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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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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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Löke DR, Helderman RFCPA, Franken NAP, Oei AL, Tanis PJ, Crezee J, Kok HP. Simulating drug penetration during hyperthermic intraperitoneal chemotherapy. Drug Deliv 2021; 28:145-161. [PMID: 33427507 PMCID: PMC7808385 DOI: 10.1080/10717544.2020.1862364] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) is administered to treat residual microscopic disease after debulking cytoreductive surgery. During HIPEC, a limited number of catheters are used to administer and drain fluid containing chemotherapy (41–43 °C), yielding heterogeneities in the peritoneum. Large heterogeneities may lead to undertreated areas, increasing the risk of recurrences. Aiming at intra-abdominal homogeneity is therefore essential to fully exploit the potential of HIPEC. More insight is needed into the extent of the heterogeneities during treatments and assess their effects on the efficacy of HIPEC. To that end we developed a computational model containing embedded tumor nodules in an environment mimicking peritoneal conditions. Tumor- and treatment-specific parameters affecting drug delivery like tumor size, tumor shape, velocity, temperature and dose were assessed using three-dimensional computational fluid dynamics (CFD) to demonstrate their effect on the drug distribution and accumulation in nodules. Clonogenic assays performed on RKO colorectal cell lines yielded the temperature-dependent IC50 values of cisplatin (19.5–6.8 micromolar for 37–43 °C), used to compare drug distributions in our computational models. Our models underlined that large nodules are more difficult to treat and that temperature and velocity are the most important factors to control the drug delivery. Moderate flow velocities, between 0.01 and 1 m/s, are optimal for the delivery of cisplatin. Furthermore, higher temperatures and higher doses increased the effective penetration depth with 69% and 54%, respectively. We plan to extend the software developed for this study toward patient-specific treatment planning software, capable of mapping and assist in reducing heterogeneous flow patterns.
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Affiliation(s)
- Daan R Löke
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roxan F C P A Helderman
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas A P Franken
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department for Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Johannes Crezee
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H Petra Kok
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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4
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Wang F, Xu S, Jiang D, Zhao B, Dong X, Zhou T, Luo X. Particle hydrodynamic simulation of thrombus formation using velocity decay factor. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106173. [PMID: 34058630 DOI: 10.1016/j.cmpb.2021.106173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Thrombus simulation plays an important role in many specialist areas in the field of medicine such as surgical education and training, clinical diagnosis and prediction, treatment planning, etc. Although a considerable number of methods have been developed to simulate various kinds of fluid flows, it remains a non-trivial task to effectively simulate thrombus because of its unique physiological properties in contrast to other types of fluids. To tackle this issue, this study introduces a novel method to model the formation mechanism of thrombus and its interaction with blood flow. METHODS The proposed method for thrombus formation simulation mainly consists of three steps. First, we formulate the formation of thrombus as a particle-based model and obtain the fibrin concentration of the particles with a discretized form of the convection-diffusion-reaction equation; then, we calculate the velocity decay factor using the obtained fibrin concentration. Finally, the formation of thrombus can be simulated by applying the velocity decay factor on particles. RESULTS We carried out extensive experiments under different settings to verify the efficacy of the proposed method. The experimental results demonstrate that our method can yield more realistic simulation of thrombus and is superior to peer method in terms of computational efficiency, maintaining the stability of the dynamic particle motion, and preventing particle penetration at the boundary. CONCLUSION The proposed method can simulate the formation mechanism of thrombus and the interaction between blood flow and thrombus both efficiently and effectively.
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Affiliation(s)
- Fei Wang
- Shantou University, Shantou, China
| | - Songhua Xu
- University of South Carolina, Columbia, SC, USA
| | | | - Baoquan Zhao
- Guilin University of Electronic Technology, Guilin, China.
| | - Xiaoqiang Dong
- General Surgery of Longhua Branch, Shenzhen People's Hospital
| | | | - Xiaonan Luo
- Guilin University of Electronic Technology, Guilin, China.
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5
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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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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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7
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Ooi EH, Popov V, Alfano M, Cheong JKK. Influence of natural convection on gold nanorods-assisted photothermal treatment of bladder cancer in mice. Int J Hyperthermia 2020; 37:634-650. [PMID: 32538190 DOI: 10.1080/02656736.2020.1771437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The thermally-induced urine flow can generate cooling that may alter the treatment outcome during hyperthermic treatments of bladder cancer. This paper investigates the effects of natural convection inside the bladder and at skin surface during gold nanorods (GNR) - assisted photothermal therapy (PTT) of bladder cancer in mice. Methods: 3D models of mouse bladder at orientations corresponding to the mouse positioned on its back, its side and its abdomen were examined. Numerical simulations were carried out for GNR volume fractions of 0.001, 0.005 and 0.01% and laser power of 0.2 and 0.3 W. Results: The obtained results showed that cooling due to natural convection inside the bladder and above the skin depends on the mouse orientation. For a mouse positioned on its back, on its side or on its abdomen, the maximum temperature achieved inside the tumour at 0.001% GNR volume fraction and 0.2 W laser power was 55.2°C, 50.0°C and 52.2°C, respectively compared to 56.8°C when natural convection was not considered. The average thermal gradients when natural convection was considered were also lower, suggesting a more homogenous temperature distribution. Conclusions: Natural convection inside the bladder can be beneficial but also detrimental to GNR-assisted PTT depending on the level of heating. At low levels of heating due to low GNR volume fraction and/or laser power, flow inside the bladder may dissipate heat from the targeted tissue; making the treatment ineffective. At high levels of heating due to high GNR volume fraction and/or laser power, cooling may prevent excessive thermal damage to surrounding tissues.
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Affiliation(s)
- Ean H Ooi
- Ascend Technologies Ltd., Southampton, UK.,School of Engineering and Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
| | | | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jason K K Cheong
- Ascend Technologies Ltd., Southampton, UK.,School of Engineering and Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Malaysia
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8
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A moderate thermal dose is sufficient for effective free and TSL based thermochemotherapy. Adv Drug Deliv Rev 2020; 163-164:145-156. [PMID: 32247801 DOI: 10.1016/j.addr.2020.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
Hyperthermia, i.e. heating the tumor to a temperature of 40-43 °C is considered by many a valuable treatment to sensitize tumor cells to radiotherapy and chemotherapy. In recent randomized trials the great potential of adding hyperthermia to chemotherapy was demonstrated for treatment of high risk soft tissue sarcoma: +11.4% 5 yrs. overall survival (OS) and for ovarian cancer with peritoneal involvement nearly +12 months OS gain. As a result interest in combining chemotherapy with hyperthermia, i.e. thermochemotherapy, is growing. Extensive biological research has revealed that hyperthermia causes multiple effects, from direct cell kill to improved oxygenation, whereby each effect has a specific temperature range. Thermal sensitization of the tumor cell for chemotherapy occurs for many drugs at temperatures ranging from 40 to 42 °C with little additional increase of sensitization at higher temperatures. Increasing perfusion/oxygenation and increased extravasation are two other important hyperthermia induced mechanisms. The combination of free drug and hyperthermia has not been found to increase tumor drug concentration. Hence, enhanced effectiveness of free drug will depend on the thermal sensitization of the tumor cells for the applied drug. In contrast to free drugs, experimental animal studies combining hyperthermia and thermo-sensitive liposomal (TSL) drugs delivery have demonstrated to result in a substantial increase of the drug concentration in the tumor. For TSL based chemotherapy, hyperthermia is critical to both increase perfusion and extravasation as well as to trigger TSL drug release, whereby the temperature controlled induction of a local high drug concentration in a highly permeable vessel is driving the enhanced drug uptake in the tumor. Increased drug concentrations up to 26 times have been reported in rodents. Good control of the tissue temperature is required to keep temperatures below 43 °C to prevent vascular stasis. Further, careful timing of the drug application relative to the start of heating is required to benefit optimal from the combined treatment. From the available experimental data it follows that irrespective whether chemotherapy is applied as free drug or using a thermal sensitive liposomal carrier, the optimal thermal dose for thermochemotherapy should be 40-42 °C for 30-60 min, i.e. equivalent to a CEM43 of 1-15 min. Timing is critical: most free drug should be applied simultaneous with heating, whereas TSL drugs should be applied 20-30 min after the start of hyperthermia.
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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:cancers11081183. [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] [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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10
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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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11
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Schooneveldt G, Kok HP, Bakker A, Geijsen ED, Rasch CRN, Rosette JJMCHDL, Hulshof MCCM, Reijke TMD, Crezee H. Clinical validation of a novel thermophysical bladder model designed to improve the accuracy of hyperthermia treatment planning in the pelvic region. Int J Hyperthermia 2018; 35:383-397. [PMID: 30381980 DOI: 10.1080/02656736.2018.1506164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Hyperthermia treatment planning for deep locoregional hyperthermia treatment may assist in phase and amplitude steering to optimize the temperature distribution. This study aims to incorporate a physically correct description of bladder properties in treatment planning, notably the presence of convection and absence of perfusion within the bladder lumen, and to assess accuracy and clinical implications for non muscle invasive bladder cancer patients treated with locoregional hyperthermia. METHODS We implemented a convective thermophysical fluid model based on the Boussinesq approximation to the Navier-Stokes equations using the (finite element) OpenFOAM toolkit. A clinician delineated the bladder on CT scans obtained from 14 bladder cancer patients. We performed (1) conventional treatment planning with a perfused muscle-like solid bladder, (2) with bladder content properties without and (3) with flow dynamics. Finally, we compared temperature distributions predicted by the three models with temperature measurements obtained during treatment. RESULTS Much higher and more uniform bladder temperatures are predicted with physically accurate fluid modeling compared to previously employed muscle-like models. The differences reflect the homogenizing effect of convection, and the absence of perfusion. Median steady state temperatures simulated with the novel convective model (3) deviated on average -0.6 °C (-12%) from values measured during treatment, compared to -3.7 °C (-71%) and +1.5 °C (+29%) deviation for the muscle-like (1) and static (2) models, respectively. The Grashof number was 3.2 ± 1.5 × 105 (mean ± SD). CONCLUSIONS Incorporating fluid modeling in hyperthermia treatment planning yields significantly improved predictions of the temperature distribution in the bladder lumen during hyperthermia treatment.
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Affiliation(s)
- Gerben Schooneveldt
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - H Petra Kok
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - Akke Bakker
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - Elisabeth D Geijsen
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - Coen R N Rasch
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | | | - Maarten C C M Hulshof
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
| | - Theo M de Reijke
- b Department of Urology , Academic Medical Center , Amsterdam , the Netherlands
| | - Hans Crezee
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , the Netherlands
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12
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Schooneveldt G, Kok HP, Bakker A, Geijsen ED, Hulshof MCCM, Reijke TMD, Crezee J. The effect of air pockets in the urinary bladder on the temperature distribution during loco-regional hyperthermia treatment of bladder cancer patients. Int J Hyperthermia 2018; 35:441-449. [PMID: 30303415 DOI: 10.1080/02656736.2018.1506890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Loco-regional hyperthermia combined with mitomycin C is used for treatment of nonmuscle invasive bladder cancer (NMIBC). Air pockets may be present in the bladder during treatment. The aim of this study is to quantify the effect of air pockets on the thermal dose of the bladder. METHODS We analysed 16 patients treated for NMIBC. Loco-regional hyperthermia was performed with the in-house developed 70 MHz AMC-4 hyperthermia device. We simulated treatments with the clinically applied device settings using Plan2Heat (developed in-house) including the air pockets delineated on CT scans made following treatment, and with the same volume filled with urine. Temperature distributions simulated with and without air pockets were compared. RESULTS The average air and fluid volumes in the bladder were 6.0 ml (range 0.8 - 19.3 ml) and 183 ml (range 47-322 ml), respectively. The effect of these air pockets varied strongly between patients. Averaged over all patients, the median bladder wall temperature (T50) remained unchanged when an air pocket was present. Temperature changes exceeded ±0.2 °C in, on average, 23% of the bladder wall volume (range 1.3-59%), in 6.0% (range 0.6-20%) changes exceeded ±0.5 °C and in 3.2% (range 0.0-7.4%) changes exceeded ±1.0 °C. There was no correlation between the differences in temperature and the air pocket or bladder volume. There was a positive correlation between air pocket surface and temperature heterogeneity. CONCLUSION Presence of air causes more heterogeneous bladder wall temperatures and lower T90, particularly for larger air pockets. The size of air pockets must therefore be minimized during bladder hyperthermia treatments.
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Affiliation(s)
- G Schooneveldt
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - H P Kok
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - A Bakker
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - E D Geijsen
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - M C C M Hulshof
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
| | - T M de Reijke
- b Department of Urology , Academic Medical Center , Amsterdam , The Netherlands
| | - J Crezee
- a Department of Radiation Oncology , Academic Medical Center , Amsterdam , The Netherlands
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13
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Kok HP, Schooneveldt G, Bakker A, de Kroon-Oldenhof R, Korshuize-van Straten L, de Jong CE, Steggerda-Carvalho E, Geijsen ED, Stalpers LJA, Crezee J. Predictive value of simulated SAR and temperature for changes in measured temperature after phase-amplitude steering during locoregional hyperthermia treatments. Int J Hyperthermia 2018; 35:330-339. [DOI: 10.1080/02656736.2018.1500720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- H. P. Kok
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G. Schooneveldt
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Bakker
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R. de Kroon-Oldenhof
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - L. Korshuize-van Straten
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - C. E. de Jong
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E. Steggerda-Carvalho
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E. D. Geijsen
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - L. J. A. Stalpers
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J. Crezee
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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14
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Kok HP, Korshuize-van Straten L, Bakker A, de Kroon – Oldenhof R, Westerveld GH, Versteijne E, Stalpers LJA, Crezee J. Feasibility of on-line temperature-based hyperthermia treatment planning to improve tumour temperatures during locoregional hyperthermia. Int J Hyperthermia 2017; 34:1082-1091. [DOI: 10.1080/02656736.2017.1400120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- H. P. Kok
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - L. Korshuize-van Straten
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A. Bakker
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R. de Kroon – Oldenhof
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G. H. Westerveld
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E. Versteijne
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - L. J. A. Stalpers
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J. Crezee
- Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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15
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Online Adaptive Hyperthermia Treatment Planning During Locoregional Heating to Suppress Treatment-Limiting Hot Spots. Int J Radiat Oncol Biol Phys 2017; 99:1039-1047. [PMID: 28870786 DOI: 10.1016/j.ijrobp.2017.07.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adequate tumor temperatures during hyperthermia are essential for good clinical response, but excessive heating of normal tissue should be avoided. This makes locoregional heating using phased array systems technically challenging. Online application of hyperthermia treatment planning could help to improve the heating quality. The aim of this study was to evaluate the clinical benefit of online treatment planning during treatment of pelvic tumors heated with the AMC-8 locoregional hyperthermia system. METHODS For online adaptive hyperthermia treatment planning, a graphical user interface was developed. Electric fields were calculated in a preprocessing step using our in-house-developed finite-difference-based treatment planning system. This allows instant calculation of the temperature distribution for user-selected phase-amplitude settings during treatment and projection onto the patient's computed tomographic scan for online visualization. Online treatment planning was used for 14 treatment sessions in 8 patients to reduce the patients' reports of hot spots while maintaining the same level of tumor heating. The predicted decrease in hot spot temperature should be at least 0.5°C, and the tumor temperature should decrease less than 0.2°C. These predictions were compared with clinical data: patient feedback about the hot spot and temperature measurements in the tumor region. RESULTS In total, 17 hot spot reports occurred during the 14 sessions, and the alternative settings predicted the hot spot temperature to decrease by at least 0.5°C, which was confirmed by the disappearance of all 17 hot spot reports. At the same time, the average tumor temperature was predicted to change on average -0.01°C (range, -0.19°C to 0.34°C). The measured tumor temperature change was on average only -0.02°C (range, -0.26°C to 0.31°C). In only 2 cases the temperature decrease was slightly larger than 0.2°C, but at most it was 0.26°C. CONCLUSIONS Online application of hyperthermia treatment planning is reliable and very useful to reduce hot spots without affecting tumor temperatures.
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16
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Kok HP, Kotte ANTJ, Crezee J. Planning, optimisation and evaluation of hyperthermia treatments. Int J Hyperthermia 2017; 33:593-607. [PMID: 28540779 DOI: 10.1080/02656736.2017.1295323] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hyperthermia treatment planning using dedicated simulations of power and temperature distributions is very useful to assist in hyperthermia applications. This paper describes an advanced treatment planning software package for a wide variety of applications. METHODS The in-house developed C++ software package Plan2Heat runs on a Linux operating system. Modules are available to perform electric field and temperature calculations for many heating techniques. The package also contains optimisation routines, post-treatment evaluation tools and a sophisticated thermal model enabling to account for 3D vasculature based on an angiogram or generated artificially using a vessel generation algorithm. The use of the software is illustrated by a simulation of a locoregional hyperthermia treatment for a pancreatic cancer patient and a spherical tumour model heated by interstitial hyperthermia, with detailed 3D vasculature included. RESULTS The module-based set-up makes the software flexible and easy to use. The first example demonstrates that treatment planning can help to focus the heating to the tumour. After optimisation, the simulated absorbed power in the tumour increased with 50%. The second example demonstrates the impact of accurately modelling discrete vasculature. Blood at body core temperature entering the heated volume causes relatively cold tracks in the heated volume, where the temperature remains below 40 °C. CONCLUSIONS A flexible software package for hyperthermia treatment planning has been developed, which can be very useful in many hyperthermia applications. The object-oriented structure of the source code allows relatively easy extension of the software package with additional tools when necessary for future applications.
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Affiliation(s)
- H P Kok
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - A N T J Kotte
- b Department of Radiotherapy , University Medical Center Utrecht , Utrecht , The Netherlands
| | - J Crezee
- a Department of Radiation Oncology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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