No abstract

For superficial hyperthermia a custom-built multi-applicator multi-amplifier superficial hyperthermia system operating at 433 MHz is utilised. Up to 6 Lucite Cone applicators can be used simultaneously to treat an area of 600 cm2. Temperatures are measured continuously with fibre optic multi-sensor probes. For patients with non-standard clinical problems, hyperthermia treatment planning is used to support decision making with regard to treatment strategy. In 74% of our patients with recurrent breast cancer treated with a reirradiation scheme of 8 fractions of 4 Gy in 4 weeks, combined with 4 or 8 hyperthermia treatments, a complete response is achieved, approximately twice as high as the CR rate following the same reirradation alone. The CR rate in tumours smaller than 30 mm is 80-90%, for larger tumours it is 65%. Hyperthermia appears beneficial for patients with microscopic residual tumour as well. To achieve high CR rates it is important to heat the whole radiotherapy field, and to use an adequate heating technique.

The SAR distributions of the Sigma-60 applicator are in good agreement with theoretically expected values. The flexible Schottky diode sheet proves to be an excellent tool to make accurate, quantitative measurements of E-field distributions at low (25 W) and medium (400 W) power levels. An important feature of the SDS is that it enables one to significantly improve quantitative quality assurance procedures and to start quantitative comparisons of the performance of the different deep hyperthermia systems used by the various hyperthermia groups.

Steering of multi-element heating arrays for superficial hyperthermia (SHT) can be a challenge in the clinic. This is because the technician has to deal with a multiple-input multiple-output system, varying tissue dynamics, and often sparse tissue temperature data. In addition, patient feedback needs to be taken into account. Effective management of the steering task determines the quality of heating. Systematic evaluation is an effective tool to control the quality of treatments. The purpose of this manuscript is to report on a treatment evaluation flow developed for SHT at the Erasmus MC. This flow is used to secure the quality of steering as well as to stimulate general quality awareness in the hyperthermia team. All treatments are evaluated in a multidisciplinary discussion. Tools and methods were developed to enable effective and efficient evaluations. The treatment evaluation sheet is a compact and intuitive representation of power and temperature data. Trend lines and a temperature-depth plot allow a quick analysis of the steering parameters and the heating profile within the target volume. In addition, the principal statistics of applicator power, water bolus and tissue temperature values are given. Power steering data includes the number of switch-off events, interruption time and the number of steering actions. A list of basic checks and reference values for clinical data support further the treatment evaluation. These tools and the systematic treatment evaluations they facilitate, ultimately lead to consistent performance and fine tuning of the set-up and steering strategy for each individual patient.

In this study, the accuracy of Schottky diode sensors mounted as a two-dimensional array on a flexible 125 micro m thick polyester foil has been studied. The diodes are placed at a distance of 2.5 x 2.5 cm, resulting in a measuring area of 20 x 20 cm. The diodes are placed across the gap between both arms (3 x 5 mm) of a dipole, total length 12 mm. High resistance (1 M Omega/m) carbon transmission lines printed on the sheet are used to connect each electrical (E) field sensor to the read-out electronics and a data-acquisition system. It is demonstrated that the flexible Schottky diode sheet can quantitatively measure E-field distributions at 433 MHz with an overall accuracy of approximately 6% (1 SD). The largest contribution to the inaccuracy is related to the phantom heterogeneity. The absolute sensitivity of this electrical field sensor is 0.71 V/m per V/m of the applied external electromagnetic field. The DC-voltage signal of the diodes shows a more or less square root relation to the RF-power applied to the applicator over a 15-fold range. An important feature of the system is that it provides the ability to perform on-line monitoring of the E-field, i.e. the SAR distribution of 433 MHz applicators. Further, it enables the introduction of fast and easy quality control protocols for superficial hyperthermia applicators.