Evaluation of tolerance and toxicity of high-dose-rate brachytherapy boost combined with interstitial hyperthermia for prostate cancer

Kukielka, A.; Hetnał, Marcin; Bereza, Krzysztof

doi:10.3109/02656736.2015.1132339

Cited by 6 publications

(3 citation statements)

References 34 publications

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“…Clinical applications of interstitial heating. Clinical use of interstitial hyperthermia includes mainly sites which are also considered suitable for brachytherapy such as prostate cancer, head and neck and brain tumors [108][109][110]204,205,228,260,261]. In a phase II/III randomized trial 79 glioblastoma patients were randomized to receive external beam radiotherapy (59.4 Gy; 1.8 Gy daily fractions), combined with a brachytherapy boost (60 Gy at 0.40-0.60 Gy/ h) ± 30 min interstitial hyperthermia at 915 MHz immediately before and after brachytherapy.…”

Section: Local Heating Techniquesmentioning

confidence: 99%

Heating technology for malignant tumors: a review

Kok

Cressman

Ceelen

et al. 2020

International Journal of Hyperthermia

277

188

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The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.

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Section: Local Heating Techniquesmentioning

confidence: 99%

Heating technology for malignant tumors: a review

Kok

Cressman

Ceelen

et al. 2020

International Journal of Hyperthermia

277

188

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“…Extensive pre-clinical research has shown that combining brachytherapy with hyperthermia (HT) (thermobrachytherapy [TB]) can significantly enhance local and regional cancer control without increasing complications or side effects. [3][4][5][6][7] Furthermore, additive and synergistic enhancement of radiation by HT provides an avenue for an effective dose de-escalation. 8 HT is defined as a type of treatment in which tissue temperature is elevated to between 39 • C and 45 • C to facilitate killing of malignant cells.…”

Section: Introductionmentioning

confidence: 99%

Optimization and experimental characterization of the innovative thermo‐brachytherapy seed for prostate cancer treatment

Taghizadeh,

Shvydka,

Shan

et al. 2023

Medical Physics

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BackgroundAdjuvant administration of hyperthermia (HT) with radiation therapy in the treatment of cancer has been extensively studied in the past five decades. Concurrent use of the two modalities leads to both complementary and synergetic enhancements in tumor management, but presents a practical challenge. Their simultaneous administration using the same implantable thermo‐brachytherapy (TB) seed source has been established theoretically through magnetically mediated heat induction with ferromagnetic materials. Careful consideration, however, showed that regular ferromagnetic alloys lack the required conductivity to generate enough power through eddy current to overcome heat dissipation due to blood perfusion at clinically measured rates.PurposeWe characterized the TB implant that combines a sealed radioactive source with a ferrimagnetic ceramic (ferrite) core, serving as a self‐regulating HT source when placed in an alternating electromagnetic field. To increase the heat production and uniformity of temperature distribution the empty spacers between radioisotope seeds were replaced by hyperthermia‐only (HT‐only) seeds.MethodsThe heat generation due to eddy currents circulating in the seed's thin metal shell, surrounding the core, depends drastically on the core permeability. We identified a soft ferrite material () as the best candidate for the core, owing to its high permeability, the HT‐range Curie temperature, adjustable through material composition, and a sharp Curie transition, leading to heat self‐regulation, with no invasive thermometry required. The core permeability as a function of temperature was calculated based on measured resistor‐inductor (RL) circuit parameters and material B‐H curves. The thickness of the shell was optimized separately for TB and HT‐only seeds, having slightly different dimensions. Heat generation was calculated using the power versus temperature approximation. Finally, the temperature distribution for a realistic prostate LDR brachytherapy plan was modeled with COMSOL Multiphysics for a set of blood perfusion rates found in the literature.ResultsThe small size of the investigated ferrite core samples resulted in demagnetization significantly decreasing the relative permeability from its intrinsic value of ∼5000 to about 11 in the range of magnetic field amplitude and frequency values relevant to HT. The power generated by the seed dropped sharply as the shell thickness deviated from the optimal value. The optimized TB and HT‐only seeds generated 45 and 267 mW power, respectively, providing a HT source sufficient for >90% volume coverage even for the highest blood perfusion rates. The toxicity of the surrounding normal tissues was minimal due to the rapid temperature fall off within a few millimeters distance from a seed.ConclusionsThe investigated TB and HT‐only seed prototypes were shown to provide sufficient power for the concurrent administration of radiation and HT. In addition to being used as a source for both radiation and heat at the onset of cancer therapy, these implanted seeds would be available for treatment intensification in the setting of salvage brachytherapy for locally radiorecurrent disease, possibly as a sensitizer to systemic therapies or as a modulator of the immune response, without another invasive procedure. Experimentally determined parameters of the ferrite material cores provided in this study establish a mechanistic foundation for future pre‐clinical and clinical validation studies.

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“…Very local heating can be performed with interstitial hyperthermia (IHT) devices. The benefit of using interstitial hyperthermia together with interstitial brachytherapy has been shown in vivo [ 10 ], while clinical studies have shown good heating characteristics in sequential HDR-BT and IHT prostate cancer treatment [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous ThermoBrachytherapy: Electromagnetic Simulation Methods for Fast and Accurate Adaptive Treatment Planning

Androulakis

Mestrom

Christianen

et al. 2022

Sensors

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The combination of interstitial hyperthermia treatment (IHT) with high dose rate brachytherapy (HDR-BT) can improve clinical outcomes since it highly enhances the efficiency of cell kill, especially when applied simultaneously. Therefore, we have developed the ThermoBrachy applicators. To effectively apply optimal targeted IHT, treatment planning is considered essential. However, treatment planning in IHT is rarely applied as it is regarded as difficult to accurately calculate the deposited energy in the tissue in a short enough time for clinical practice. In this study, we investigated various time-efficient methods for fast computation of the electromagnetic (EM) energy deposition resulting from the ThermoBrachy applicators. Initially, we investigated the use of an electro-quasistatic solver. Next, we extended our investigation to the application of geometric simplifications. Furthermore, we investigated the validity of the superpositioning principle, which can enable adaptive treatment plan optimization without the need for continuous recomputation of the EM field. Finally, we evaluated the accuracy of the methods by comparing them to the golden standard Finite-Difference Time-Domain calculation method using gamma-index analysis. The simplifications considerably reduced the computation time needed, improving from >12 h to a few seconds. All investigated methods showed excellent agreement with the golden standard by showing a >99% passing rate with 1%/0.5 mm Dose Difference and Distance-to-Agreement criteria. These results allow the proposed electromagnetic simulation method to be used for fast and accurate adaptive treatment planning.

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Evaluation of tolerance and toxicity of high-dose-rate brachytherapy boost combined with interstitial hyperthermia for prostate cancer

Cited by 6 publications

References 34 publications

Heating technology for malignant tumors: a review

Heating technology for malignant tumors: a review

Optimization and experimental characterization of the innovative thermo‐brachytherapy seed for prostate cancer treatment

Simultaneous ThermoBrachytherapy: Electromagnetic Simulation Methods for Fast and Accurate Adaptive Treatment Planning

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