMC, Kolkman-Deurloo IKK, van Rhoon GC. Design of the novel ThermoBrachy applicators enabling simultaneous interstitial hyperthermia and high dose rate brachytherapy. Int J Hyperthermia 2021; 38:1660-1671. [PMID: 34814784 DOI: 10.1080/02656736.2021.2005160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE In High Dose Rate Brachytherapy for prostate cancer there is a need for a new way of increasing cancer cell kill in combination with a stable dose to the organs at risk. In this study, we propose a novel ThermoBrachy applicator that offers the unique ability to apply interstitial hyperthermia while simultaneously serving as an afterloading catheter for high dose rate brachytherapy for prostate cancer. This approach achieves a higher thermal enhancement ratio than in sequential application of radiation and hyperthermia and has the potential to decrease the overall treatment time. METHODS The new applicator uses the principle of capacitively coupled electrodes. We performed a proof of concept experiment to demostrate the feasibility of the proposed applicator. Moreover, we used electromagnetic and thermal simulations to evaluate the power needs and temperature homogeneity in different tissues. Furthermore we investigated whether dynamic phase and amplitude adaptation can be used to improve longitudinal temperature control. RESULTS Simulations demonstrate that the electrodes achieve good temperature homogeneity in a homogenous phantom when following current applicator spacing guidelines. Furthermore, we demonstrate that by dynamic phase and amplitude adaptation provides a great advancement for further adaptability of the heating pattern. CONCLUSIONS This newly designed ThermoBrachy applicator has the potential to revise the interest in interstitial thermobrachytherapy, since the simultaneous application of radiation and hyperthermia enables maximum thermal enhancement and at maximum efficiency for patient and organization.
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Affiliation(s)
- Ioannis Androulakis
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Rob M C Mestrom
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | | | - Gerard C van Rhoon
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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23
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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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24
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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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Löke DR, Helderman RFCPA, Rodermond HM, Tanis PJ, Streekstra GJ, Franken NAP, Oei AL, Crezee J, Kok HP. Demonstration of treatment planning software for hyperthermic intraperitoneal chemotherapy in a rat model. Int J Hyperthermia 2021; 38:38-54. [PMID: 33487083 DOI: 10.1080/02656736.2020.1852324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) is administered to treat residual microscopic disease after cytoreductive surgery (CRS). During HIPEC, fluid (41-43 °C) is administered and drained through a limited number of catheters, risking thermal and drug heterogeneities within the abdominal cavity that might reduce effectiveness. Treatment planning software provides a unique tool for optimizing treatment delivery. This study aimed to investigate the influence of treatment-specific parameters on the thermal and drug homogeneity in the peritoneal cavity in a computed tomography based rat model. METHOD We developed computational fluid dynamics (CFD) software simulating the dynamic flow, temperature and drug distribution during oxaliplatin based HIPEC. The influence of location and number of catheters, flow alternations and flow rates on peritoneal temperature and drug distribution were determined. The software was validated using data from experimental rat HIPEC studies. RESULTS The predicted core temperature and systemic oxaliplatin concentration were comparable to the values found in literature. Adequate placement of catheters, additional inflow catheters and higher flow rates reduced intraperitoneal temperature spatial variation by -1.4 °C, -2.3 °C and -1.2 °C, respectively. Flow alternations resulted in higher temperatures (up to +1.5 °C) over the peritoneal surface. Higher flow rates also reduced the spatial variation of chemotherapy concentration over the peritoneal surface resulting in a more homogeneous effective treatment dose. CONCLUSION The presented treatment planning software provides unique insights in the dynamics during HIPEC, which enables optimization of treatment-specific parameters and provides an excellent basis for HIPEC treatment planning in human applications.
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Affiliation(s)
- Daan R Löke
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Roxan F C P A Helderman
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hans M Rodermond
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department for Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas A P Franken
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - H Petra Kok
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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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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Nadobny J, Lim A, Seifert G, Sullivan D, Chrzon B, Weihrauch M, Zschaeck S, Herz E, Moczynska A, Pellicer-Guridi R, Wust P, Beck M, Ghadjar P. Improved patient-specific hyperthermia planning based on parametrized electromagnetic and thermal models for the SIGMA-30 applicator. Int J Hyperthermia 2021; 38:663-678. [PMID: 33899658 DOI: 10.1080/02656736.2021.1909757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To create an improved planning method for pediatric regional hyperthermia (RHT) using the SIGMA-30 applicator (SIGMA-30). MATERIALS AND METHODS An electromagnetic model of SIGMA-30 was generated for use with the finite-difference time-domain (FDTD) method. Applying special MATLAB-based algorithms, voxel models of a pediatric patient with pelvic rhabdomyosarcoma were created from Computed-Tomography (CT) contours for use with the FDTD method and the finite-difference (FD) method capable of using either temperature-independent or temperature-dependent perfusion models for solving the Bioheat Transfer Equation (BHTE). Patient models were parametrized regarding, first, the positioning in the applicator, second, the absorbed power range and, third, different perfusion models, resulting in the so-called Parametrized Treatment Models (PTMs). A novel dedicated optimization procedure was developed based on quantitative comparison of numerical calculations against temperature and power measurements from two RHT therapies. RESULTS Using measured data, a realistic absorbed power range in the patient model was estimated. Within this range, several FDTD and BHTE runs were performed and, applying the aforementioned optimization scheme, the best PTMs and perfusion models were identified for each therapy via a retrospective comparison with measurements in 14 temperature sensor positions: 5 in the tumor, 8 in rectum and one in bladder. CONCLUSION A novel dedicated optimization procedure for identification of suitable patient-specific electromagnetic and thermal models, which can be used for improved patient planning, was developed and evaluated by comparison with treatment-derived measurements using SIGMA-30. The optimization procedure can be extended to other hyperthermia applicators and to other patient types, including adults.
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Affiliation(s)
- Jacek Nadobny
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Amanda Lim
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg Seifert
- Department of Paediatric Oncology/Haematology, Otto-Heubner Centre for Paediatric and Adolescent Medicine (OHC), Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dennis Sullivan
- Department of Electrical and Computer Engineering, University of Idaho, Moscow, ID, USA
| | - Benjamin Chrzon
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mirko Weihrauch
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Enrico Herz
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Aleksandra Moczynska
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ruben Pellicer-Guridi
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Wust
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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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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In Vitro Examinations of Cell Death Induction and the Immune Phenotype of Cancer Cells Following Radiative-Based Hyperthermia with 915 MHz in Combination with Radiotherapy. Cells 2021; 10:cells10061436. [PMID: 34201238 PMCID: PMC8230049 DOI: 10.3390/cells10061436] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022] Open
Abstract
Multimodal tumor treatment settings consisting of radiotherapy and immunomodulating agents such as immune checkpoint inhibitors are more and more commonly applied in clinics. In this context, the immune phenotype of tumor cells has a major influence on the anti-tumor immune response as well as the composition of the tumor microenvironment. A promising approach to further boost anti-tumor immune responses is to add hyperthermia (HT), i.e., heating the tumor tissue between 39 °C to 45 °C for 60 min. One key technique is the use of radiative hyperthermia systems. However, knowledge is limited as to how the frequency of the used radiative systems affects the immune phenotype of the treated tumor cells. By using our self-designed in vitro hyperthermia system, we compared cell death induction and expression of immune checkpoint molecules (ICM) on the tumor cell surface of murine B16 melanoma and human MDA-MB-231 and MCF-7 breast cancer cells following HT treatment with clinically relevant microwaves at 915 MHz or 2.45 GHz alone, radiotherapy (RT; 2 × 5 Gy or 5 × 2 Gy) alone or in combination (RHT). At 44 °C, HT alone was the dominant cell death inductor with inactivation rates of around 70% for B16, 45% for MDA-MB-231 and 35% for MCF-7 at 915 MHz and 80%, 60% and 50% at 2.45 GHz, respectively. Additional RT resulted in 5–15% higher levels of dead cells. The expression of ICM on tumor cells showed time-, treatment-, cell line- and frequency-dependent effects and was highest for RHT. Computer simulations of an exemplary spherical cell revealed frequency-dependent local energy absorption. The frequency of hyperthermia systems is a newly identified parameter that could also affect the immune phenotype of tumor cells and consequently the immunogenicity of tumors.
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Shimomura O, Oda T, Hashimoto S, Doi M, Hiroshima Y, Numajiri H, Takahashi K, Furuya K, Miyazaki Y, Owada Y, Ogawa K, Ohara Y, Hisakura K, Akashi Y, Enomoto T, Sakurai H. Survival impact on triple-modal strategy comprising hyperthermia, external radiation, and chemotherapy for unresectable locally advanced (UR-LA) pancreatic ductal adenocarcinoma. Surg Oncol 2021; 37:101542. [PMID: 33740629 DOI: 10.1016/j.suronc.2021.101542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Present treatment strategy for unresectable locally advanced (UR-LA) pancreatic ductal adenocarcinoma (PDAC) patients is controversial. Hence, a triple-modal therapy, which is a multidisciplinary strategy, was designed for patients with UR-LA PDAC by adding hyperthermia to conventional chemoradiotherapy at our institution. In this study we aimed to evaluate the effectiveness of this strategy. METHODS Data of 21 UR-LA PDAC patients who underwent the triple-modal treatment were retrospectively analyzed for evaluating the safety and oncological effect of the treatment. The treatment schedule included, five concurrent infusions of gemcitabine (800 mg/m2) followed by hyperthermia (1 h) and X-ray (2 Gy) or proton beam radiation (2.7 Gy) on days 1, 8, 15, 29, and 36. Additional radiotherapies applied a total dose of 50 Gy/25 fr for X-ray radiation or 67.5 Gy/25 fr for proton beam radiation. RESULTS Median overall survival (OS) was 23.6 months. Conversion surgery was performed in 5 patients (23.8%), and a R0 margin could be achieved in 4 of them; however, their median OS (16.3 months) tended to be shorter than that of the patients who did not undergo resection (23.6 months, p = 0.562). Further, the median OS of patients who underwent proton beam radiation (28.0 months) was significantly longer than that of patients who underwent X-ray radiation (13.9 months, p = 0.045). Most adverse events were manageable, except for one grade 3 gastric ulcer. The median tumor size and marker reduction rates were -17% and -91%, respectively. The tumor responses were partial response, stable disease, and progressive disease in 3, 15, and 3 patients, respectively. CONCLUSION Triple-modal strategy, especially when combined with proton beam radiation, is feasible and results in favorable survival outcomes in patients with UR-LA PDAC.
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Affiliation(s)
- Osamu Shimomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Shinji Hashimoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Manami Doi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuhiro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kinji Furuya
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshihiro Miyazaki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yohei Owada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Koichi Ogawa
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yusuke Ohara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Katsuji Hisakura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshimasa Akashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tsuyoshi Enomoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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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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Kandala SK, Sharma A, Mirpour S, Liapi E, Ivkov R, Attaluri A. Validation of a coupled electromagnetic and thermal model for estimating temperatures during magnetic nanoparticle hyperthermia. Int J Hyperthermia 2021; 38:611-622. [PMID: 33853493 PMCID: PMC8363028 DOI: 10.1080/02656736.2021.1913244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 11/02/2022] Open
Abstract
PURPOSE Alternating magnetic field (AMF) tissue interaction models are generally not validated. Our aim was to develop and validate a coupled electromagnetic and thermal model for estimating temperatures in large organs during magnetic nanoparticle hyperthermia (MNH). MATERIALS AND METHODS Coupled finite element electromagnetic and thermal model validation was performed by comparing the results to experimental data obtained from temperatures measured in homogeneous agar gel phantoms exposed to an AMF at fixed frequency (155 ± 10 kHz). The validated model was applied to a three-dimensional (3D) rabbit liver built from computed tomography (CT) images to investigate the contribution of nanoparticle heating and nonspecific eddy current heating as a function of AMF amplitude. RESULTS Computed temperatures from the model were in excellent agreement with temperatures calculated using the analytical method (error < 1%) and temperatures measured in phantoms (maximum absolute error <2% at each probe location). The 3D rabbit liver model for a fixed concentration of 5 mg Fe/cm3 of tumor revealed a maximum temperature ∼44 °C in tumor and ∼40 °C in liver at AMF amplitude of ∼12 kA/m (peak). CONCLUSION A validated coupled electromagnetic and thermal model was developed to estimate temperatures due to eddy current heating in homogeneous tissue phantoms. The validated model was successfully used to analyze temperature distribution in complex rabbit liver tumor geometry during MNH. In future, model validation should be extended to heterogeneous tissue phantoms, and include heat sink effects from major blood vessels.
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Affiliation(s)
- Sri Kamal Kandala
- Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anirudh Sharma
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sahar Mirpour
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eleni Liapi
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
- Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Ivkov
- Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
- 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 Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Anilchandra Attaluri
- Department of Mechanical Engineering, The Pennsylvania State University - Harrisburg, Middletown, PA, USA
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Singh M, Singh T, Soni S. Pre-operative Assessment of Ablation Margins for Variable Blood Perfusion Metrics in a Magnetic Resonance Imaging Based Complex Breast Tumour Anatomy: Simulation Paradigms in Thermal Therapies. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 198:105781. [PMID: 33065492 DOI: 10.1016/j.cmpb.2020.105781] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Image-guided medical interventions facilitates precise visualization at treatment site. The conformal prediction for sparing healthy tissue fringes precisely in the vicinity of irregular tumour anatomy remains clinically challenging. Pre-clinical image-based computational modelling is imperative as it helps in enhancement of treatment quality, augmenting clinical-decision making, while planning, targeting, controlling, monitoring and assessing treatment response with an effective risk assessment before the onset of treatment in clinical settings. In this study, the influence of heat deposition rate (SAR), exposure duration, and variable blood perfusion metrics for a patient-specific breast tumour is quantified considering the tumour margins thereby suggesting need of geometrically accurate models. METHODS A three-dimensional realistic model mimicking dimensions of a female breast, comprising ~1.7 cm irregular tumour, was generated from patient specific two-dimensional DICOM format MRI images through image segmentation tools MIMICS 19.0® and 3-Matic 11.0® which is finally exported to COMSOL Multiphysics 5.2® as a volumetric mesh for finite element analysis. The Pennes bioheat transfer model and Arrhenius thermal damage model of cell-death are integrated to simulate a coupled biophysics problem. A comparative blood perfusion analysis is done to evaluate the response of tumour during heating considering thermal damage extent, including the tumour margins while sparing critical adjoining healthy tissues. RESULTS The evaluated thermal damage zones for 1 mm, 2 mm and 3 mm fringe heating region (beyond tumour boundary) reveals 0.09%, 0.21% and 0.34% thermal damage to the healthy tissue (which is <1%) and thus successful necrosis of the tumour. The iterative computational experiments suggests treatment margins < 5 mm are sufficient enough as heating beyond 3 mm fringe layer leads to higher damage surrounding the tumour approximately 1.5 times the tumour volume. Further, the heat-dosage requirements are 22% more for highly perfused tumour as compared to moderately perfused tumour with an approximate double time to ablate the whole tumour volume. CONCLUSIONS Depending on the blood perfusion characteristics of a tumour, it is a trade-off between heat-dosage (SAR) and exposure/treatment duration to get desired thermal damage including the irregular tumour boundaries while taking into account, the margin of healthy tissue. The suggested patient-specific integrated multiphysics-model based on MRI-Images may be implemented for pre-treatment planning based on the tumour blood perfusion to evaluate the thermal ablation zone dimensions clinically and thereby avoiding the damage of off-target tissues. Thus, risks involving underestimation or overestimation of thermal coagulation zones may be minimised while preserving the surrounding normal breast parenchyma.
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Affiliation(s)
- Manpreet Singh
- Department of Mechanical Engineering, University of Maryland Baltimore County, Baltimore, Maryland, USA; Biomedical Instrumentation Division, CSIR-Central Scientific Instruments Organisation, Chandigarh, India; Department of Mechanical Engineering, Thapar Institute of Engineering and Technology University, Patiala, Punjab, India.
| | - Tulika Singh
- Department of Radio-diagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Soni
- Biomedical Instrumentation Division, CSIR-Central Scientific Instruments Organisation, Chandigarh, India
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Kok HP, Beck M, Löke DR, Helderman RFCPA, van Tienhoven G, Ghadjar P, Wust P, Crezee H. Locoregional peritoneal hyperthermia to enhance the effectiveness of chemotherapy in patients with peritoneal carcinomatosis: a simulation study comparing different locoregional heating systems. Int J Hyperthermia 2020; 37:76-88. [PMID: 31969039 DOI: 10.1080/02656736.2019.1710270] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Introduction: Intravenous chemotherapy plus abdominal locoregional hyperthermia is explored as a noninvasive alternative to hyperthermic intraperitoneal chemotherapy (HIPEC) in treatment of peritoneal carcinomatosis (PC). First clinical results demonstrate feasibility, but survival data show mixed results and for pancreatic and gastric origin results are not better than expected for chemotherapy alone. In this study, computer simulations are performed to compare the effectiveness of peritoneal heating for five different locoregional heating systems.Methods: Simulations of peritoneal heating were performed for a phantom and two pancreatic cancer patients, using the Thermotron RF8, the AMC-4/ALBA-4D system, the BSD Sigma-60 and Sigma-Eye system, and the AMC-8 system. Specific absorption rate (SAR) distributions were optimized and evaluated. Next, to provide an indication of possible enhancement factors, the corresponding temperature distributions and thermal enhancement ratio (TER) of oxaliplatin were estimated.Results: Both phantom and patient simulations showed a relatively poor SAR coverage for the Thermotron RF8, a fairly good coverage for the AMC-4/ALBA-4D, Sigma-60, and Sigma-Eye systems, and the best and most homogeneous coverage for the AMC-8 system. In at least 50% of the peritoneum, 35-45 W/kg was predicted. Thermal simulations confirmed these favorable peritoneal heating properties of the AMC-8 system and TER values of ∼1.4-1.5 were predicted in at least 50% of the peritoneum.Conclusion: Locoregional peritoneal heating with the AMC-8 system yields more favorable heating patterns compared to other clinically used locoregional heating devices. Therefore, results of this study may promote the use of the AMC-8 system for locoregional hyperthermia in future multidisciplinary studies for treatment of PC.
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Affiliation(s)
- H Petra Kok
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcus Beck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daan R Löke
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Roxan F C P A Helderman
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular and Molecular Medicine (CEMM), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Geertjan van Tienhoven
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans Crezee
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Cavagnaro M, Ruvio G. Numerical Sensitivity Analysis for Dielectric Characterization of Biological Samples by Open-Ended Probe Technique. SENSORS 2020; 20:s20133756. [PMID: 32635581 PMCID: PMC7374459 DOI: 10.3390/s20133756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022]
Abstract
Dielectric characterization of biological tissues has become a fundamental aspect of the design of medical treatments based on electromagnetic energy delivery and their pre-treatment planning. Among several measuring techniques proposed in the literature, broadband and minimally-invasive open-ended probe measurements are best-suited for biological tissues. However, several challenges related to measurement accuracy arise when dealing with biological tissues in both ex vivo and in vivo scenarios such as very constrained set-ups in terms of limited sample size and probe positioning. By means of the Finite Integration Technique in the CST Studio Suite® software, the numerical accuracy of the reconstruction of the complex permittivity of a high water-content tissue such as liver and a low water-content tissue such as fat is evaluated for different sample dimensions, different location of the probe, and considering the influence of the background environment. It is found that for high water-content tissues, the insertion depth of the probe into the sample is the most critical parameter on the accuracy of the reconstruction. Whereas when low water-content tissues are measured, the probe could be simply placed in contact with the surface of the sample but a deeper and wider sample is required to mitigate biasing effects from the background environment. The numerical analysis proves to be a valid tool to assess the suitability of a measurement set-up for a target accuracy threshold.
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Affiliation(s)
- Marta Cavagnaro
- Department of Information Engineering, Electronics, and Telecommunications, Sapienza University, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-4458-5465
| | - Giuseppe Ruvio
- School of Medicine, National University of Ireland Galway, University Road, H91 TK33 Galway, Ireland;
- Endowave Ltd., Dublin 2, Ireland
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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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Gavazzi S, van den Berg CAT, Savenije MHF, Kok HP, de Boer P, Stalpers LJA, Lagendijk JJW, Crezee H, van Lier ALHMW. Deep learning-based reconstruction of in vivo pelvis conductivity with a 3D patch-based convolutional neural network trained on simulated MR data. Magn Reson Med 2020; 84:2772-2787. [PMID: 32314825 PMCID: PMC7402024 DOI: 10.1002/mrm.28285] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To demonstrate that mapping pelvis conductivity at 3T with deep learning (DL) is feasible. METHODS 210 dielectric pelvic models were generated based on CT scans of 42 cervical cancer patients. For all dielectric models, electromagnetic and MR simulations with realistic accuracy and precision were performed to obtain B 1 + and transceive phase (ϕ± ). Simulated B 1 + and ϕ± served as input to a 3D patch-based convolutional neural network, which was trained in a supervised fashion to retrieve the conductivity. The same network architecture was retrained using only ϕ± in input. Both network configurations were tested on simulated MR data and their conductivity reconstruction accuracy and precision were assessed. Furthermore, both network configurations were used to reconstruct conductivity maps from a healthy volunteer and two cervical cancer patients. DL-based conductivity was compared in vivo and in silico to Helmholtz-based (H-EPT) conductivity. RESULTS Conductivity maps obtained from both network configurations were comparable. Accuracy was assessed by mean error (ME) with respect to ground truth conductivity. On average, ME < 0.1 Sm-1 for all tissues. Maximum MEs were 0.2 Sm-1 for muscle and tumour, and 0.4 Sm-1 for bladder. Precision was indicated with the difference between 90th and 10th conductivity percentiles, and was below 0.1 Sm-1 for fat, bone and muscle, 0.2 Sm-1 for tumour and 0.3 Sm-1 for bladder. In vivo, DL-based conductivity had median values in agreement with H-EPT values, but a higher precision. CONCLUSION Anatomically detailed, noise-robust 3D conductivity maps with good sensitivity to tissue conductivity variations were reconstructed in the pelvis with DL.
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Affiliation(s)
- Soraya Gavazzi
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis A T van den Berg
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.,Computational Imaging Group for MR diagnostics and therapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark H F Savenije
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.,Computational Imaging Group for MR diagnostics and therapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Petra Kok
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Peter de Boer
- Radiotherapy Institute Friesland, Leeuwarden, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan J W Lagendijk
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans Crezee
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Zhang J, Chauhan S. Fast computation of soft tissue thermal response under deformation based on fast explicit dynamics finite element algorithm for surgical simulation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 187:105244. [PMID: 31805458 DOI: 10.1016/j.cmpb.2019.105244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/03/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES During thermal heating surgical procedures such as electrosurgery, thermal ablative treatment and hyperthermia, soft tissue deformation due to surgical tool-tissue interaction and patient movement can affect the distribution of thermal energy induced. Soft tissue temperature must be obtained from the deformed tissue for precise delivery of thermal energy. However, the classical Pennes bio-heat transfer model can handle only the static non-moving state of tissue. In addition, in order to enable a surgeon to visualise the simulated results immediately, the solution procedure must be suitable for real-time thermal applications. METHODS This paper presents a formulation of bio-heat transfer under the effect of soft tissue deformation for fast or near real-time tissue temperature prediction, based on fast explicit dynamics finite element algorithm (FED-FEM) for transient heat transfer. The proposed thermal analysis under deformation is achieved by transformation of the unknown deformed tissue state to the known initial static state via a mapping function. The appropriateness and effectiveness of the proposed formulation are evaluated on a realistic virtual human liver model with blood vessels to demonstrate a clinically relevant scenario of thermal ablation of hepatic cancer. RESULTS For numerical accuracy, the proposed formulation can achieve a typical 10-3 level of normalised relative error at nodes and between 10-4 and 10-5 level of total errors for the simulation, by comparing solutions against the commercial finite element analysis package. For computation time, the proposed formulation under tissue deformation with anisotropic temperature-dependent properties consumes 2.518 × 10-4 ms for one element thermal loads computation, compared to 2.237 × 10-4 ms for the formulation without deformation which is 0.89 times of the former. Comparisons with three other formulations for isotropic and temperature-independent properties are also presented. CONCLUSIONS Compared to conventional methods focusing on numerical accuracy, convergence and stability, the proposed formulation focuses on computational performance for fast tissue thermal analysis. Compared to the classical Pennes model that handles only the static state of tissue, the proposed formulation can achieve fast thermal analysis on deformed states of tissue and can be applied in addition to tissue deformable models for non-linear heating analysis at even large deformation of soft tissue, leading to great translational potential in dynamic tissue temperature analysis and thermal dosimetry computation for computer-integrated medical education and personalised treatment.
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Affiliation(s)
- Jinao Zhang
- Department of Mechanical and Aerospace Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia.
| | - Sunita Chauhan
- Department of Mechanical and Aerospace Engineering, Monash University, Wellington Road, Clayton, VIC 3800, Australia
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Paulides M, Dobsicek Trefna H, Curto S, Rodrigues D. Recent technological advancements in radiofrequency- andmicrowave-mediated hyperthermia for enhancing drug delivery. Adv Drug Deliv Rev 2020; 163-164:3-18. [PMID: 32229271 DOI: 10.1016/j.addr.2020.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/23/2022]
Abstract
Hyperthermia therapy is a potent enhancer of chemotherapy and radiotherapy. In particular, microwave (MW) and radiofrequency (RF) hyperthermia devices provide a variety of heating approaches that can treat most cancers regardless the size. This review introduces the physics of MW/RF hyperthermia, the current state-of-the-art systems for both localized and regional heating, and recent advancements in hyperthermia treatment guidance using real-time computational simulations and magnetic resonance thermometry. Clinical trials involving RF/MW hyperthermia as adjuvant for chemotherapy are also presented per anatomical site. These studies favor the use of adjuvant hyperthermia since it significantly improves curative and palliative clinical outcomes. The main challenge of hyperthermia is the distribution of state-of-the-art heating systems. Nevertheless, we anticipate that recent technology advances will expand the use of hyperthermia to chemotherapy centers for enhanced drug delivery. These new technologies hold great promise not only for (image-guided) perfusion modulation and sensitization for cytotoxic drugs, but also for local delivery of various compounds using thermosensitive liposomes.
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Kok HP, Groen J, Bakker A, Crezee J. Modelling Curved Contact Flexible Microstrip Applicators for Patient-Specific Superficial Hyperthermia Treatment Planning. Cancers (Basel) 2020; 12:cancers12030656. [PMID: 32168959 PMCID: PMC7139424 DOI: 10.3390/cancers12030656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 12/18/2022] Open
Abstract
This paper describes a method to reconstruct bendable superficial hyperthermia applicators for routine clinical patient-specific treatment planning. The reconstruction uses a CT scan with a flexible silicone dummy applicator positioned on the patient. The curvature was approximated by two second-degree polynomial functions. A realistic treatment series was mimicked using a standard Alderson radiation therapy phantom and a treatment planning model was reconstructed from a CT scan. The variation among treatment curvatures was compared to the modelled curvature. The mathematical approximation of the applicator curvature was validated for this phantom experiment, as well as for clinical treatments. The average maximum variation among the successive mimicked sessions was 3.67 ± 0.69 mm (range 2.98-4.60mm). The maximum deviation between the treatment curvature and the modelled curvature was 4.35 mm. Comparing the treatment and approximated curvature yielded a maximum deviation between 2.98 mm and 4.12 mm. For clinical treatments the maximum deviation of the treatment and approximated curvature varied between 0.48 mm and 1.98 mm. These results allow adequate reconstruction of bendable hyperthermia applicators for treatment planning, which can further improve treatment quality, for example by optimizing the water bolus temperature for patient-specific tumor depths. Predictive parameters for hyperthermia treatment outcome can easily be evaluated and compared for various input parameters.
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Wust P, Ghadjar P, Nadobny J, Beck M, Kaul D, Winter L, Zschaeck S. Physical analysis of temperature-dependent effects of amplitude-modulated electromagnetic hyperthermia. Int J Hyperthermia 2019; 36:1246-1254. [DOI: 10.1080/02656736.2019.1692376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jacek Nadobny
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas Winter
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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Neural network methodology for real-time modelling of bio-heat transfer during thermo-therapeutic applications. Artif Intell Med 2019; 101:101728. [DOI: 10.1016/j.artmed.2019.101728] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/30/2019] [Accepted: 09/26/2019] [Indexed: 12/26/2022]
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Role of Simulations in the Treatment Planning of Radiofrequency Hyperthermia Therapy in Clinics. JOURNAL OF ONCOLOGY 2019; 2019:9685476. [PMID: 31558904 PMCID: PMC6735211 DOI: 10.1155/2019/9685476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/20/2019] [Accepted: 07/28/2019] [Indexed: 12/26/2022]
Abstract
Hyperthermia therapy is a treatment modality in which tumor temperatures are elevated to higher temperatures to cause damage to cancerous tissues. Numerical simulations are integral in the development of hyperthermia treatment systems and in clinical treatment planning. In this study, simulations in radiofrequency hyperthermia therapy are reviewed in terms of their technical development and clinical aspects for effective clinical use. This review offers an overview of mathematical models and the importance of tissue properties; locoregional mild hyperthermia therapy, including phantom and realistic human anatomy models; phase array systems; tissue damage; thermal dose analysis; and thermoradiotherapy planning. This review details the improvements in numerical approaches in treatment planning and their application for effective clinical use. Furthermore, the modeling of thermoradiotherapy planning, which can be integrated with radiotherapy to provide combined hyperthermia and radiotherapy treatment planning strategies, are also discussed. This review may contribute to the effective development of thermoradiotherapy planning in clinics.
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Sumser K, Neufeld E, Verhaart RF, Fortunati V, Verduijn GM, Drizdal T, van Walsum T, Veenland JF, Paulides MM. Feasibility and relevance of discrete vasculature modeling in routine hyperthermia treatment planning. Int J Hyperthermia 2019; 36:801-811. [DOI: 10.1080/02656736.2019.1641633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kemal Sumser
- Department of Radiation Oncology, University Medical Center Rotterdam, Erasmus MC – Cancer Institute, Rotterdam, The Netherlands
| | - Esra Neufeld
- Computational Life Sciences Group, Foundation for Research on Information Technologies in Society (IT’IS), Zurich, Switzerland
| | - René F. Verhaart
- Department of Radiation Oncology, University Medical Center Rotterdam, Erasmus MC – Cancer Institute, Rotterdam, The Netherlands
| | - Valerio Fortunati
- Department of Medical Informatics and Radiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Gerda M. Verduijn
- Department of Radiation Oncology, University Medical Center Rotterdam, Erasmus MC – Cancer Institute, Rotterdam, The Netherlands
| | - Tomas Drizdal
- Department of Radiation Oncology, University Medical Center Rotterdam, Erasmus MC – Cancer Institute, Rotterdam, The Netherlands
- Department of Biomedical Technology, Czech Technical University in Prague, Prague, Czech Republic
| | - Theo van Walsum
- Department of Medical Informatics and Radiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Jifke F. Veenland
- Department of Medical Informatics and Radiology, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Margarethus M. Paulides
- Department of Radiation Oncology, University Medical Center Rotterdam, Erasmus MC – Cancer Institute, Rotterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Schooneveldt G, Dobšíček Trefná H, Persson M, de Reijke TM, Blomgren K, Kok HP, Crezee H. Hyperthermia Treatment Planning Including Convective Flow in Cerebrospinal Fluid for Brain Tumour Hyperthermia Treatment Using a Novel Dedicated Paediatric Brain Applicator. Cancers (Basel) 2019; 11:E1183. [PMID: 31443246 PMCID: PMC6721488 DOI: 10.3390/cancers11081183] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/29/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022] Open
Abstract
Hyperthermia therapy (40-44 °C) is a promising option to increase efficacy of radiotherapy/chemotherapy for brain tumours, in particular paediatric brain tumours. The Chalmers Hyperthermia Helmet is developed for this purpose. Hyperthermia treatment planning is required for treatment optimisation, but current planning systems do not involve a physically correct model of cerebrospinal fluid (CSF). This study investigates the necessity of fluid modelling for treatment planning. We made treatments plans using the Helmet for both pre-operative and post-operative cases, comparing temperature distributions predicted with three CSF models: a convective "fluid" model, a non-convective "solid" CSF model, and CSF models with increased effective thermal conductivity ("high-k"). Treatment plans were evaluated by T90, T50 and T10 target temperatures and treatment-limiting hot spots. Adequate heating is possible with the helmet. In the pre-operative case, treatment plan quality was comparable for all three models. In the post-operative case, the high-k models were more accurate than the solid model. Predictions to within ±1 °C were obtained by a 10-20-fold increased effective thermal conductivity. Accurate modelling of the temperature in CSF requires fluid dynamics, but modelling CSF as a solid with enhanced effective thermal conductivity might be a practical alternative for a convective fluid model for many applications.
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Affiliation(s)
- Gerben Schooneveldt
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Hana Dobšíček Trefná
- Department of Electrical Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden
| | - Mikael Persson
- Department of Electrical Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Klas Blomgren
- Department of Women's and Children's Health, Karolinska Institutet, 17164 Stockholm, Sweden
- Department of Pediatric Oncology, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - H Petra Kok
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Hans Crezee
- Department of Radiotherapy, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Zhang J, Hills J, Zhong Y, Shirinzadeh B, Smith J, Gu C. Modeling of soft tissue thermal damage based on GPU acceleration. Comput Assist Surg (Abingdon) 2019; 24:5-12. [DOI: 10.1080/24699322.2018.1557891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jinao Zhang
- School of Engineering, RMIT University, Bundoora, Australia
| | - Jeremy Hills
- School of Engineering, RMIT University, Bundoora, Australia
| | - Yongmin Zhong
- School of Engineering, RMIT University, Bundoora, Australia
| | - Bijan Shirinzadeh
- Robotics and Mechatronics Research Laboratory, Department of Mechanical and Aerospace Engineering, Monash University, Clayton, Australia
| | - Julian Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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Abdolhosseinzadeh A, Mojra A, Ashrafizadeh A. A numerical study on thermal ablation of brain tumor with intraoperative focused ultrasound. J Therm Biol 2019; 83:119-133. [DOI: 10.1016/j.jtherbio.2019.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/13/2019] [Accepted: 05/19/2019] [Indexed: 02/07/2023]
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Quantitative Estimation of the Equivalent Radiation Dose Escalation using Radiofrequency Hyperthermia in Mouse Xenograft Models of Human Lung Cancer. Sci Rep 2019; 9:3942. [PMID: 30850669 PMCID: PMC6408478 DOI: 10.1038/s41598-019-40595-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/20/2019] [Indexed: 12/29/2022] Open
Abstract
Hyperthermia is a potent radiosensitizer, and its effect varies according to the different types of cancer cells. In the present study, the radiosensitizing effect of hyperthermia on lung cancer cell lines A549 and NCI-H1299 was determined based on the equivalent radiation dose escalation. In vitro cell experiments were conducted using lung cancer cell lines A549 and NCI-H1299 to determine thermal radiosensitivity. In vivo experiments were conducted using mouse heterotopic xenograft models to determine the treatment response and increase in the temperature of tumors using a 13.56 MHz radiofrequency (RF) hyperthermia device. Using the α and β values of the linear–quadratic equations of cell survival curves, numerical simulations were performed to calculate the equivalent radiation dose escalations. The dielectric properties of tumors were measured, and their effect on the calculated equivalent radiation dose was analyzed. Hyperthermia increased the equivalent radiation dose of lung cancer xenografts and a higher escalation was found in NCI-H1299 cells compared with that observed in A549 cells. An underestimation of the calculated equivalent radiation dose was observed when the dielectric property of the tumor was varied. This study may contribute to the effective planning of thermoradiotherapy in clinics.
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Aklan B, Zilles B, Paprottka P, Manz K, Pfirrmann M, Santl M, Abdel-Rahman S, Lindner LH. Regional deep hyperthermia: quantitative evaluation of predicted and direct measured temperature distributions in patients with high-risk extremity soft-tissue sarcoma. Int J Hyperthermia 2019; 36:170-185. [PMID: 30777497 DOI: 10.1080/02656736.2018.1545098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Temperature distributions resulting from hyperthermia treatment of patients with high-risk soft-tissue sarcoma (STS) were quantitatively evaluated and globally compared with thermal simulations performed by a treatment planning system. The aim was to test whether the treatment planning system was able to predict correct temperature distributions. METHODS Five patients underwent computed tomography (CT) fluoroscopy-guided placement of tumor catheters used for the interstitial temperature measurements. For the simulations, five 3 D patient models were reconstructed by segmenting the patient CT datasets into different tissues. The measured and simulated data were evaluated by calculating the temperature change ( ΔT ), T90, T50, T20, Tmean, Tmin and Tmax, as well as the 90th percentile thermal dose (CEM43T90). In order to measure the agreement between both methods quantitatively, the Bland-Altman analysis was applied. RESULTS The absolute difference between measured and simulated temperatures were found to be 2°, 6°, 1°, 4°, 5° and 4 °C on average for Tmin, Tmax, T90, T50, T20 and Tmean, respectively. Furthermore, the thermal simulations exhibited relatively higher thermal dose compared to those that were measured. Finally, the results of the Bland-Altman analysis showed that the mean difference between both methods was above 2 °C which is considered to be clinically unacceptable. CONCLUSION Given the current practical limitations on resolution of calculation grid, tissue properties, and perfusion information, the software SigmaHyperPlan™ is incapable to produce thermal simulations with sufficient correlation to typically heterogeneous tissue temperatures to be useful for clinical treatment planning.
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Affiliation(s)
- B Aklan
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
| | - B Zilles
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
| | - P Paprottka
- b Institute for Clinical Radiology, Ludwig Maximilians University Hospital , Munich, Germany
| | - K Manz
- c Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich , Munich , Germany
| | - M Pfirrmann
- c Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich , Munich , Germany
| | - M Santl
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
| | - S Abdel-Rahman
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
| | - L H Lindner
- a Department of Internal Medicine III , Ludwig Maximilians University Hospital , Munich , Germany
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