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Almasri F, Sakarya EH, Karshafian R. Radioenhancement with the Combination of Docetaxel and Ultrasound Microbubbles: In Vivo Prostate Cancer. Pharmaceutics 2023; 15:pharmaceutics15051468. [PMID: 37242710 DOI: 10.3390/pharmaceutics15051468] [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: 03/27/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Using an in vitro prostate cancer model, we previously demonstrated the significant enhancement of radiotherapy (XRT) with the combined treatment of docetaxel (Taxotere; TXT) and ultrasound-microbubbles (USMB). Here, we extend these findings to an in vivo cancer model. Severe combined immune-deficient male mice were xenografted with the PC-3 prostate cancer cell line in the hind leg and treated with USMB, TXT, radiotherapy (XRT), and their combinations. The tumors were imaged with ultrasound pre-treatment and 24 h post-treatment, following which they were extracted for the histological analysis of the tumor-cell death (DN; H&E) and apoptosis (DA; TUNEL). The tumors' growths were assessed for up to ~6 weeks and analysed using the exponential Malthusian tumor-growth model. The tumors' doubling time (VT) was characterized as growth (positive) or shrinkage (negative). The cellular death and apoptosis increased ~5-fold with the TXT + USMB + XRT (Dn = 83% and Da = 71%) compared to the XRT alone (Dn = 16% and Da = 14%), and by ~2-3-fold with the TXT + XRT (Dn = 50% and Da = 38%) and USMB + XRT (Dn = 45% and Da = 27%) compared to the XRT. The USMB enhanced the cellular bioeffects of the TXT by ~2-5-fold with the TXT + USMB (Dn = 42% and Da = 50%), compared with the TXT alone (Dn = 19% and Da = 9%). The USMB alone caused cell death (Dn = 17% and Da = 10%) compared to the untreated control (Dn = 0.4% and Da = 0%). The histological cellular bioeffects were correlated with the changes in the ultrasound RF mid-band-fit data, which were associated with the cellular morphology. The linear regression analysis displayed a positive linear correlation between the mid-band fit and the overall cell death (R2 = 0.9164), as well as a positive linear correlation between the mid-band fit and the apoptosis (R2 = 0.8530). These results demonstrate a correlation between the histological and spectral measurements of the tissue microstructure and that cellular morphological changes can be detected by ultrasound scattering analysis. In addition, the tumor volumes from the triple-combination treatment were significantly smaller than those from the control, XRT, USMB + XRT, and TXT + XRT, from day 2 onward. The TXT + USMB + XRT-treated tumors shrank from day 2 and at each subsequent time-point measured (VT ~-6 days). The growth of the XRT-treated tumors was inhibited during the first 16 days, following which the tumors grew (VT ~9 days). The TXT + XRT and USMB + XRT groups displayed an initial decrease in tumor size (day 1-14; TXT + XRT VT ~-12 days; USMB + XRT VT ~-33 days), followed by a growth phase (day 15-37; TXT + XRT VT ~11 days; USMB + XRT VT ~22 days). The triple-combination therapy induced tumor shrinkage to a greater extent than any of the other treatments. This study demonstrates the in vivo radioenhancement potential of chemotherapy combined with therapeutic ultrasound-microbubble treatment in inducing cell death and apoptosis, as well as long-term tumor shrinkage.
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Affiliation(s)
- Firas Almasri
- Department of Physics, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
- Biomedical Engineering Department, International University of Science and Technology in Kuwait, Ardiya 92400, Kuwait
| | - Emmanuel H Sakarya
- Department of Physics, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), A Partnership Between Toronto Metropolitan University and St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5G 0A3, Canada
| | - Raffi Karshafian
- Department of Physics, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), A Partnership Between Toronto Metropolitan University and St. Michael's Hospital, Toronto, ON M5B 1T8, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5G 0A3, Canada
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Barzegar-Fallah A, Gandhi K, Rizwan SB, Slatter TL, Reynolds JNJ. Harnessing Ultrasound for Targeting Drug Delivery to the Brain and Breaching the Blood–Brain Tumour Barrier. Pharmaceutics 2022; 14:pharmaceutics14102231. [PMID: 36297666 PMCID: PMC9607160 DOI: 10.3390/pharmaceutics14102231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Despite significant advances in developing drugs to treat brain tumours, achieving therapeutic concentrations of the drug at the tumour site remains a major challenge due to the presence of the blood–brain barrier (BBB). Several strategies have evolved to enhance brain delivery of chemotherapeutic agents to treat tumours; however, most approaches have several limitations which hinder their clinical utility. Promising studies indicate that ultrasound can penetrate the skull to target specific brain regions and transiently open the BBB, safely and reversibly, with a high degree of spatial and temporal specificity. In this review, we initially describe the basics of therapeutic ultrasound, then detail ultrasound-based drug delivery strategies to the brain and the mechanisms by which ultrasound can improve brain tumour therapy. We review pre-clinical and clinical findings from ultrasound-mediated BBB opening and drug delivery studies and outline current therapeutic ultrasound devices and technologies designed for this purpose.
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Affiliation(s)
- Anita Barzegar-Fallah
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
| | - Kushan Gandhi
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
| | - Shakila B. Rizwan
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
- School of Pharmacy, University of Otago, Dunedin 9016, New Zealand
| | - Tania L. Slatter
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
| | - John N. J. Reynolds
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
- Correspondence: ; Tel.: +64-3-479-5781; Fax: +64-3-479-7254
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Mathematical model for the thermal enhancement of radiation response: thermodynamic approach. Sci Rep 2021; 11:5503. [PMID: 33750833 PMCID: PMC7970926 DOI: 10.1038/s41598-021-84620-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/15/2021] [Indexed: 02/08/2023] Open
Abstract
Radiotherapy can effectively kill malignant cells, but the doses required to cure cancer patients may inflict severe collateral damage to adjacent healthy tissues. Recent technological advances in the clinical application has revitalized hyperthermia treatment (HT) as an option to improve radiotherapy (RT) outcomes. Understanding the synergistic effect of simultaneous thermoradiotherapy via mathematical modelling is essential for treatment planning. We here propose a theoretical model in which the thermal enhancement ratio (TER) relates to the cell fraction being radiosensitised by the infliction of sublethal damage through HT. Further damage finally kills the cell or abrogates its proliferative capacity in a non-reversible process. We suggest the TER to be proportional to the energy invested in the sensitisation, which is modelled as a simple rate process. Assuming protein denaturation as the main driver of HT-induced sublethal damage and considering the temperature dependence of the heat capacity of cellular proteins, the sensitisation rates were found to depend exponentially on temperature; in agreement with previous empirical observations. Our findings point towards an improved definition of thermal dose in concordance with the thermodynamics of protein denaturation. Our predictions well reproduce experimental in vitro and in vivo data, explaining the thermal modulation of cellular radioresponse for simultaneous thermoradiotherapy.
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Jose J, Kumar R, Harilal S, Mathew GE, Parambi DGT, Prabhu A, Uddin MS, Aleya L, Kim H, Mathew B. Magnetic nanoparticles for hyperthermia in cancer treatment: an emerging tool. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:19214-19225. [PMID: 31884543 DOI: 10.1007/s11356-019-07231-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/02/2019] [Indexed: 05/07/2023]
Abstract
Cancer remains as the major cause of death worldwide. The main reason why available therapies fail is that a vicious cycle in established which initiates multiple pathways and recurrence after metastasis. Hyperthermic treatment, which involves heating tumor tissues to a moderate temperature of 40-43 °C, has emerged as an effective strategy for treating tumors. This method is highly efficient at destroying tumor cells and does not induce the side effects of conventional cancer treatments. On the other hand, hyperthermic treatment method can be co-administered with conventional treatments. Nanotechnology had created huge opportunities in almost all areas of research, including the field of hyperthermic treatment. The utilization of magnetic nanoparticles (MNPs) offers functionalities not possible using conventional magnetic materials. In this review, we detail recent developments and applications of MNPs for hyperthermic treatment and discuss future possibilities.
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Affiliation(s)
- Jobin Jose
- Department of Pharmaceutics, NGSM Institute of Pharmaceutical Science, NITTE Deemed to be University, Mangalore, 575018, India
| | - Rajesh Kumar
- Kerala University of Health Sciences, Thrissur, Kerala, 680596, India
| | - Seetha Harilal
- Kerala University of Health Sciences, Thrissur, Kerala, 680596, India
| | | | | | - Ankitha Prabhu
- Department of Pharmaceutics, NGSM Institute of Pharmaceutical Science, NITTE Deemed to be University, Mangalore, 575018, India
| | - Md Sahab Uddin
- Department of Pharmacy, Southeast University, Dhaka, Bangladesh
- Pharmakon Neuroscience Research Network, Dhaka, Bangladesh
| | - Lotfi Aleya
- Chrono-Environment Laboratory, CNRS-6249, Bourgogne Franche-Comte University, Besancon, France
| | - Hoon Kim
- Department of Pharmacy, and Research Institute of Life Pharmaceutical Sciences, Sunchon National University, Suncheon, 57922, Republic of Korea.
| | - Bijo Mathew
- Department of Pharmaceutical Chemistry, Division of Drug Design and Medicinal Chemistry Research Lab, Ahalia School of Pharmacy, Palakkad, Kerala, 678557, India.
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Liu X, Zhang Y, Wang Y, Zhu W, Li G, Ma X, Zhang Y, Chen S, Tiwari S, Shi K, Zhang S, Fan HM, Zhao YX, Liang XJ. Comprehensive understanding of magnetic hyperthermia for improving antitumor therapeutic efficacy. Theranostics 2020; 10:3793-3815. [PMID: 32206123 PMCID: PMC7069093 DOI: 10.7150/thno.40805] [Citation(s) in RCA: 247] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Magnetic hyperthermia (MH) has been introduced clinically as an alternative approach for the focal treatment of tumors. MH utilizes the heat generated by the magnetic nanoparticles (MNPs) when subjected to an alternating magnetic field (AMF). It has become an important topic in the nanomedical field due to their multitudes of advantages towards effective antitumor therapy such as high biosafety, deep tissue penetration, and targeted selective tumor killing. However, in order for MH to progress and to realize its paramount potential as an alternative choice for cancer treatment, tremendous challenges have to be overcome. Thus, the efficiency of MH therapy needs enhancement. In its recent 60-year of history, the field of MH has focused primarily on heating using MNPs for therapeutic applications. Increasing the thermal conversion efficiency of MNPs is the fundamental strategy for improving therapeutic efficacy. Recently, emerging experimental evidence indicates that MNPs-MH produces nano-scale heat effects without macroscopic temperature rise. A deep understanding of the effect of this localized induction heat for the destruction of subcellular/cellular structures further supports the efficacy of MH in improving therapeutic therapy. In this review, the currently available strategies for improving the antitumor therapeutic efficacy of MNPs-MH will be discussed. Firstly, the recent advancements in engineering MNP size, composition, shape, and surface to significantly improve their energy dissipation rates will be explored. Secondly, the latest studies depicting the effect of local induction heat for selectively disrupting cells/intracellular structures will be examined. Thirdly, strategies to enhance the therapeutics by combining MH therapy with chemotherapy, radiotherapy, immunotherapy, photothermal/photodynamic therapy (PDT), and gene therapy will be reviewed. Lastly, the prospect and significant challenges in MH-based antitumor therapy will be discussed. This review is to provide a comprehensive understanding of MH for improving antitumor therapeutic efficacy, which would be of utmost benefit towards guiding the users and for the future development of MNPs-MH towards successful application in medicine.
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Affiliation(s)
- Xiaoli Liu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education; School of Medicine, Northwest University, Xi'an 710069, China
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, No. 11, First North Road, Zhongguancun, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yifan Zhang
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an 710127, China
| | - Yanyun Wang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education; School of Medicine, Northwest University, Xi'an 710069, China
| | - Wenjing Zhu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education; School of Medicine, Northwest University, Xi'an 710069, China
| | - Galong Li
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education; School of Medicine, Northwest University, Xi'an 710069, China
| | - Xiaowei Ma
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, No. 11, First North Road, Zhongguancun, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yihan Zhang
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an 710127, China
| | - Shizhu Chen
- Beijing General Pharmaceutical Corporation, Beijing 100101, China
- The National Institutes of Pharmaceutical R&D Co., Ltd., China Resources Pharmaceutical Group Limited, Beijing 102206, China
| | - Shivani Tiwari
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an 710127, China
| | - Kejian Shi
- Beijing Institute of Traumatology and Orthopaedics, Beijing 100035, China
| | - Shouwen Zhang
- Neurophysiology Department, Beijing ChaoYang Emergency Medical Center, Beijing 100122, China
| | - Hai Ming Fan
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education; School of Medicine, Northwest University, Xi'an 710069, China
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an 710127, China
| | - Yong Xiang Zhao
- National Center for International Research of Biotargeting Theranostics, Guangxi Key Laboratory of Biotargeting Theranostics, Collaborative Innovation Center for Targeting Tumour Theranostics and Therapy, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xing-Jie Liang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, No. 11, First North Road, Zhongguancun, Beijing 100190, China; University of Chinese Academy of Sciences, Beijing 100049, China
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6
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de Andrade Mello P, Bian S, Savio LEB, Zhang H, Zhang J, Junger W, Wink MR, Lenz G, Buffon A, Wu Y, Robson SC. Hyperthermia and associated changes in membrane fluidity potentiate P2X7 activation to promote tumor cell death. Oncotarget 2017; 8:67254-67268. [PMID: 28978031 PMCID: PMC5620171 DOI: 10.18632/oncotarget.18595] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/22/2017] [Indexed: 12/19/2022] Open
Abstract
Extracellular ATP (eATP) accumulation within the tumor microenvironment (TME) has the potential to activate purinergic signaling. The eATP evoked signaling effects bolster antitumor immune responses while exerting direct cytotoxicity on tumor cells and vascular endothelial cells, mediated at least in part through P2X7 receptors. Approaches to augment purinergic signaling in TME e.g. by ectonucleotidase CD39 blockade, and/or boosting P2X7 functional responses, might be used as immunomodulatory therapies in cancer treatment. In this study, we delineated the translatable strategy of hyperthermia to demonstrate impacts on P2X7 responsiveness to eATP. Hyperthermia (40°C) was noted to enhance eATP-mediated cytotoxicity on MCA38 colon cancer cells. Increased membrane fluidity induced by hyperthermia boosted P2X7 functionality, potentiating pore opening and modulating downstream AKT/PRAS40/mTOR signaling events. When combined with cisplatin or mitomycin C, hyperthermia and eATP together markedly potentiate cancer cell death. Our data indicate that clinically tolerable hyperthermia with modulated P2X7-purinergic signaling will boost efficacy of conventional cancer treatments.
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Affiliation(s)
- Paola de Andrade Mello
- Laboratório de Análises Bioquímicas e Citológicas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Shu Bian
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA.,Department of Gastroenterology, Tianjin Union Medical Center, Tianjin, P.R. China
| | - Luiz Eduardo Baggio Savio
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA.,Programa de Imunobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Haohai Zhang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA.,Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Jingping Zhang
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Wolfgang Junger
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Márcia Rosângela Wink
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Guido Lenz
- Departamento de Biofísica e Centro de Biotecnologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Andréia Buffon
- Laboratório de Análises Bioquímicas e Citológicas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Yan Wu
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Simon Christopher Robson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, USA
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Curto S, Garcia-Miquel A, Suh M, Vidal N, Lopez-Villegas JM, Prakash P. Design and characterisation of a phased antenna array for intact breast hyperthermia. Int J Hyperthermia 2017; 34:250-260. [PMID: 28605946 DOI: 10.1080/02656736.2017.1337935] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Currently available hyperthermia technology is not well suited to treating cancer malignancies in the intact breast. This study investigates a microwave applicator incorporating multiple patch antennas, with the goal of facilitating controllable power deposition profiles for treating lesions at diverse locations within the intact breast. MATERIALS AND METHODS A 3D-computational model was implemented to assess power deposition profiles with 915 MHz applicators incorporating a hemispheric groundplane and configurations of 2, 4, 8, 12, 16 and 20 antennas. Hemispheric breast models of 90 mm and 150 mm diameter were considered, where cuboid target volumes of 10 mm edge length (1 cm3) and 30 mm edge length (27 cm3) were positioned at the centre of the breast, and also located 15 mm from the chest wall. The average power absorption (αPA) ratio expressed as the ratio of the PA in the target volume and in the full breast was evaluated. A 4-antenna proof-of-concept array was fabricated and experimentally evaluated. RESULTS Computational models identified an optimal inter-antenna spacing of 22.5° along the applicator circumference. Applicators with 8 and 12 antennas excited with constant phase presented the highest αPA at centrally located and deep-seated targets, respectively. Experimental measurements with a 4-antenna proof-of-concept array illustrated the potential for electrically steering power deposition profiles by adjusting the relative phase of the signal at antenna inputs. CONCLUSIONS Computational models and experimental results suggest that the proposed applicator may have potential for delivering conformal thermal therapy in the intact breast.
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Affiliation(s)
- Sergio Curto
- a Department of Electrical and Computer Engineering , Kansas State University , Manhattan , KS , USA.,b Department of Radiation Oncology , Erasmus MC Cancer Institute , Rotterdam , The Netherlands
| | | | - Minyoung Suh
- d Department of Textile and Apparel, Technology and Management, College of Textiles , North Carolina State University , Raleigh , NC , USA
| | - Neus Vidal
- c Electronics Department , University of Barcelona , Barcelona , Spain
| | | | - Punit Prakash
- a Department of Electrical and Computer Engineering , Kansas State University , Manhattan , KS , USA
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Trefná HD, Crezee H, Schmidt M, Marder D, Lamprecht U, Ehmann M, Hartmann J, Nadobny J, Gellermann J, van Holthe N, Ghadjar P, Lomax N, Abdel-Rahman S, Bert C, Bakker A, Hurwitz MD, Diederich CJ, Stauffer PR, van Rhoon GC. Quality assurance guidelines for superficial hyperthermia clinical trials: I. Clinical requirements. Int J Hyperthermia 2017; 33:471-482. [PMID: 28049386 DOI: 10.1080/02656736.2016.1277791] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Quality assurance guidelines are essential to provide uniform execution of clinical trials and treatment in the application of hyperthermia. This document provides definitions for a good hyperthermia treatment and identifies the clinical conditions where a certain hyperthermia system can or cannot adequately heat the tumour volume. It also provides brief description of the characteristics and performance of the current electromagnetic (radiative and capacitive), ultrasound and infra-red heating techniques. This information helps to select the appropriate heating technique for the specific tumour location and size, and appropriate settings of the water bolus and thermometry. Finally, requirements of staff training and documentation are provided. The guidelines in this document focus on the clinical application and are complemented with a second, more technical quality assurance document providing instructions and procedure to determine essential parameters that describe heating properties of the applicator for superficial hyperthermia. Both sets of guidelines were developed by the ESHO Technical Committee with participation of senior STM members and members of the Atzelsberg Circle.
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Affiliation(s)
| | - Hans Crezee
- b Radiotherapy , AMC , Amsterdam , The Netherlands
| | - Manfred Schmidt
- c Radiotherapy Clinics, Universitatsklinikum Erlangen , Erlangen , Germany
| | | | - Ulf Lamprecht
- e Radiation Oncology , University Hospital Tuebingen , Tuebingen , Germany
| | - Michael Ehmann
- f Radiation Oncology , University Medical Centre Mannheim , Mannheim , Germany
| | - Josefin Hartmann
- c Radiotherapy Clinics, Universitatsklinikum Erlangen , Erlangen , Germany
| | - Jacek Nadobny
- g Klinik für Radioonkologie und Strahlentherapie , Campus Virchow Klinikum, Charite Universitatsmedizin Berlin , Berlin , Germany
| | - Johanna Gellermann
- e Radiation Oncology , University Hospital Tuebingen , Tuebingen , Germany.,h Praxis/Zentrum für Strahlentherapie und Radioonkologie , Berlin , Germany
| | - Netteke van Holthe
- i Radiation Oncology , Erasmus MC Daniel den Hoed Cancer Center , Rotterdam , The Netherlands
| | - Pirus Ghadjar
- g Klinik für Radioonkologie und Strahlentherapie , Campus Virchow Klinikum, Charite Universitatsmedizin Berlin , Berlin , Germany
| | | | - Sultan Abdel-Rahman
- j Department of Internal Medicine III , Ludwig Maximilians University of Munich , Munich , Germany
| | - Christoph Bert
- c Radiotherapy Clinics, Universitatsklinikum Erlangen , Erlangen , Germany.,k Department of Biophysics , GSI - Helmholtz Centre for Heavy Ion Research , Darmstadt , Germany
| | - Akke Bakker
- b Radiotherapy , AMC , Amsterdam , The Netherlands
| | - Mark D Hurwitz
- l Department of Radiation Oncology , Thomas Jefferson University , Philadelphia , PA , USA
| | - Chris J Diederich
- m Department of Radiation Oncology , UCSF , San Francisco , CA , USA
| | - Paul R Stauffer
- l Department of Radiation Oncology , Thomas Jefferson University , Philadelphia , PA , USA
| | - Gerard C van Rhoon
- i Radiation Oncology , Erasmus MC Daniel den Hoed Cancer Center , Rotterdam , The Netherlands
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Notter M, Piazena H, Vaupel P. Hypofractionated re-irradiation of large-sized recurrent breast cancer with thermography-controlled, contact-free water-filtered infra-red-A hyperthermia: a retrospective study of 73 patients. Int J Hyperthermia 2016; 33:227-236. [PMID: 27618745 DOI: 10.1080/02656736.2016.1235731] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Evaluation of the efficacy and toxicity of a new setup of thermographically controlled water-filtered infra-red-A (wIRA) superficial hyperthermia (HT) combined with hypofractionated re-irradiation (re-RT) to treat large-sized breast cancer recurrences. METHODS Records of 73 heavily pre-irradiated patients with 103 treatment regions, treated from September 2009 to July 2015 were retrospectively analysed. Sixty-four patients with macroscopic disease were treated with 94 regions including 46 patients with lymphangiosis carcinomatosa. Hypofractionated RT consisted of 4 Gy once per week up to a total dose of 20 Gy delivered within 1-4 min after wIRA-HT. Heating of tumour nodules and diffusely spreading cancer lesions was performed under real-time thermographic temperature monitoring, maintaining the maximum skin temperature in the ROI between 42 °C and 43 °C, achieving intratumoural temperatures up to a depth of 2 cm between 39.5 °C and 42 °C. Seventeen patients received re-re-irradiation (re-re-RT) using the same HT/RT-treatment schedule. RESULTS Response rates in patients with macroscopic disease: 61% CR, 33% PR, 5% NC and 1% PD. Local control throughout life time after CR of macroscopic disease: 59%. All nine patients with microscopic disease had CR and local control throughout lifetime. Only grade 1 toxicities were observed. CONCLUSIONS Application of thermographically controlled wIRA-HT combined with extremely low-dose re-irradiation provides good local control throughout lifetime of heavily pre-treated breast cancer recurrences. The twin wIRA radiator provides a sufficiently homogeneous heat deposition for the treatment of larger areas. The time lag between HT and re-RT is substantially reduced. The possibility of re-re-RT opens new therapeutic options for the future.
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Affiliation(s)
- Markus Notter
- a Service de Radiothérapie , Hôpital neuchâtelois , La Chaux-de-Fonds , Switzerland
| | - Helmut Piazena
- b Medical Photobiology Group, Dept. Internal Medicine , Charité University Medicine , Berlin , Germany
| | - Peter Vaupel
- c Department of Radiooncology and Radiotherapy, Klinikum rechts der Isar , Technische Universität München (TUM) , München , Germany
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Crezee H, van Leeuwen CM, Oei AL, Stalpers LJA, Bel A, Franken NA, Kok HP. Thermoradiotherapy planning: Integration in routine clinical practice. Int J Hyperthermia 2015; 32:41-9. [PMID: 26670625 DOI: 10.3109/02656736.2015.1110757] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Planning of combined radiotherapy and hyperthermia treatments should be performed taking the synergistic action between the two modalities into account. This work evaluates the available experimental data on cytotoxicity of combined radiotherapy and hyperthermia treatment and the requirements for integration of hyperthermia and radiotherapy treatment planning into a single planning platform. The underlying synergistic mechanisms of hyperthermia include inhibiting DNA repair, selective killing of radioresistant hypoxic tumour tissue and increased radiosensitivity by enhanced tissue perfusion. Each of these mechanisms displays different dose-effect relations, different optimal time intervals and different optimal sequences between radiotherapy and hyperthermia. Radiosensitisation can be modelled using the linear-quadratic (LQ) model to account for DNA repair inhibition by hyperthermia. In a recent study, an LQ model-based thermoradiotherapy planning (TRTP) system was used to demonstrate that dose escalation by hyperthermia is equivalent to ∼10 Gy for prostate cancer patients treated with radiotherapy. The first step for more reliable TRTP is further expansion of the data set of LQ parameters for normally oxygenated normal and tumour tissue valid over the temperature range used clinically and for the relevant time intervals between radiotherapy and hyperthermia. The next step is to model the effect of hyperthermia in hypoxic tumour cells including the physiological response to hyperthermia and the resulting reoxygenation. Thermoradiotherapy planning is feasible and a necessity for an optimal clinical application of hyperthermia combined with radiotherapy in individual patients.
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Affiliation(s)
- Hans Crezee
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and
| | | | - Arlene L Oei
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and.,b Laboratory for Experimental Oncology and Radiobiology , Academic Medical Centre , Amsterdam , The Netherlands
| | - Lukas J A Stalpers
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and
| | - Arjan Bel
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and
| | - Nicolaas A Franken
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and.,b Laboratory for Experimental Oncology and Radiobiology , Academic Medical Centre , Amsterdam , The Netherlands
| | - H Petra Kok
- a Department of Radiation Oncology , Academic Medical Centre , Amsterdam and
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Multifunctional liposomes having target specificity, temperature-triggered release, and near-infrared fluorescence imaging for tumor-specific chemotherapy. J Control Release 2015; 216:69-77. [DOI: 10.1016/j.jconrel.2015.08.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/09/2015] [Accepted: 08/04/2015] [Indexed: 01/16/2023]
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Kosterev VV, Kramer-Ageev EA, Mazokhin VN, van Rhoon GC, Crezee J. Development of a novel method to enhance the therapeutic effect on tumours by simultaneous action of radiation and heating. Int J Hyperthermia 2015; 31:443-52. [PMID: 25875224 DOI: 10.3109/02656736.2015.1026413] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This paper describes the development of a new type of electromagnetic hyperthermia applicator delivering dose control within large application fields and increased effectiveness by providing simultaneous action of radiation and heating (SRH) in malignant tumours, and development of a dosimetric feedback method to support SRH. MATERIALS AND METHODS Single and phased arrays of flexible applicators have been developed to allow simultaneous hyperthermia and external beam therapy. A frequency of 434 MHz is used to heat near-surface and moderately deep-seated tumours and 70 MHz for deep-seated tumours. Phase and amplitude control allows focusing of electromagnetic energy (EM) to deep-seated tumours. The specific absorption rate (SAR) dose distribution can be modified to achieve uniform heating of tumours with complex shapes and heterogeneous tissue properties. A lithium fluoride thermoluminescent dosimeter (TLD) in a flexible film cassette has been developed for real-time dose measurement. RESULTS Four types of 434 MHz applicators were manufactured with 3, 4, 9 or 12 independent applicators. Two types of 70 MHz applicators were made with 4 or 6 independent applicators. Phantom tests demonstrated the ability to control the SAR pattern by phase and amplitude control. Placement of the dosimeter between bolus and phantom increased the phantom surface temperature up to 3 °C and showed that the ratio of absorbed energy in TLD to dose in water approaches (0.83 ± 3%) for photon energies >60 keV. CONCLUSIONS Simultaneous and controlled radiation and local hyperthermia is technically feasible in a preclinical setting, a clinical feasibility test is the next step.
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Affiliation(s)
- Vladimir V Kosterev
- Moscow Engineering Physics Institute (MEPhI), National Research Nuclear University , Moscow , Russia
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13
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Arvanitis CD, McDannold N. Integrated ultrasound and magnetic resonance imaging for simultaneous temperature and cavitation monitoring during focused ultrasound therapies. Med Phys 2014; 40:112901. [PMID: 24320468 DOI: 10.1118/1.4823793] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Ultrasound can be used to noninvasively produce different bioeffects via viscous heating, acoustic cavitation, or their combination, and these effects can be exploited to develop a wide range of therapies for cancer and other disorders. In order to accurately localize and control these different effects, imaging methods are desired that can map both temperature changes and cavitation activity. To address these needs, the authors integrated an ultrasound imaging array into an MRI-guided focused ultrasound (MRgFUS) system to simultaneously visualize thermal and mechanical effects via passive acoustic mapping (PAM) and MR temperature imaging (MRTI), respectively. METHODS The system was tested with an MRgFUS system developed for transcranial sonication for brain tumor ablation in experiments with a tissue mimicking phantom and a phantom-filled ex vivo macaque skull. In experiments on cavitation-enhanced heating, 10 s continuous wave sonications were applied at increasing power levels (30-110 W) until broadband acoustic emissions (a signature for inertial cavitation) were evident. The presence or lack of signal in the PAM, as well as its magnitude and location, were compared to the focal heating in the MRTI. Additional experiments compared PAM with standard B-mode ultrasound imaging and tested the feasibility of the system to map cavitation activity produced during low-power (5 W) burst sonications in a channel filled with a microbubble ultrasound contrast agent. RESULTS When inertial cavitation was evident, localized activity was present in PAM and a marked increase in heating was observed in MRTI. The location of the cavitation activity and heating agreed on average after registration of the two imaging modalities; the distance between the maximum cavitation activity and focal heating was -3.4 ± 2.1 mm and -0.1 ± 3.3 mm in the axial and transverse ultrasound array directions, respectively. Distortions and other MRI issues introduced small uncertainties in the PAM∕MRTI registration. Although there was substantial variation, a nonlinear relationship between the average intensity of the cavitation maps, which was relatively constant during sonication, and the peak temperature rise was evident. A fit to the data to an exponential had a correlation coefficient (R(2)) of 0.62. The system was also found to be capable of visualizing cavitation activity with B-mode imaging and of passively mapping cavitation activity transcranially during cavitation-enhanced heating and during low-power sonication with an ultrasound contrast agent. CONCLUSIONS The authors have demonstrated the feasibility of integrating an ultrasound imaging array into an MRgFUS system to simultaneously map localized cavitation activity and temperature. The authors anticipate that this integrated approach can be utilized to develop controllers for cavitation-enhanced ablation and facilitate the optimization and development of this and other ultrasound therapies. The integrated system may also provide a useful tool to study the bioeffects of acoustic cavitation.
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Affiliation(s)
- Costas D Arvanitis
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, Massachusetts 02115
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Paulides MM, Stauffer PR, Neufeld E, Maccarini PF, Kyriakou A, Canters RAM, Diederich CJ, Bakker JF, Van Rhoon GC. Simulation techniques in hyperthermia treatment planning. Int J Hyperthermia 2013; 29:346-57. [PMID: 23672453 PMCID: PMC3711016 DOI: 10.3109/02656736.2013.790092] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract Clinical trials have shown that hyperthermia (HT), i.e. an increase of tissue temperature to 39-44 °C, significantly enhance radiotherapy and chemotherapy effectiveness [1]. Driven by the developments in computational techniques and computing power, personalised hyperthermia treatment planning (HTP) has matured and has become a powerful tool for optimising treatment quality. Electromagnetic, ultrasound, and thermal simulations using realistic clinical set-ups are now being performed to achieve patient-specific treatment optimisation. In addition, extensive studies aimed to properly implement novel HT tools and techniques, and to assess the quality of HT, are becoming more common. In this paper, we review the simulation tools and techniques developed for clinical hyperthermia, and evaluate their current status on the path from 'model' to 'clinic'. In addition, we illustrate the major techniques employed for validation and optimisation. HTP has become an essential tool for improvement, control, and assessment of HT treatment quality. As such, it plays a pivotal role in the quest to establish HT as an efficacious addition to multi-modality treatment of cancer.
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Affiliation(s)
- Margarethus M Paulides
- Hyperthermia Unit, Department of Radiation Oncology, Daniel den Hoed Cancer Centre, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Arunachalam K, Craciunescu OI, Markewitz EJ, Maccarini PF, Schlorff JL, Stauffer PR. Preclinical assessment of comfort and secure fit of thermobrachytherapy surface applicator (TBSA) on volunteer subjects. J Appl Clin Med Phys 2012; 13:3845. [PMID: 22955650 PMCID: PMC3439213 DOI: 10.1120/jacmp.v13i5.3845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/06/2012] [Accepted: 05/02/2012] [Indexed: 11/23/2022] Open
Abstract
A thermobrachytherapy surface applicator (TBSA) was developed for simultaneous heat and brachytherapy treatment of chest wall (CW) recurrence of breast cancer. The ability to comfortably secure the applicator over the upper torso relative to the CW target throughout treatment is assessed on volunteers. Male and postmastectomy female volunteers were enrolled to evaluate applicator secure fit to CW. Female subjects with intact breast were also enrolled to assess the ability to treat challenging cases. Magnetic resonance (MR) images of volunteers wearing a TBSA over the upper torso were acquired once every 15 minutes for 90 minutes. Applicator displacement over this time period required for treatment preplanning and delivery was assessed using MR visible markers. Applicator comfort and tolerability were assessed using a questionnaire. Probability estimates of applicator displacements were used to investigate dosimetric impact for the worst‐case variation in radiation source‐to‐skin distance for 5 and 10 mm deep targets spread 17×13 cm on a torso phantom. Average and median displacements along lateral and radial directions were less than 1.2 mm over 90 minutes for all volunteers. Maximum lateral and radial displacements were measured to be less than 1 and 1.5 mm, respectively, for all CW volunteers and less than 2 mm for intact breast volunteers, excluding outliers. No complaint of pain or discomfort was reported. Phantom treatment planning for the maximum displacement of 2 mm indicated <10% increase in skin dose with <5% loss of homogeneity index (HI) for ‐2 mm uniform HDR source displacement. For +2 mm uniform displacement, skin dose decreased and HI increased by 20%. The volunteer study demonstrated that such large and uniform displacements should be rare for CW subjects, and the measured variation is expected to be low for multifraction conformal brachytherapy treatment. PACS numbers: 41.20.Jb, 41.75.‐i, 44.
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Affiliation(s)
- Kavitha Arunachalam
- Department of Engineering Design, Indian Institute of Technology Madras, Tamil Nadu, India.
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Abstract
A small rise in tumor temperature (hyperthermia) makes cancer cells more susceptible to radiation and chemotherapy. The means of achieving this is not trivial, and traditional methods have certain drawbacks. Loading tumors with systematically asministered energy-transducing nanoparticles can circumvent several of the obstacles to achieve tumor hyperthermia. However, nanoparticles also face unique challenges prior to clinical implementation. This article summarizes the state-of-the-art current technology and discusses the advantages and challenges of the three major nanoparticle formulations in focus: gold nanoshells and nanorods, superparamagnetic iron oxide particles and carbon nanotubes.
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Tumor radiation response enhancement by acoustical stimulation of the vasculature. Proc Natl Acad Sci U S A 2012; 109:E2033-41. [PMID: 22778441 DOI: 10.1073/pnas.1200053109] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We have discovered that ultrasound-mediated microbubble vascular disruption can enhance tumor responses to radiation in vivo. We demonstrate this effect using a human PC3 prostate cancer xenograft model. Results indicate a synergistic effect in vivo with combined single treatments of ultrasound-stimulated microbubble vascular perturbation and radiation inducing an over 10-fold greater cell kill with combined treatments. We further demonstrate with experiments in vivo that induction of ceramide-related endothelial cell apoptosis, leading to vascular disruption, is a causative mechanism. In vivo experiments with ultrasound and bubbles permit radiation doses to be decreased significantly for comparable effect. We envisage this unique combined ultrasound-based vascular perturbation and radiation treatment method being used to enhance the effects of radiation in a tumor, leading to greater tumor eradication.
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Al-Jamal WT, Al-Ahmady ZS, Kostarelos K. Pharmacokinetics & tissue distribution of temperature-sensitive liposomal doxorubicin in tumor-bearing mice triggered with mild hyperthermia. Biomaterials 2012; 33:4608-17. [DOI: 10.1016/j.biomaterials.2012.03.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Maluta S, Dall'oglio S, Palazzi M. “Reirradiation: Hopes and Concerns of the Radiation Oncologist”. TUMORI JOURNAL 2012; 98:172; author reply 172-3. [DOI: 10.1177/030089161209800125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sergio Maluta
- Radiotherapy Department, University Hospital, Verona, Italy
| | | | - Mario Palazzi
- Radiotherapy Department, University Hospital, Verona, Italy
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Linthorst M, Drizdal T, Joosten H, van Rhoon GC, van der Zee J. Procedure for creating a three-dimensional (3D) model for superficial hyperthermia treatment planning. Strahlenther Onkol 2011; 187:835-41. [PMID: 22127361 DOI: 10.1007/s00066-011-2272-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 09/14/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE To make a patient- and treatment-specific computed tomography (CT) scan and to create a three-dimensional (3D) patient model for superficial hyperthermia treatment planning (SHTP). PATIENTS, MATERIALS, AND METHODS Patients with recurrent breast adenocarcinoma in previously irradiated areas referred for radiotherapy (RT) and hyperthermia (HT) treatment and giving informed consent were included. After insertion of the thermometry catheters in the treatment area, a CT scan in the treatment position was made. RESULTS A total of 26 patients have been, thus far, included in the study. During the study period, five types of adjustments were made to the procedure: (1) marking the RT field with radioopaque markers, (2) making the CT scan after the first HT treatment instead of before, (3) using an air- and foam-filled (dummy) water bolus, (4) a change to radiolucent catheters for which radioopaque markers were needed, and (5) marking the visible/palpable extent of the tumor with radioopaque markers, if necessary. With these adjustments, all necessary information is visible on the CT scan. Each CT slice was automatically segmented into muscle, fat, bone, and air. RT field, catheters, applicators, and tumor lesions, if indicated, were outlined manually using the segmentation program iSeg. Next the model was imported into SEMCAD X, a 3D electromagnetic field simulator. CONCLUSION Using the final procedure to obtain a patient- and treatment-specific CT scan, it is possible to create a 3D model for SHTP.
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Affiliation(s)
- Marianne Linthorst
- Erasmus MC Rotterdam, Department of Radiation Oncology, Hyperthermia Unit, Rotterdam, The Netherlands.
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Chen D, Xia R, Chen X, Shafirstein G, Corry PM, Griffin RJ, Penagaricano JA, Tulunay-Ugur OE, Moros EG. SonoKnife: feasibility of a line-focused ultrasound device for thermal ablation therapy. Med Phys 2011; 38:4372-85. [PMID: 21859038 DOI: 10.1118/1.3601017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the feasibility of line-focused ultrasound for thermal ablation of superficially located tumors. METHODS A SonoKnife is a cylindrical-section ultrasound transducer designed to radiate from its concave surface. This geometry generates a line-focus or acoustic edge. The motivation for this approach was the noninvasive thermal ablation of advanced head and neck tumors and positive neck nodes in reasonable treatment times. Line-focusing may offer advantages over the common point-focusing of spherically curved radiators such as faster coverage of a target volume by scanning of the acoustic edge. In this paper, The authors report studies using numerical models and phantom and ex vivo experiments using a SonoKnife prototype. RESULTS Acoustic edges were generated by cylindrical-section single-element ultrasound transducers numerically, and by the prototype experimentally. Numerically, simulations were performed to characterize the acoustic edge for basic design parameters: transducer dimensions, line-focus depth, frequency, and coupling thickness. The dimensions of the acoustic edge as a function of these parameters were determined. In addition, a step-scanning simulation produced a large thermal lesion in a reasonable treatment time. Experimentally, pressure distributions measured in degassed water agreed well with acoustic simulations, and sonication experiments in gel phantoms and ex vivo porcine liver samples produced lesions similar to those predicted with acoustic and thermal models. CONCLUSIONS Results support the feasibility of noninvasive thermal ablation with a SonoKnife.
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Affiliation(s)
- Duo Chen
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Wang H, Li X, Xi X, Hu B, Zhao L, Liao Y, Tang J. Effects of magnetic induction hyperthermia and radiotherapy alone or combined on a murine 4T1 metastatic breast cancer model. Int J Hyperthermia 2011; 27:563-72. [DOI: 10.3109/02656736.2011.583618] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Assessment of the evolution of cancer treatment therapies. Cancers (Basel) 2011; 3:3279-330. [PMID: 24212956 PMCID: PMC3759197 DOI: 10.3390/cancers3033279] [Citation(s) in RCA: 437] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 07/07/2011] [Accepted: 08/08/2011] [Indexed: 11/16/2022] Open
Abstract
Cancer therapy has been characterized throughout history by ups and downs, not only due to the ineffectiveness of treatments and side effects, but also by hope and the reality of complete remission and cure in many cases. Within the therapeutic arsenal, alongside surgery in the case of solid tumors, are the antitumor drugs and radiation that have been the treatment of choice in some instances. In recent years, immunotherapy has become an important therapeutic alternative, and is now the first choice in many cases. Nanotechnology has recently arrived on the scene, offering nanostructures as new therapeutic alternatives for controlled drug delivery, for combining imaging and treatment, applying hyperthermia, and providing directed target therapy, among others. These therapies can be applied either alone or in combination with other components (antibodies, peptides, folic acid, etc.). In addition, gene therapy is also offering promising new methods for treatment. Here, we present a review of the evolution of cancer treatments, starting with chemotherapy, surgery, radiation and immunotherapy, and moving on to the most promising cutting-edge therapies (gene therapy and nanomedicine). We offer an historical point of view that covers the arrival of these therapies to clinical practice and the market, and the promises and challenges they present.
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