Characterization of a digital microwave radiometry system for noninvasive thermometry using a temperature-controlled homogeneous test load.

Microwave radiometry has been proposed as a viable noninvasive thermometry approach for monitoring subsurface tissue temperatures and potentially controlling power levels of multielement heat applicators during clinical hyperthermia treatments. With the evolution of technology, several analog microwave radiometry devices have been developed for biomedical applications. In this paper, we describe a digital microwave radiometer with built-in electronics for signal processing and automatic self-calibration. The performance of the radiometer with an Archimedean spiral receive antenna is evaluated over a bandwidth of 3.7-4.2 GHz in homogeneous and layered water test loads. Controlled laboratory experiments over the range of 30-50 degrees C characterize measurement accuracy, stability, repeatability and penetration depth sensitivity. The ability to sense load temperature through an intervening water coupling bolus of 6 mm thickness is also investigated. To assess the clinical utility and sensitivity to electromagnetic interference (EMI), experiments are conducted inside standard clinical hyperthermia treatment rooms with no EM shielding. The digital radiometer provided repeatable measurements with 0.075 degrees C resolution and standard deviation of 0.217 degrees C for homogeneous and layered tissue loads at temperatures between 32-45 degrees C. Within the 3.7-4.2 GHz band, EM noise rejection was good other than some interference from overhead fluorescent lights in the same room as the radiometer. The system response obtained for ideal water loads suggests that this digital radiometer should be useful for estimating subcutaneous tissue temperatures under a 6 mm waterbolus used during clinical hyperthermia treatments. The accuracy and stability data obtained in water test loads of several configurations support our expectation that single band radiometry should be sufficient for sub-surface temperature monitoring and power control of large multielement array superficial hyperthermia applicators.

Microwave thermal balloon angioplasty in the normal rabbit.

The feasibility of utilizing microwave energy for thermal angioplasty was evaluated in 28 normal New Zealand white rabbits. Angioplasty catheters were inserted via bilateral femoral arteriotomy and balloon angioplasty was performed on the external iliac arteries. There were three variables in the microwave angioplasty procedure: peak temperature, energy duration, and peak balloon pressure. At 1 week after the angioplasty, animals were put to death and the iliac arteries were removed after perfusion fixation. Histologic analysis was performed. Injuries to the medial and intimal proliferation were evaluated using an index based on the circumferential extent and depth of abnormality. There was no relationship noted between intimal proliferation or medial injury and energy duration of peak balloon pressure. There was a direct relationship between peak temperature and medial injury. Furthermore, there was an inverse relationship between medial injury and intimal proliferation. The axial extent of change induced by microwave energy was 1.6 cm. Microwave thermal energy delivery through a balloon angioplasty catheter is feasible and can be performed conveniently.

Microwave hyperthermia radiosensitized iridium-192 for recurrent brain malignancy.

Twenty-one patients whose solitary detectable biopsy proven recurrent brain malignancies produced Central Nervous System (CNS) symptoms warranting further intervention received 60-minute 43 degrees C (180 degree-minute) interstitial 2450 MHz microwave hyperthermia fractions. All received brain teletherapy prior to recurrence. The first 15 received no brachytherapy and served as a toxicity pilot. All 15 enjoyed neurologic improvement, 12 symptomatic improvement, and 12 objective response as mass reduction and/or tumor necrosis. The next 6 patients were selected with more favorable Karnofsky performance status, no known active malignancy elsewhere, and received afterloading Ir-192 interstitial implantation juxtaposed to radiosensitizing hyperthermia. Volume dose varied from 1000 to 2245 rad, and dose rate from 40 to 100 rad/hr. Dose selected varied as a function of pre-recurrence teletherapy dose, general condition, histologic type, and volume. Neurosurgical debulking, if technically indicated through no additional aperture or trauma, was permitted if consistent with preservation of neurological function. Six enjoyed neurologic improvement, symptom reduction, and objective tumor response; three remain alive, and one experienced transient improvement. Complications, histologic subtypes, autopsy findings, stereotactic approach, thermal monitoring methods and CT follow-up of objective response are presented along with computer dosimetry and isotherm chart. Our microtraumatic universal catheter technique for CT guided stereotactic biopsy, aspiration, decompression, thermal sensory loop, thermalization antennae, and brachytherapy without multiple trauma nor changing catheters is stressed. The rationale for combined modes peculiar to the CNS will be outlined.2+ Proposal for incorporating controlled-release ARA-C chemotherapy polymer micro-rods into the interstitial format will be offered. The preceeding is an FDA-approved controlled clinical trial.(ABSTRACT TRUNCATED AT 250 WORDS)

Microwave hyperthermia for brain tumors.

Twelve patients with malignant brain tumors who had failed to respond to conventional therapies were treated with thermotherapy. Hyperthermic temperatures (approximately 43 degrees C) were induced in the tumors using microwaves at a frequency of 2450 MHz that were guided into the tumors by one or more semirigid coaxial applicators. These applicators fit into 16 gauge tubes or needles and can be inserted into the brain with minimal damage to healthy tissues. During each treatment, the tumors were maintained at hyperthermic temperatures for 1 hour. Several treatments spaced a few days apart were usually administered. The procedure used for producing hyperthermia in brain tumors with microwaves proved to be safe and could be repeated several times without producing toxic effects. Objective tumor responses were obtained in 75% of the patients (decrease in tumor size, 3 patients; slowing of tumor growth, 2 patients; necrosis of tumor tissues verified by pathological examination, 4 patients). Favorable clinical responses were observed in 75% of the patients (rapid decrease in intractable headaches, 5 patients; improvements in clinical deficits, 4 patients). Also, in all patients, the microwave power required to heat for a given time or a given volume decreased during most of the thermotherapy sessions, possibly because of heat damage to the tumor vasculature. Our results, taken together with the results of other investigators, indicate that thermotherapy is a promising modality for treating malignant brain tumors, either as the sole therapy or in combination with radiotherapy and chemotherapy. The next logical steps would be Phase I/II type trials of subjects whose disease is less advanced than the disease of patients treated in the current series of investigations.

Some practical considerations for the use of localized hyperthermia in the treatment of cancer.

Practical considerations in the selection and administration of microwave and RF induced hyperthermia in the treatment of various tumors are discussed. A thorough knowledge of the thermal properties of the tumor and its environment is required for the establishment of an effective therapeutic regimen. Examples of clinical observations illustrate the patients' general tolerance to the therapy and highlight the problems presented by some special cases. Possible ways of avoiding adverse effects during localized microwave induce heating of superficial tumors and RF heating of deep seated tumors are described.

Therapeutic potential of conformal applicators for induction of hyperthermia.

One of the basic requirements for effective use of hyperthermia in treatment of cancer is the delivery of uniform heat to specific volumes of tissues and maintenance of the optimal temperature for an appropriate period of time. Preliminary results of temperature distribution in volumes of tissue placed between two conformal applicators energized at 2.45 GHz are presented. The applicators consist of a jointed-circuit antenna array comprising a multiplicity of dipoles backed by a metal cavity filled with a powder of high dielectric constant, and separated from the treatment area by a "beanbag" filled with the same powder. Uniform heating could be achieved in a tissue mass confined between two applicators placed 5 cm apart.