Feasibility and patient tolerance of a novel transrectal ultrasound hyperthermia system for treatment of prostate cancer

Abstract

This report describes patient tolerance and toxicity of a transrectal ultrasound hyperthermia system used with external beam radiation therapy in treatment of locally advanced prostate cancer. Nine patients with clinical T2B-T3B (4th edition AJCC criteria) disease received external beam radiation therapy, with two hyperthermia treatments scheduled at least 1 week apart during the first 4 weeks of radiation. Five patients also received hormonal therapy. Interstitial and anterior rectal wall thermometry were performed. Median temperature for each treatment (T50) was 40.8 degrees C and mean CEM T90 = 43 degrees C was 3.4 min. Rectal wall temperature was maintained at < or = 40 degrees C. Treatment duration was limited in three of 17 sessions due to positional discomfort which was alleviated with light IV sedation and use of a 'New Life' mattress (Comfortex, Inc. Winoba, MN, USA). Acute toxicity was limited to NCI common toxicity criteria grade 1 and no excess toxicity was noted with full course radiation therapy +/- hormonal therapy. These findings are consistent with those reported in a previous phase I trial assessing this device. Given the favourable toxicity profile demonstrated to date, modification of treatment parameters for this ongoing phase II study have been instituted that should further the efficacy of transrectal ultrasound hyperthermia for treatment of prostate cancer.

Localized Hyperthermia Combined with Intratumoral Dendritic Cells Induces Systemic Antitumor Immunity

“…Hyperthermia has been used effectively as a radiation sensitizer in the treatment of locally advanced and recurrent solid tumors, including breast, head and neck, and prostate cancer (2)(3)(4). Although hyperthermia has been evaluated as a definitive treatment in combination with external beam radiation therapy for locally advanced prostate cancer, the inability to achieve high temperature uniformly within the tumor limits its application (2).…”

Model‐based feasibility assessment and evaluation of prostate hyperthermia with a commercial MR‐guided endorectal HIFU ablation array

“…[21][22][23][24][25][26][27][28][29][30] Whole gland hyperthermia may not be possible simply through beamforming alone. However, the ExAblate 2100 has a rotational and translational positioning module that affords accurate positioning and orientation of the applicator within the patient.…”

“…Several studies about hyperthermia to the prostate using endorectal ultrasound utilize a bolus of temperature-controlled water for applicator coupling and rectal wall protection. 21,22,27,29,30 The InSightec system can regulate bolus temperature over a large range (as low as 10…”

“…[21][22][23][24][25][26] Clinical studies have demonstrated feasibility of safe, reliable, and effective application of prostate hyperthermia with ERUS applicators. [27][28][29][30] Currently, MR guided high intensity focused ultrasound (MRgHIFU) systems are being increasingly utilized for noninvasive or minimally invasive thermal ablation of soft tissue tumors in multiple organ sites. 31,32 Typically, these are multielement phased array applicators capable of delivering ultrasound energy with precise spatial control.…”

The Effects of Microwave Thermotherapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective, Randomized Study

“…Moreover, multiple interventional techniques, including microwave thermotherapy, injection of botulinum toxin, transurethral needle ablation of the prostate, neuromodulation, and extracorporeal shockwave therapy, have been utilized, with each offering varying degrees of benefit. Transrectal microwave hyperthermia of the prostate was developed as a treatment for prostate cancer [6][7][8], and its application was subsequently extended to benign prostatic hyperplasia and CP [9,10]. Transrectal prostatic hyperthermia has shown efficacy in selected patients with CP who did not respond to conventional therapies [11,12].…”