Tumor bed brachytherapy for locally advanced laryngeal cancer: a feasibility assessment of combination with ferromagnetic hyperthermia

Characterization of Ferromagnetic Composite Implants for Tumor Bed Hyperthermia

Hyperthermia therapy (HT) is becoming a well-recognized method for the treatment of cancer when combined with radiation or chemotherapy. There are many ways to heat a tumor and the optimum approach depends on the treatment site. This study investigates a composite ferromagnetic surgical implant inserted in a tumor bed for the delivery of local HT. Heating of the implant is achieved by inductively coupling energy from an external magnetic field of sub-megahertz frequency. Implants are formed by mechanically filling a resected tumor bed with self-polymerizing plastic mass mixed with small ferromagnetic thermoseeds. Model implants were manufactured and then heated in a 35 cm diameter induction coil of our own design. Experimental results showed that implants were easily heated to temperatures that allow either traditional HT (39-45°C) or thermal ablation therapy (>50°C) in an external magnetic field with a frequency of 90 kHz and amplitude not exceeding 4 kA/m. These results agreed well with a numerical solution of combined electromagnetic and heat transfer equations solved using the finite element method.

Feasibility of removable balloon implant for simultaneous magnetic nanoparticle heating and HDR brachytherapy of brain tumor resection cavities

AIM

Hyperthermia (HT) has been shown to improve clinical response to radiation therapy (RT) for cancer. Synergism is dramatically enhanced if HT and RT are combined simultaneously, but appropriate technology to apply treatments together does not exist. This study investigates the feasibility of delivering HT with RT to a 5-10mm annular rim of at-risk tissue around a tumor resection cavity using a temporary thermobrachytherapy (TBT) balloon implant.

METHODS

A balloon catheter was designed to deliver radiation from High Dose Rate (HDR) brachytherapy concurrent with HT delivered by filling the balloon with magnetic nanoparticles (MNP) and immersing it in a radiofrequency magnetic field. Temperature distributions in brain around the TBT balloon were simulated with temperature dependent brain blood perfusion using numerical modeling. A magnetic induction system was constructed and used to produce rapid heating (>0.2°C/s) of MNP-filled balloons in brain tissue-equivalent phantoms by absorbing 0.5 W/ml from a 5.7 kA/m field at 133 kHz.

RESULTS

Simulated treatment plans demonstrate the ability to heat at-risk tissue around a brain tumor resection cavity between 40-48°C for 2-5cm diameter balloons. Experimental thermal dosimetry verifies the expected rapid and spherically symmetric heating of brain phantom around the MNP-filled balloon at a magnetic field strength that has proven safe in previous clinical studies.

CONCLUSIONS

These preclinical results demonstrate the feasibility of using a TBT balloon to deliver heat simultaneously with HDR brachytherapy to tumor bed around a brain tumor resection cavity, with significantly improved uniformity of heating over previous multi-catheter interstitial approaches. Considered along with results of previous clinical thermobrachytherapy trials, this new capability is expected to improve both survival and quality of life in patients with glioblastoma multiforme.