Abstract
Background and purpose
To investigate the clinical benefit of replacing the BSD-2000 Sigma-60 with the Sigma-Eye applicator, taking into account effects of uncertainties in tissue and water bolus parameters.
Patients and methods
For 20 patients, specific absorption rate (SAR) and temperature distributions were calculated and optimized, based on computed tomography (CT) scans in treatment position. The impact of uncertainties on predicted distributions was studied using a Monte Carlo uncertainty assessment.
Results
Replacing the Sigma-60 by the Sigma-Eye applicator resulted in a higher SAR in the tumor [on average a decrease of the hotspot tumor quotient (HTQ) by 24%; p < 0.001], and higher temperatures (T90: +0.4°C, p < 0.001; T50: +0.6°C, p < 0.001) using literature values and SAR optimization. When temperature optimization (T90) was used, a larger average increase was found (T90: +0.7°C, p < 0.001; T50: +0.8°C, p < 0.001). When taking into account uncertainties, a decrease of 23% in median HTQ (p < 0.001) and an increase in T50 and T90 of 0.4°C (p < 0.001) could be demonstrated.
Conclusion
Based on this uncertainty analysis, significant and clinically relevant improvements in HTQ and tumor temperature were achieved when replacing the Sigma-60 by the Sigma-Eye applicator.
Zusammenfassung
Ziel
Untersuchung des Ersatzes des Sigma-60-Applikators des BSD-2000-Hyperthermiesystems durch den Sigma-Eye-Applikator, unter Berücksichtigung der Auswirkungen der Unsicherheiten in den Gewebeparametern.
Methode
Modelle von 20 Patienten wurden aus den CT-Scans in Behandlungsposition erstellt und für die Berechnung und Optimierung von spezifischen Absorptionsraten(SAR)- und Temperaturverteilungen verwendet. Die klinische Relevanz von Unsicherheiten wurde mithilfe der Monte-Carlo-Methode ausgiebig untersucht.
Ergebnisse
Der Ersatz des Sigma-60 durch den Sigma-Eye führt zu erhöhten SAR-Werten im Tumor [durchschnittliche Verbesserung der HTQ um 24% (p < 0,001)] und zu erhöhten Temperaturen (T90: +0,4°C, p < 0,001; T50: +0,6°C, p < 0,001). Durch Verwendung der Temperaturoptimierung (T90) wird eine größere Zunahme festgestellt (T90: + 0,7°C, p < 0,001; T50: + 0,8°C, p < 0,001). Wenn die Unsicherheiten berücksichtigt werden, ergibt sich eine Verbesserung der mittleren HTQ um 23% (p < 0,001) und eine Erhöhung der mittleren T50 und T90 um 0,4°C (p < 0,001).
Schlussfolgerung
Auf Basis einer Unsicherheitsanalyse ergibt sich eine signifikante und klinisch relevante Verbesserung der Tumor-SAR und der Tumortemperatur, wenn der Sigma-60- durch den Sigma-Eye-Applikator ersetzt wird.
References
Bakker JF, Paulides MM, Neufeld E et al (2011) Children and adults exposed to electromagnetic fields at the ICNIRP reference levels: theoretical assessment of the induced peak temperature increase. Phys Med Biol 56:4967–4989
Bruggmoser G, Bauchowitz S, Canters R et al (2011) Quality assurance for clinical studies in regional deep hyperthermia. Strahlenther Onkol 187:605–610
Canters RA, Franckena M, Paulides MM et al (2009) Patient positioning in deep hyperthermia: influences of inaccuracies, signal correction possibilities and optimization potential. Phys Med Biol 54:3923–3936
Canters RA, Franckena M, Zee J van der et al (2008) Complaint-adaptive power density optimization as a tool for HTP-guided steering in deep hyperthermia treatment of pelvic tumors. Phys Med Biol 53:6799–6820
Canters RA, Franckena M, Zee J van der et al (2011) Optimizing deep hyperthermia treatments: are locations of patient pain complaints correlated with modelled SAR peak locations? Phys Med Biol 56:439–451
Canters RAM, Wust P, Bakker JF et al (2009) A literature survey on indicators for characterization and optimization of SAR distributions in deep hyperthermia, a plea for standardization. Int J Hyperthermia
Cox RS, Kapp DS (1992) Correlation of thermal parameters with outcome in combined radiation therapy-hyperthermia trials. Int J Hyperthermia 8:719–732
Das SK, Clegg ST, Samulski TV (1999) Computational techniques for fast hyperthermia temperature optimization. Med Phys 26:319–328
Das SK, Clegg ST, Samulski TV (1999) Electromagnetic thermal therapy power optimization for multiple source applicators. Int J Hyperthermia 15:291–308
de Bruijne M, Holt B van der, Rhoon GC van et al (2010) Evaluation of CEM43 degrees CT90 thermal dose in superficial hyperthermia: a retrospective analysis. Strahlenther Onkol 186:436–443
De Greef M, Kok HP, Bel A et al (2011) 3D versus 2D steering in patient anatomies: a comparison using hyperthermia treatment planning. Int J Hyperthermia 27:74–85
de Greef M, Kok HP, Correia D et al (2010) Optimization in hyperthermia treatment planning: the impact of tissue perfusion uncertainty. Med Phys 37:4540–4550
de Greef M, Kok HP, Correia D et al (2011) Uncertainty in hyperthermia treatment planning: the need for robust system design. Phys Med Biol 56:3233–3250
Franckena M, Canters R, Termorshuizen F et al (2010) Clinical implementation of hyperthermia treatment planning guided steering: A cross over trial to assess its current contribution to treatment quality. Int J Hyperthermia 26:145–157
Franckena M, Fatehi D, Bruijne M de et al (2009) Hyperthermia dose-effect relationship in 420 patients with cervical cancer treated with combined radiotherapy and hyperthermia. Eur J Cancer 45:1969–1978
Gabriel S, Lau RW, Gabriel C (1996) The dielectric properties of biological tissues: II. Measurements in the frequency range 10 Hz to 20 GHz. Phys Med Biol 41:2251–2269
Gabriel S, Lau RW, Gabriel C (1996) The dielectric properties of biological tissues: III. Parametric models for the dielectric spectrum of tissues. Phys Med Biol 41:2271–2293
Gellermann J, Goke J, Figiel R et al (2007) Simulation of different applicator positions for treatment of a presacral tumour. Int J Hyperthermia 23:37–47
Gellermann J, Hildebrandt B, Issels R et al (2006) Noninvasive magnetic resonance thermography of soft tissue sarcomas during regional hyperthermia: correlation with response and direct thermometry. Cancer 107:1373–1382
Gellermann J, Wust P, Stalling D et al (2000) Clinical evaluation and verification of the hyperthermia treatment planning system hyperplan. Int J Radiat Oncol Biol Phys 47:1145–1156
Hasgall PA, Neufeld E, Gosselin MC et al (2011) IT’IS Database for thermal and electromagnetic parameters of biological tissues
Kohler T, Maass P, Wust P et al (2001) A fast algorithm to find optimal controls of multiantenna applicators in regional hyperthermia. Phys Med Biol 46:2503–2514
Kok HP, Greef M de, Borsboom PP et al (2011) Improved power steering with double and triple ring waveguide systems: the impact of the operating frequency. Int J Hyperthermia 27:224–239
Linthorst M, Drizdal T, Joosten H et al (2011) Procedure for creating a three-dimensional (3D) model for superficial hyperthermia treatment planning. Strahlenther Onkol 187:835–841
Maguire PD, Samulski TV, Prosnitz LR et al (2001) A phase II trial testing the thermal dose parameter CEM43 degrees T90 as a predictor of response in soft tissue sarcomas treated with pre-operative thermoradiotherapy. Int J Hyperthermia 17:283–290
McIntosh RL, Anderson V (2010) Comprehensive tissue properties database provided for the thermal assessment of a human at rest. Biophys Rev Lett 5:129–151
Paulides MM, Bakker JF, Linthorst M et al (2010) The clinical feasibility of deep hyperthermia treatment in the head and neck: new challenges for positioning and temperature measurement. Phys Med Biol 55:2465–2480
Paulides MM, Bakker JF, Neufeld E et al (2007) Winner of the “New Investigator Award” at the European Society of Hyperthermia Oncology Meeting 2007. The HYPERcollar: a novel applicator for hyperthermia in the head and neck. Int J Hyperthermia 23:567–576
Sauer R, Creeze H, Hulshof M et al (2012) Concerning the final report “Hyperthermia: a systematic review” of the Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, March 2010. Strahlenther Onkol 188:209–213
Seebass M, Beck R, Gellermann J et al (2001) Electromagnetic phased arrays for regional hyperthermia: optimal frequency and antenna arrangement. Int J Hyperthermia 17:321–336
Sherar M, Liu FF, Pintilie M et al (1997) Relationship between thermal dose and outcome in thermoradiotherapy treatments for superficial recurrences of breast cancer: data from a phase III trial. Int J Radiat Oncol Biol Phys 39:371–380
Song CW, Lokshina A, Rhee JG et al (1984) Implication of blood flow in hyperthermic treatment of tumors. IEEE Trans Biomed Eng 31:9–16
Sreenivasa G, Gellermann J, Rau B et al (2003) Clinical use of the hyperthermia treatment planning system HyperPlan to predict effectiveness and toxicity. Int J Radiat Oncol Biol Phys 55:407–419
Thrall DE, LaRue SM, Yu D et al (2005) Thermal dose is related to duration of local control in canine sarcomas treated with thermoradiotherapy. Clin Cancer Res 11:5206–5214
Trefna HD, Togni P, Shiee R et al (2012) Design of a wideband multi-channel system for time reversal hyperthermia. Int J Hyperthermia 28:175–183
Van de Kamer JB, Van Wieringen N, De Leeuw AA et al (2001) The significance of accurate dielectric tissue data for hyperthermia treatment planning. Int J Hyperthermia 17:123–142
van der Zee J, Gonzalez Gonzalez D, van Rhoon GC et al (2000) Comparison of radiotherapy alone with radiotherapy plus hyperthermia in locally advanced pelvic tumours: a prospective, randomised, multicentre trial. Dutch Deep Hyperthermia Group. Lancet 355:1119–1125
van der Zee J, Rhoon GC van, Wike-Hooley JL et al (1985) Clinically derived dose effect relationship for hyperthermia given in combination with low dose radiotherapy. Br J Radiol 58:243–250
Wust P, Stahl H, Dieckmann K et al (1996) Local hyperthermia of N2/N3 cervical lymph node metastases: correlationof technical/thermal parameters and response. Int J Radiat Oncol Biol Phys 34:635–646
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On behalf of all authors, the corresponding author states that there are no conflicts of interest.
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Canters, R., Paulides, M., Franckena, M. et al. Benefit of replacing the Sigma-60 by the Sigma-Eye applicator. Strahlenther Onkol 189, 74–80 (2013). https://doi.org/10.1007/s00066-012-0241-x
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DOI: https://doi.org/10.1007/s00066-012-0241-x