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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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Trujillo-Romero CJ, Paulides MM, Drizdal T, van Rhoon GC. Impact of silicone and metal port-a-cath implants on superficial hyperthermia treatment quality. Int J Hyperthermia 2014; 31:15-22. [DOI: 10.3109/02656736.2014.985748] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kato H, Kondo M, Imada H, Kuroda M, Kamimura Y, Saito K, Kuroda K, Ito K, Takahashi H, Matsuki H. Quality assurance: recommended guidelines for safe heating by capacitive-type heating technique to treat patients with metallic implants. Int J Hyperthermia 2013; 29:194-205. [PMID: 23557324 DOI: 10.3109/02656736.2013.774059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article is a redissemination of the previous Japanese Quality Assurance Guide guidelines. Specific absorption rate and temperature distribution were investigated with respect to various aspects including metallic implant size and shape, insertion site, insertion direction, blood flow and heating power, and simulated results were compared with adverse reactions of patients treated by radio frequency capacitive-type heating. Recommended guidelines for safe heating methods for patients with metallic implants are presented based on our findings.
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Affiliation(s)
- Hirokazu Kato
- Graduate School of Health Sciences, Okayama University, Okayama, Japan.
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Bruggmoser G, Bauchowitz S, Canters R, Crezee H, Ehmann M, Gellermann J, Lamprecht U, Lomax N, Messmer M, Ott O, Abdel-Rahman S, Schmidt M, Sauer R, Thomsen A, Wessalowski R, van Rhoon G. Guideline for the clinical application, documentation and analysis of clinical studies for regional deep hyperthermia. Strahlenther Onkol 2012; 188 Suppl 2:198-211. [DOI: 10.1007/s00066-012-0176-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
The hyperthermia effect is based on its thermal influence on tumours. Therefore a controlled heating of the tumours must be achieved. In order to guarantee this, two points must be fulfilled at least: First, the hyperthermia equipment must have the necessary power and steering capability. Second, the distribution of the 'hyperthermic drug', the heat, has to be measured and controlled over the whole treatment time. To reach this aim both a sophisticated technique and a staff trained in hyperthermia are required. In treating patients such as those with cervical cancer, the volume to be exposed and the dosage must be clarified. This means that very special technical and medical conditions must be fulfilled in hyperthermia. To reach and maintain a certain level of quality, hyperthermia is embedded in a framework of procedures. These procedures are defined in the modules of quality management. Therefore quality management must contain specific guidelines for each application, i.e. coordinated standards have to be defined. When adapting these standards in hyperthermia, comparable and comprehensible results of the treatment are guaranteed. Furthermore, an analysis of the treatments under a scientific point of view will be possible and finally result in improvements of this method.
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Affiliation(s)
- Gregor Bruggmoser
- Department of Radiotherapy, University Hospital of Freiburg, Freiburg, Germany.
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Bruggmoser G, Bauchowitz S, Canters R, Crezee H, Ehmann M, Gellermann J, Lamprecht U, Lomax N, Messmer MB, Ott O, Abdel-Rahman S, Sauer R, Schmidt M, Thomsen A, Wessalowski R, van Rhoon G. Quality assurance for clinical studies in regional deep hyperthermia. Strahlenther Onkol 2011; 187:605-10. [DOI: 10.1007/s00066-011-1145-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 07/04/2011] [Indexed: 10/17/2022]
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de Bruijne M, Wielheesen DHM, van der Zee J, Chavannes N, van Rhoon GC. Benefits of superficial hyperthermia treatment planning: Five case studies. Int J Hyperthermia 2010; 23:417-29. [PMID: 17701533 DOI: 10.1080/02656730701502077] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To demonstrate the benefits of treatment planning in superficial hyperthermia. MATERIALS AND METHODS Five patient cases are presented, in which treatment planning was applied to troubleshoot treatment-limiting hotspots, to select the optimum applicator type and orientation, to assess the risk associated with metallic implants, to assess the feasibility of heating a deeper seated tumour, and to analyse the effective SAR coverage resulting from arrays of multiple incoherent applicators. FDTD simulation tools were used to investigate treatment options, either based on segmented or simplified anatomies. RESULTS The background, approach and model implementation are presented per case. SAR cross-sections, profiles and isosurfaces are visualized to predict the effective SAR coverage of the target and the location of the maximum power absorption. In addition, the followed treatment strategy and the implications for the clinical treatment are given: for example, higher temperatures, relief of treatment limiting hot-spots or increased power input. CONCLUSIONS Treatment planning in superficial hyperthermia can be applied to improve clinical routine. Its application supports the selection of the optimum technique in non-standard cases, leading to direct benefits for the patient. In addition, treatment planning has shown to be an excellent tool for education and training for hyperthermia technicians and physicians.
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Affiliation(s)
- M de Bruijne
- Hyperthermia Unit, Department of Radiation Oncology, Erasmus Medical Center - Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
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Sathiaseelan V, Mittal BB, Fenn AJ, Taflove A. Recent advances in external electromagnetic hyperthermia. Cancer Treat Res 1998; 93:213-45. [PMID: 9513783 DOI: 10.1007/978-1-4615-5769-2_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- V Sathiaseelan
- Department of Radiology, Northwestern University Medical School, Chicago, IL, USA
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Lagendijk JJ, Van Rhoon GC, Hornsleth SN, Wust P, De Leeuw AC, Schneider CJ, Van Dijk JD, Van Der Zee J, Van Heek-Romanowski R, Rahman SA, Gromoll C. ESHO quality assurance guidelines for regional hyperthermia. Int J Hyperthermia 1998; 14:125-33. [PMID: 9589319 DOI: 10.3109/02656739809018219] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Technical Committee and the Clinical Committee of the ESHO evaluated the experience of the institutes which are active in clinical regional hyperthermia using radiative equipment. Based on this evaluation, QA guidelines have been formulated. The focus of these guidelines lies on what must be done not on how it should be done. Subjects covered are: treatment planning, treatment, treatment documentation, requirements and characterization of equipment, safety aspects, hyperthermia staff requirements and instrumentation for quality assurance.
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Cetas TC, Gross EJ, Contractor Y. A ferrite core/metallic sheath thermoseed for interstitial thermal therapies. IEEE Trans Biomed Eng 1998; 45:68-77. [PMID: 9444841 DOI: 10.1109/10.650354] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An alternative form of ferromagnetic seed for thermal therapy has been developed following Matsuki, Murakami, and their colleagues [1]-[4]. A nearly lossless ceramic ferrite core (FC) is surrounded by an electrically conductive sheath. The FC has a high relative intrinsic permeability, typically 3000 at low magnetic field strengths, and a sharp transition from the ferrimagnetic state to the nonmagnetic state. The sheath is either a metallic tube or coating on the core. When this composite seed is excited with a radiofrequency magnetic field, large eddy currents are induced in the metallic sheath (MS) due to the concentrated magnetic flux in the core leading to Joule heating. Advantages of this configuration are that this ferrite core/metallic sheath (FC/MS) thermoseed has high power absorption efficiency and a sharp transition compared to ferromagnetic alloy systems; means of optimizing efficiency are apparent from simple expressions; the outer sheath can be of any biocompatible metal; the production method for the ferrites leads to large quantities of seeds with reproducible properties. The FC/MS configuration solves many of the technical problems that have hindered the clinical implementation of thermally regulating ferromagnetic implants for thermal therapies.
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Affiliation(s)
- T C Cetas
- Department of Radiation Oncology, University of Arizona, Tucson 85724, USA.
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Jia X, Paulsen KD, Buechler DN, Gibbs FA, Meaney PM. Finite element simulation of Sigma 60 heating in the Utah phantom: computed and measured data compared. Int J Hyperthermia 1994; 10:755-74. [PMID: 7884237 DOI: 10.3109/02656739409012369] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
An initial series of comparisons are made between finite element computations and laboratory measurements obtained during heterogeneous phantom heating with the Sigma 60 applicator. The phantom is a relatively complex, though still idealized, rendering of the pelvic area which has been used to study the deep heating characteristics of the Sigma 60 in this anatomy. Direct electric field measurements as well as inferred SAR through transient temperature analysis are plotted against computed results along 11 one-dimensional tracks through the phantom. Quantitative comparisons provided through the track-by-track analysis show generally good agreement between computation and measurement. The finite element method is found to predict well the jumps in the electric field when polarized perpendicularly to a muscle/fat interface. Visualizations of the complete three-dimensional distributions are also highlighted and correlate well with physical reasoning about the expected behaviour of the fields produced. Some discrepancies in the data persist and are discussed and analysed in depth. They underscore the difficulties that can arise in performing comparisons between measured and computed results and stress the need for careful and thorough investigations when attempting these types of model validation studies.
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Affiliation(s)
- X Jia
- Thayer School of Engineering, Dartmouth College Hanover, NH 03755
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Sullivan DM, Ben-Yosef R, Kapp DS. Stanford 3D hyperthermia treatment planning system. Technical review and clinical summary. Int J Hyperthermia 1993; 9:627-43. [PMID: 8245576 DOI: 10.3109/02656739309032052] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In the field of deep regional hyperthermia cancer therapy the Sigma 60 applicator of the BSD-2000 Hyperthermia System is one of the most widely used devices. This device employs four independent sources of radiofrequency electromagnetic energy to heat tumour sites deep within the body. The difficulty in determining the input parameters for the four sources has motivated the development of a computer-based three-dimensional (3D) treatment planning system. The Stanford 3D Hyperthermia Treatment Planning System has been in clinical use at Stanford Medical Center for the past 2 years. It utilizes a patient-specific, three-dimensional computer simulation to determine safe and effective power deposition plans. An optimization programme for the selection of the amplitudes, phases and frequency for the sources has been developed and used in the clinic. Examples of the application of the treatment planning for hyperthermia treatment of pulmonary, pelvic, and mediastinal tumours are presented. Methods for quantifying the relative effectiveness of various treatment plans are reviewed.
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Affiliation(s)
- D M Sullivan
- Department of Radiation Oncology, Stanford University School of Medicine, CA 94305
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