No abstract

The model was used to set up guidelines for the water bolus temperature selection in clinical practice for the target depths and applicator arrays used in the Rotterdam Erasmus Medical Center.

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.

In this retrospective study, no clear CEM43 degrees CT90 thermal dose targets or associations with clinical endpoints could be established.

Treatment planning in superficial hyperthermia can be applied to improve clinical routine. Its application supports the selection of the optimum technique in non-standard cases, leading to direct benefits for the patient. In addition, treatment planning has shown to be an excellent tool for education and training for hyperthermia technicians and physicians.

Treatment reproducibility is important to guarantee reproducible treatment-outcome, a low-complication rate and efficient treatment procedures. This study evaluated the performance of loco-regional deep hyperthermia with four BSD-2000 configurations during 1990-2005 using the direct available parameters, i.e., temperature and power. Primary cervical cancer patients (n = 444) were all treated within the Sigma-60. Patients were grouped in three weight-groups: <61 kg, 61-70 kg, >70 kg. Different temperature and power indices were extensively analyzed per BSD configuration, per weight-group, and over the time-period. No substantial variations were found for temperature/power indices over the four BSD configurations or for the temperature doses in similar weight-groups. The 'bare' power indices were increased with weight; however, the derivative power-related (W/kg, W/cm(2)) and temperature indices decreased. Large variations were found in the power-related parameters during 1991-1996 (1st time-period), whereas they were much smaller during 1997-2005 (2nd time-period). The most relevant change noted was the adaptation of the treatment strategy with respect to power modulation. The average frequency of switched-off was 3.4 and 8.9 times/treatment session for the 1st and 2nd time-period, respectively, while the average duration of each switched-off time was 78.2 vs. 38.3 s. The yearly average of vagina T(50) was in the range of 39.3-40.2 degrees C (1st time-period) and 40.0-40.5 degrees C (2nd time-period). In 40% of the patients, a positive correlation was found between normalized net integrated power per pelvic area and vagina T(50). Good reproducible heating is achieved with the BSD-2000 Sigma-60 irrespective of the regular technological upgrades of the system and variation of trained staff-members.

For quality assurance of hyperthermia treatment planning systems, quantitative validation of the electromagnetic model of an applicator is essential. The objective of this study was to validate a finite-difference time-domain (FDTD) model implementation of the Lucite cone applicator (LCA) for superficial hyperthermia. The validation involved (i) the assessment of the match between the predicted and measured 3D specific absorption rate (SAR) distribution, and (ii) the assessment of the ratio between model power and real-world power. The 3D SAR distribution of seven LCAs was scanned in a phantom bath using the DASY4 dosimetric measurement system. The same set-up was modelled in SEMCAD X. The match between the predicted and the measured SAR distribution was quantified with the gamma method, which combines distance-to-agreement and dose difference criteria. Good quantitative agreement was observed: more than 95% of the measurement points met the acceptance criteria 2 mm/2% for all applicators. The ratio between measured and predicted power absorption ranged from 0.75 to 0.92 (mean 0.85). This study shows that quantitative validation of hyperthermia applicator models is feasible and is worth considering as a part of hyperthermia quality assurance procedures.

The effects of waterbolus dimensions and configuration on the effective field size (EFS) of the Lucite cone applicator (LCA) for superficial hyperthermia are presented. The goal of the research is to develop guidelines which mark out a sub-set of optimal LCA-waterbolus set-ups. The effects of variations in (i) waterbolus thickness, (ii) waterbolus area, (iii) waterbolus length/width ratio and (iv) eccentric placement of the applicator have been investigated in an FDTD model study. The prominent effects are verified with IR thermography measurements. An optimal EFS value of 80 cm2 is found for waterbolus area of 200-400 cm2. A small (10 x 10 cm2) waterbolus area restricts the EFS to 25% of the optimal value. The sensitivity to sub-optimal waterbolus area and length/width ratio increases with waterbolus height. Eccentric placement of the LCA near the waterbolus edge reduces the EFS to up to 50% of the optimal value. The IR measurements confirm the model findings. Based on the results, the following guidelines for the clinical application of the LCA have been defined: the waterbolus (i) should extend the LCA aperture at least 2.5 cm, especially at the Lucite windows, and (ii) the height should not exceed 2 cm.