Hyperthermia Unit

Rotterdam, Netherlands

Hyperthermia Unit

Rotterdam, Netherlands

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Paulides M.M.,Hyperthermia Unit | Stauffer P.R.,Duke University | Neufeld E.,Foundation for Research on Information Technologies in Society | MacCarini P.F.,Duke University | And 5 more authors.
International Journal of Hyperthermia | Year: 2013

Clinical trials have shown that hyperthermia (HT), i.e. an increase of tissue temperature to 39-44 °C, significantly enhance radiotherapy and chemotherapy effectiveness [1]. Driven by the developments in computational techniques and computing power, personalised hyperthermia treatment planning (HTP) has matured and has become a powerful tool for optimising treatment quality. Electromagnetic, ultrasound, and thermal simulations using realistic clinical set-ups are now being performed to achieve patient-specific treatment optimisation. In addition, extensive studies aimed to properly implement novel HT tools and techniques, and to assess the quality of HT, are becoming more common. In this paper, we review the simulation tools and techniques developed for clinical hyperthermia, and evaluate their current status on the path from 'model' to 'clinic'. In addition, we illustrate the major techniques employed for validation and optimisation. HTP has become an essential tool for improvement, control, and assessment of HT treatment quality. As such, it plays a pivotal role in the quest to establish HT as an efficacious addition to multi-modality treatment of cancer. © 2013 Informa UK Ltd. All rights reserved.


Numan W.C.M.,Hyperthermia Unit | Hofstetter L.W.,General Electric | Kotek G.,Hyperthermia Unit | Bakker J.F.,Hyperthermia Unit | And 5 more authors.
International Journal of Hyperthermia | Year: 2014

Magnetic resonance thermometry (MRT) offers non-invasive temperature imaging and can greatly contribute to the effectiveness of head and neck hyperthermia. We therefore wish to redesign the HYPERcollar head and neck hyperthermia applicator for simultaneous radio frequency (RF) heating and magnetic resonance thermometry. In this work we tested the feasibility of this goal through an exploratory experiment, in which we used a minimally modified applicator prototype to heat a neck model phantom and used an MR scanner to measure its temperature distribution. We identified several distorting factors of our current applicator design and experimental methods to be addressed during development of a fully MR compatible applicator. To allow MR imaging of the electromagnetically shielded inside of the applicator, only the lower half of the HYPERcollar prototype was used. Two of its antennas radiated a microwave signal (150W, 434MHz) for 11min into the phantom, creating a high gradient temperature profile (ΔTmax=5.35°C). Thermal distributions were measured sequentially, using drift corrected proton resonance frequency shift-based MRT. Measurement accuracy was assessed using optical probe thermometry and found to be about 0.4°C (0.1-0.7°C). Thermal distribution size and shape were verified by thermal simulations and found to have a good correlation (r2=0.76). © 2014 Informa UK Ltd.


Fortunati V.,Erasmus University Rotterdam | Verhaart R.F.,Hyperthermia Unit | Van Der Lijn F.,Erasmus University Rotterdam | Niessen W.J.,Erasmus University Rotterdam | And 4 more authors.
Proceedings - International Symposium on Biomedical Imaging | Year: 2012

Outcome optimization of hyperthermia tumor treatment in the head and neck requires accurate hyperthermia treatment planning. Hyperthermia treatment planning is based on tissue segmentation for 3D patient model generation. We present here an automatic atlas-based segmentation algorithm for the organs at risk from CT images of the head and neck. To overcome the large anatomical variability, atlas registration and intensity-based classification were combined. A cost function composed of an intensity energy term, a spatial prior energy term based on the atlas registration and a regularization term is globally minimized using graph cut. The method was evaluated by measuring Dice similarity coefficient, mean and Hausdorff surface distances with respect to manual delineation. Overall a high correspondence was found with Dice similarity coefficient higher than 0.86 and a mean distance lower than the voxel resolution. © 2012 IEEE.


Van Der Zee J.,Hyperthermia Unit | De Bruijne M.,Hyperthermia Unit | Mens J.W.M.,Hyperthermia Unit | Ameziane A.,Hyperthermia Unit | And 4 more authors.
International Journal of Hyperthermia | Year: 2010

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 8090, 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. © 2010 Informa UK Ltd. All rights reserved.


Rijnen Z.,Hyperthermia Unit | Bakker J.F.,Hyperthermia Unit | Canters R.A.M.,Hyperthermia Unit | Togni P.,Hyperthermia Unit | And 4 more authors.
International Journal of Hyperthermia | Year: 2013

Background and purpose: In Rotterdam, patient-specific hyperthermia (HT) treatment planning (HTP) is applied for all deep head and neck (H&N) HT treatments. In this paper we introduce VEDO (the Visualisation Tool for Electromagnetic Dosimetry and Optimisation), the software tool required, and demonstrate its value for HTP-guided online complaint-adaptive (CA) steering based on specific absorption rate (SAR) optimisation during a H&N HT treatment. Materials and methods: VEDO integrates CA steering, visualisation of the SAR patterns and mean tumour SAR (SARtarget) optimisation in a single screen. The pre-calculated electromagnetic fields are loaded into VEDO. During treatment, VEDO shows the SAR pattern, overlaid on the patients' CT-scan, corresponding to the actually applied power settings and it can (re-)optimise the SAR pattern to minimise SAR at regions where the patient senses discomfort while maintaining a high SARtarget. Results: The potential of the quantitative SAR steering approach using VEDO is demonstrated by analysis of the first treatment in which VEDO was used for two patients using the HYPERcollar. These cases show that VEDO allows response to power-related complaints of the patient and to quantify the change in absolute SAR: increasing either SARtarget from 96 to 178W/kg (case 1); or show that the first SAR distribution was already optimum (case 2). Conclusion: This analysis shows that VEDO facilitates a quantitative treatment strategy allowing standardised application of HT by technicians of different HT centres, which will potentially lead to improved treatment quality and the possibility of tracking the effectiveness of different treatment strategies. © 2013 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.


Linthorst M.,Hyperthermia Unit | Van Geel A.N.,The Surgical Center | Baartman E.A.,Erasmus Daniel Den Hoed Cancer Center | Oei S.B.,Bernard Verbeeten Institute | And 3 more authors.
Strahlentherapie und Onkologie | Year: 2013

Purpose: Radiation-induced angiosarcoma (RAS) of the chest wall/breast has a poor prognosis due to the high percentage of local failures. The efficacy and side effects of re-irradiation plus hyperthermia (reRT + HT) treatment alone or in combination with surgery were assessed in RAS patients. Patients and methods: RAS was diagnosed in 23 breast cancer patients and 1 patient with melanoma. These patients had previously undergone breast conserving therapy (BCT, n = 18), mastectomy with irradiation (n=5) or axillary lymph node dissection with irradiation (n = 1). Treatment consisted of surgery followed by reRT + HT (n = 8), reRT + HT followed by surgery (n = 3) or reRT + HT alone (n = 13). Patients received a mean radiation dose of 35 Gy (32-54 Gy) and 3-6 hyperthermia treatments (mean 4). Hyperthermia was given once or twice a week following radiotherapy (RT). Results: The median latency interval between previous radiation and diagnosis of RAS was 106 months (range 45-212 months). Following reRT + HT, the complete response (CR) rate was 56 %. In the subgroup of patients receiving surgery, the 3-month, 1- and 3-year actuarial local control (LC) rates were 91, 46 and 46 %, respectively. In the subgroup of patients without surgery, the rates were 54, 32 and 22 %, respectively. Late grade 4 RT toxicity was seen in 2 patients. Conclusion: The present study shows that reRT + HT treatment - either alone or combined with surgery - improves LC rates in patients with RAS. © 2013 Urban & Vogel. Zusammenfassung: Ziel: Das strahleninduzierte Angiosarkom (RAS, "radiation-induced angiosarcoma") der Brustwand hat wegen des hohen Anteils an lokalem Versagen eine schlechte Prognose. Die Wirksamkeit und Nebenwirkungen von Rebestrahlung und Hyperthermie (ReRT + HT) allein oder in Kombination mit vorhergehender oder nachfolgender Operation wurden bei Patienten mit einem RAS der Brustwand überprüft Patienten und Methoden: RAS wurde bei 23 Patientinnen mit Brustkrebs und bei einer Patientin mit malignem Melanom, nach früherer brusterhaltender Brustkrebstherapie (n=18), Mastektomie mit Bestrahlung (n=5) und axillärer Lymphknotendissektion mit Bestrahlung (n=1) diagnostiziert. Die Behandlung des RAS bestand aus Chirurgie gefolgt von ReRT + HT (n=8), ReRT + HT gefolgt von Chirurgie (n=3) oder ReRT + HT allein (n=13). Die Patienten wurden mit einer Strahlendosis von 32-54 Gy behandelt (durchschnittlich 35 Gy) und 3-6 Hyperthermiebehandlungen (durchschnittlich 4). Die Hyperthermie wurde 1-mal oder 2-mal pro Woche nach der Bestrahlung gegeben. Ergebnisse: Das durchschnittliche Latenzzeitintervall zwischen ehemaliger Bestrahlung und RAS-Diagnose betrug 106 Monate (Bereich 45-212 Monate). Nach ReRT + HT lag die komplette Remission (CR) bei 56%. In der Untergruppe von Patienten mit Chirurgie lagen die 3-Monats-, 1- und 3-Jahres-Lokalkontrollraten (LC) bei 91%, 46% und 46%. In der Untergruppe von Patienten ohne Operation waren dies 54%, 32% und 22%. Eine Grad-4-Spättoxizität zeigte sich bei 2 Patienten. Schlussfolgerung: Die vorliegende Studie zeigt, dass ReRT + HT entweder allein oder in Kombination mit Chirurgie zu einer verbesserten LC-Rate bei Patienten mit RAS führt. © 2013 Urban & Vogel.


De Bruijne M.,Hyperthermia Unit | Van Der Zee J.,Hyperthermia Unit | Ameziane A.,Hyperthermia Unit | Van Rhoon G.C.,Hyperthermia Unit
International Journal of Hyperthermia | Year: 2011

Steering of multi-element heating arrays for superficial hyperthermia (SHT) can be a challenge in the clinic. This is because the technician has to deal with a multiple-input multiple-output system, varying tissue dynamics, and often sparse tissue temperature data. In addition, patient feedback needs to be taken into account. Effective management of the steering task determines the quality of heating. Systematic evaluation is an effective tool to control the quality of treatments. The purpose of this manuscript is to report on a treatment evaluation flow developed for SHT at the Erasmus MC. This flow is used to secure the quality of steering as well as to stimulate general quality awareness in the hyperthermia team. All treatments are evaluated in a multidisciplinary discussion. Tools and methods were developed to enable effective and efficient evaluations. The treatment evaluation sheet is a compact and intuitive representation of power and temperature data. Trend lines and a temperature-depth plot allow a quick analysis of the steering parameters and the heating profile within the target volume. In addition, the principal statistics of applicator power, water bolus and tissue temperature values are given. Power steering data includes the number of switch-off events, interruption time and the number of steering actions. A list of basic checks and reference values for clinical data support further the treatment evaluation. These tools and the systematic treatment evaluations they facilitate, ultimately lead to consistent performance and fine tuning of the set-up and steering strategy for each individual patient. © 2011 Informa UK Ltd.


PubMed | Hyperthermia Unit
Type: Journal Article | Journal: International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group | Year: 2013

In Rotterdam, patient-specific hyperthermia (HT) treatment planning (HTP) is applied for all deep head and neck (H&N) HT treatments. In this paper we introduce VEDO (the Visualisation Tool for Electromagnetic Dosimetry and Optimisation), the software tool required, and demonstrate its value for HTP-guided online complaint-adaptive (CA) steering based on specific absorption rate (SAR) optimisation during a H&N HT treatment.VEDO integrates CA steering, visualisation of the SAR patterns and mean tumour SAR (SAR(target)) optimisation in a single screen. The pre-calculated electromagnetic fields are loaded into VEDO. During treatment, VEDO shows the SAR pattern, overlaid on the patients CT-scan, corresponding to the actually applied power settings and it can (re-)optimise the SAR pattern to minimise SAR at regions where the patient senses discomfort while maintaining a high SAR(target).The potential of the quantitative SAR steering approach using VEDO is demonstrated by analysis of the first treatment in which VEDO was used for two patients using the HYPERcollar. These cases show that VEDO allows response to power-related complaints of the patient and to quantify the change in absolute SAR: increasing either SAR(target) from 96 to 178 W/kg (case 1); or show that the first SAR distribution was already optimum (case 2).This analysis shows that VEDO facilitates a quantitative treatment strategy allowing standardised application of HT by technicians of different HT centres, which will potentially lead to improved treatment quality and the possibility of tracking the effectiveness of different treatment strategies.


PubMed | Hyperthermia Unit
Type: Journal Article | Journal: International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group | Year: 2012

Breast cancer recurrences in previously irradiated areas are treated with reirradiation (reRT) and hyperthermia (HT). The aim of this retrospective study is to quantify the toxicity of HT in breast cancer patients with reconstruction.Between 1992 and 2009, 36 patients were treated with reRT with a scheme of 8 fractions of 4.0Gy in 4 weeks, and HT on a total of 37 tissue reconstructions. The types of reconstructions were: split-thickness skin graft (15), transverse rectus abdominis myocutaneous flap (1), latissimus dorsi flap (14), rhomboid flap (1) or a combination of grafts and flaps (6). Toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Patient, tumour, and treatment characteristics predictive for the endpoints were identified in univariate and multivariate analyses. The primary endpoint was HT toxicity. Secondary endpoints were acute and late radiotherapy (RT) toxicity, complete response (CR), local control (LC) and overall survival (OS).The median follow-up time was 64 months. Grade 2 HT toxicity occurred in four patients and grade 3 in three. The three patients with grade 3 HT toxicity required reoperation. None of the evaluated parameters showed a significant relationship with HT toxicity. The CR rate in 15 patients with macroscopic disease was 80%. The 3 and 5 year LC rates were 74% and 69%; the median OS was 55 months.Combined reRT and HT in breast cancer patients with reconstruction is safe and effective.


PubMed | Hyperthermia Unit
Type: Journal Article | Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology | Year: 2013

Evaluation of efficacy and side effects of combined re-irradiation and hyperthermia electively or for subclinical disease in the management of locoregional recurrent breast cancer.Records of 198 patients with recurrent breast cancer treated with re-irradiation and hyperthermia from 1993 to 2010 were reviewed. Prior treatments included surgery (100%), radiotherapy (100%), chemotherapy (42%), and hormonal therapy (57%). Ninety-one patients were treated for microscopic residual disease following resection or systemic therapy and 107 patients were treated electively for areas at high risk for local recurrences. All patients were re-irradiated to 28-36Gy (median 32) and treated with 3-8 hyperthermia treatments (mean 4.36). Forty percent of the patients received concurrent hormonal therapy. Patient and tumor characteristics predictive for actuarial local control (LC) and toxicity were studied in univariate and multivariate analysis.The median follow-up was 42months. Three and 5year LC-rates were 83% and 78%. Mean of T90 (tenth percentile of temperature distribution), maximum and average temperatures were 39.8C, 43.6C, and 41.2C, respectively. Mean of the cumulative equivalent minutes (CEM43) at T90 was 4.58min. Number of previous chemotherapy and surgical procedures were most predictive for LC. Cumulative incidence of grade 3 and 4 late toxicity at 5years was 11.9%. The number of thermometry sensors and depth of treatment volume were associated with acute hyperthermia toxicity.The combination of re-irradiation and hyperthermia results in a high LC-rate with acceptable toxicity.

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