A flexible 70 MHz phase-controlled double waveguide system for hyperthermia treatment of superficial tumours with deep infiltration.

PURPOSE: Superficial tumours with deep infiltration in the upper 15 cm of the trunk cannot be treated adequately with existing hyperthermia systems. The aim of this study was to develop, characterise and evaluate a new flexible two-channel hyperthermia system (AMC-2) for tumours in this region. MATERIALS AND METHODS: The two-channel AMC-2 system has two horizontally revolving and height adjustable 70 MHz waveguides. Three different interchangeable antennas with sizes 20 × 34, 15 × 34 and 8.5 × 34 cm were developed and their electrical properties were determined. The performance of the AMC-2 system was tested by measurements of the electric field distribution in a saline water filled elliptical phantom, using an electric field vector probe. Clinical feasibility was demonstrated by treatment of a melanoma in the axillary region. RESULTS: Phantom measurements showed a good performance for all waveguides. The large reflection of the smallest antenna has to be compensated by increased forward power. Field patterns become asymmetrical when using smaller top antennas, necessitating phase corrections. The clinical application showed that tumours deeper than 4 cm can be heated adequately. A median tumour temperature of 42 °C can be reached up to 12 cm depth with adequate antenna positioning and phase-amplitude steering. CONCLUSIONS: This 70 MHz AMC-2 waveguide system is a useful addition to existing loco-regional hyperthermia equipment as it is capable of heating axillary tumours and other tumours deeper than 4 cm.

Toward online adaptive hyperthermia treatment planning: correlation between measured and simulated specific absorption rate changes caused by phase steering in patients.

PURPOSE: Hyperthermia is the clinical application of heat, in which tumor temperatures are raised to 40°C to 45°C. This proven radiation and chemosensitizer significantly improves clinical outcome for several tumor sites. Earlier studies of the use of pre-treatment planning for hyperthermia showed good qualitative but disappointing quantitative reliability. The purpose of this study was to investigate whether hyperthermia treatment planning (HTP) can be used more reliably for online adaptive treatment planning during locoregional hyperthermia treatments. METHODS AND MATERIALS: This study included 78 treatment sessions for 15 patients with non-muscle-invasive bladder cancer. At the start of treatments, temperature rise measurements were performed with 3 different antenna settings optimized for each patient, from which the absorbed power (specific absorption rate [SAR]) was derived. HTP was performed based on a computed tomography (CT) scan in treatment position with the bladder catheter in situ. The SAR along the thermocouple tracks was extracted from the simulated SAR distributions. Correlations between measured and simulated (average) SAR values were determined. To evaluate phase steering, correlations between the changes in simulated and measured SAR values averaged over the thermocouple probe were determined for all 3 combinations of antenna settings. RESULTS: For 42% of the individual treatment sessions, the correlation coefficient between measured and simulated SAR profiles was higher than 0.5, whereas 58% showed a weak correlation (R of <0.5). The overall correlation coefficient between measured and simulated average SAR was weak (R=0.31; P<.001). The measured and simulated changes in average SAR after adapting antenna settings correlated much better (R=0.70; P<.001). The ratio between the measured and simulated quotients of maximum and average SARs was 1.03 ± 0.26 (mean ± SD), indicating that HTP can also correctly predict the relative amplitude of SAR peaks. CONCLUSIONS: HTP can correctly predict SAR changes after adapting antenna settings during hyperthermia treatments. This allows online adaptive treatment planning, assisting the operator in determining antenna settings resulting in increased tumor temperatures.

SAR deposition by curved CFMA-434 applicators for superficial hyperthermia: Measurements and simulations.

INTRODUCTION: Contact flexible microstrip applicators (CFMA) are applied for superficial hyperthermia. In the clinic these flexible applicators are mostly applied bent along the body curvature. This paper investigates the specific absorption rate (SAR) patterns of CFMA applicators, when bent around an elliptical tissue-equivalent phantom. METHODS: The 2H (aperture size 14.8 x 14.3 cm(2)), 3H (28.7 x 20.7 cm(2)), 4H (19.6 x 19.6 cm(2)) and 5H (19.7 x 28.5 cm(2)) applicators were examined. Measurements were performed for the 5H applicator; existing measurement data were analysed for the 3H applicator. Finite difference time domain (FDTD) simulations with a resolution of 2 x 2 x 1 mm(3) were performed for all applicators. Applicators were bent around the top and the side of the elliptical phantom to examine different curvatures. The SAR deposition, effective field size (EFS) and effective heating depth (EHD) were evaluated and compared to results for straight applicators. RESULTS: Bending the applicators generally yielded a focusing effect of the SAR, which was most pronounced with a strong curvature, but especially the 5H applicator showed a stronger power absorption at the sides of the applicator, compared to the centre region. The EFS became smaller when bending the applicators; this effect was also more pronounced for a strong curvature. The EHD increased for bent applicators, but the degree depended strongly on the location. CONCLUSION: The behaviour of bent CFMA applicators is not trivial and the SAR deposition is not similar for all applicators. The EFS decreases and the EHD increases, but very locally. Therefore, it is generally advisable to analyse the SAR distribution of flexible applicators in both straight and bent state.

FDTD simulations to assess the performance of CFMA-434 applicators for superficial hyperthermia.

INTRODUCTION: Contact flexible microstrip applicators (CFMA), operating at 434 MHz, are applied at the Academic Medical Center (AMC) for superficial hyperthermia (e.g. chest wall recurrences and melanoma). This paper investigates the performance of CFMA, evaluating the stability of the specific absorption rate (SAR) distribution, effective heating depth (EHD) and effective field size (EFS) under different conditions. METHODS: Simulations were performed using finite differences and were compared to existing measurement data, performed using a rectangular phantom with a superficial fat-equivalent layer of 1 cm and filled with saline solution. The electrode plates of the applicators measure approximately 7 x 20, 29 x 21 and 20 x 29 cm(2). Bolus thickness varied between 1 and 2 cm. The impact of the presence of possible air layers between the rubber frame and the electrodes on the SAR distribution was investigated. RESULTS: The EHD was approximately 1.4 cm and the EFS ranged between approximately 60 and approximately 300 cm(2), depending on the applicator type. Both measurements and simulations showed a split-up of the SAR focus with a 2 cm water bolus. The extent and location of air layers has a strong influence on the shape and size of the iso-SAR contours with a value higher than 50%, but the impact on EFS and EHD is limited. CONCLUSION: Simulations, confirmed by measurements, showed that the presence of air between the rubber and the electrodes changes the iso-SAR contours, but the impact on the EFS and EHD is limited.