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Recently published results confirm the positive effect of regional hyperthermia combined with external radiotherapy on pelvic tumours. Several studies have been published on the improvement of RF annular array applicator systems with dipoles and a closed water bolus. This study investigates the performance of a next-generation applicator system for regional hyperthermia with a multi-ring annular array of antennas and an open water bolus. A cavity slot antenna is introduced to enhance the directivity and reduce mutual coupling between the antennas. Several design parameters, i.e. dimensions, number of antennas and operating frequency, have been evaluated using several patient models. Performance indices have been defined to evaluate the effect of parameter variation on the specific absorption rate (SAR) distribution. The performance of the new applicator type is compared with the Coaxial TEM. Operating frequency appears to be the main parameter with a positive influence on the performance. A SAR increase in tumour of 1.7 relative to the Coaxial TEM system can be obtained with a three-ring, six-antenna per ring cavity slot applicator operating at 150 MHz.

To investigate the patterns of nodal failure in patients enrolled in the international multicentre EMBRACE study. Materials/Methods: Nodal disease at diagnosis (NÀ, N+) and nodal failure were analysed per region (NF) (pelvic (parametrial, common iliac, internal/external iliac), inguinal and para-aortic (PAO)) in 1338 patients. Treatment consisted of chemo-radiation and MRI guided brachytherapy. PAO radiotherapy and/or nodal boost was left to the treating centre. At time of diagnosis 52% of patients had pathologic nodes. Frequency analyses were performed in relation to patient, primary tumour and nodal disease characteristics, and treatment related factors. Results: Median follow up was 34 months and 83% of NF occurred within 24 months. At diagnosis 99% of the N+ patients had pathologic nodes in the pelvis and 14% in the PAO. NF pelvic and NF PAO were reported in 55% and 68% of patients with NF, respectively. Overall NF was reported in 152 patients (11%); 7 and 16% for N-and N+ patients. Of the patients with NF, 41% were located outside the elective target (39% PAO), 40% inside and 35% inside the nodal boost target. Twelve percent of N+ patients that received a nodal boost had a NF inside the nodal boost target. Conclusion: Within the EMBRACE study cohort the overall number of patients developing nodal failure is low, significantly lower for NÀ compared to N+ patients. Pathological nodes at diagnosis are mainly located in the pelvis, whereas nodal failures are more often reported in the PAO region. About 40% of all nodal failures were reported outside the treatment targets.

Multisensor (7-14) thermocouple thermometry is used at our department for temperature measurement with our 'Coaxial TEM' regional hyperthermia system. A special design of the thermometry system with high resolution (0.005 degrees C) and fast data-acquisition (all channels within 320 ms) together with a pulsed power technique allows assessment of specific absorption rate (SAR) information in patients along catheter tracks. A disadvantage of thermocouple thermometry, EM interference, is almost entirely eliminated by application of absorbing ferrite beads around the probe leads. We investigated the effect of remaining disturbance on the temperature decay after power-off, both experimentally in phantoms and in the clinic, and with numerical simulations. Probe and tissue characteristics influence the response time tau dist of the decay of the disturbance. In our clinical practice a normal pulse sequence is 50 s power-on, 10 s power-off: a response time longer than the power-off time results in a deflection of the temperature course at the start. Based on analysis of temperature decays correction of temperature is possible. A double-pulse technique is introduced to provide an initial correction of temperature, and fast information about accuracy. Sometimes disturbance with a relatively long response time occurs, probably due to a bad contact between probe, catheter and/or tissue. Thermocouple thermometry proved to be suitable to measure the SAR along a catheter track. This is used to optimize the SAR distribution by patient positioning before treatment. A clinical example illustrates this.