Interstitial Thermoradiotherapy for Pelvic Tumors: a Cooperative Phase 1–2 Study

Seegenschmiedt, M. H.; Sauer, Rolf; Miyamoto, Curtis; Brady, Luther W.

doi:10.1007/978-3-642-84801-8_31

Cited by 3 publications

(3 citation statements)

References 56 publications

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“…With the notable exception of highly focused external beam ultrasound, much of the equipment for high temperature thermal ablation has either evolved from earlier development efforts or stems from independent efforts that parallel or duplicate principles characterized in the interstitial moderate temperature hyperthermia field. Results of decades of equipment development for interstitial hyperthermia applications have been summarized previously [31][32][33][34][35] . One important and fortuitous difference for interstitial heating equipment applied to thermal ablation treatments is that, rather than aiming for a narrow therapeutic window of only 41-45 C, the high temperature thermal ablation systems can aim to treat tissue over a much larger temperature range from 50-100 C or more.…”

mentioning

confidence: 99%

Introduction: Thermal ablation therapy

Stauffer

Goldberg

2004

International Journal of Hyperthermia

105

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The diseases which medicines cannot cure, excision cures: those which excision cannot cure, are cured by the cautery; but those which the cautery cannot cure, may be deemed incurable (Hippocrates Aphorisms, 400 BCE).Ever since initial discoveries of fire and ice, medical applications of thermal energy have continued to increase in both number and sophistication. Initially, treatments were limited to very cold (ice) or very hot (cautery) temperatures that could not be controlled but were maintained for a sufficient time to obtain visually obvious effects on surface tissues. Over time, therapeutic applications of hot and cold temperature have increased in clinical complexity in direct correspondence with improvements in the devices and techniques used to deliver and monitor the effects of thermal energy. Efforts to generate specific interactions with tissue in a safe and reproducible manner have been restricted by the availability of controllable energy sources (cryotherapy, radiofrequency (RF), microwave (MW), laser, etc.), accurate monitoring systems (MR, CT, thermal mapping, etc.), and problems/complications unique to treating each specific organ (liver, prostate, brain, heart, skin, etc.). At present, due to the wide range of possible therapeutic effects, 'thermal medicine' is often practiced independently with large variation in methodology based on geography as well as sub-discipline within the medical community.To meet the specialized demands of various clinical applications, site-specific applicators and condition-specific treatment protocols have been developed, refined and further customized to meet evolving requirements. While optimization of thermal therapy techniques for specific medical conditions has produced many therapeutic tools, the development continues to evolve in numerous directions at once. While parallel development can speed the time to useful solutions, without due caution and co-ordination it can suffer from repeated mistakes and brilliant but non-innovative re-development efforts. This special issue on thermal ablation is an attempt to publish in one place representative ongoing efforts from a cross-section of sub-disciplines, thereby enhancing visibility of conclusions made under similar research conditions. By encouraging cross-fertilization of results, one might anticipate further acceleration of development timeframes.In order to simplify reading articles written for the various sub-disciplines, a uniform language is encouraged. While standardized terminology for tumour ablation has already been proposed 1 , due to the range of disciplines covered in International Journal of Hyperthermia Int J Hyperthermia Downloaded from informahealthcare.com by Nyu Medical Center on 08/01/15 For personal use only.this special issue it seems appropriate to reiterate the essence of that standard and supplement its content with additional clarification of general thermal therapy concepts as apply to hot, warm and cold temperatures alike. It is anticipated that efforts to consolidate a 'lingua communa...

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confidence: 99%

Introduction: Thermal ablation therapy

Stauffer

Goldberg

2004

International Journal of Hyperthermia

105

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“…This controllability compares favourably to existing clinical RF and MW interstitial and intrauterine heating systems, which are limited in ability to tailor temperature profiles [5,12]. The multi-electrode RF current source is an exception, which has demonstrated power control along the length of an interstitial implant to improve resultant temperature distributions [13,14].…”

Section: Introductionmentioning

confidence: 93%

Optimisation-based thermal treatment planning for catheter-based ultrasound hyperthermia

Chen

Diederich

Wootton

et al. 2010

International Journal of Hyperthermia

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A patient-specific optimisation-based hyperthermia treatment planning program for catheter-based ultrasound technology was developed for a priori evaluation of proposed applicator implant strategies and determination of initial applied power settings. The interstitial and endocavity heating applicators, designed for delivering 3-D controllable hyperthermia within High Dose Rate (HDR) brachytherapy implants, consist of linear and sectored arrays of ultrasound transducers with variable power control in both length and angle. A 3D biothermal model, which incorporates relevant anatomical structures and implant geometries based upon HDR treatment planning, has been developed to simulate the temperature distributions induced by these ultrasound applicators within the catheter implants. A temperature-based constrained optimisation algorithm was devised and integrated within the finite-element thermal solver to determine the optimal applied power levels. A temperature-expressed objective function and constraints were employed to limit maximum temperature (T(max)), maximise target coverage (T(target)), and minimise thermal exposure to normal tissue and surrounding organs. The optimisation-based treatment planning was applied on representative examples of clinical HDR implants for endocavity treatment of cervix (n = 3) and interstitial treatment of prostate (n = 3). Applicator positioning and orientation, T(max), and T(target), were varied, and temperature volume and thermal dose volume histograms calculated for each plan. The optimisation approach provided optimal applied power levels (4-24 independent transducer sections) leading to conforming or tailored temperature distributions for all cases, as indicated with improved temperature index T(90) in the target volume and negligible temperature and thermal dose (t(43,max) < 1 min) exposure in surrounding non-targeted tissues, such as bladder and rectum. The precision of the optimised power estimates was shown to be within <5% for a range of starting levels and were similarly convergent. The execution times of this optimisation (<16 min) and forward thermal treatment planning (<22 min) is sufficiently fast to be integrated into the clinical setting. This optimisation-based treatment planning platform for catheter-based ultrasound applicators is a useful tool to provide feedback for applicator selection (sector angle, number of transducer sections along length), positioning (angle or orientation), optimal initial power settings, and has potential to significantly improve the delivery of hyperthermia in conjunction with HDR brachytherapy.

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“…The differences between different kinds of applicator mainly involve their shape. If cylindrical areas of coagulation necrosis are necessary, tubular transducers seems to be preferable [2] but a recent paper [3] showed that rotating plane transducers are more effective and faster for inducing deep necrosis. This difference is due to the much more rapid decrease of the pressure with a tubular transducer than with a plane transducer.…”

Section: Introductionmentioning

confidence: 99%