| 1. |
- Bakker, A., et al.
(författare)
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Analysis of clinical data to determine the minimum number of sensors required for adequate skin temperature monitoring of superficial hyperthermia treatments
- 2018
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Ingår i: International Journal of Hyperthermia. - : Informa UK Limited. - 0265-6736 .- 1464-5157. ; 34:7, s. 910-917
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Tumor response and treatment toxicity are related to minimum and maximum tissue temperatures during hyperthermia, respectively. Using a large set of clinical data, we analyzed the number of sensors required to adequately monitor skin temperature during superficial hyperthermia treatment of breast cancer patients. Methods: Hyperthermia treatments monitored with >60 stationary temperature sensors were selected from a database of patients with recurrent breast cancer treated with re-irradiation (23 × 2 Gy) and hyperthermia using single 434 MHz applicators (effective field size 351–396 cm2). Reduced temperature monitoring schemes involved randomly selected subsets of stationary skin sensors, and another subset simulating continuous thermal mapping of the skin. Temperature differences (ΔT) between subsets and complete sets of sensors were evaluated in terms of overall minimum (Tmin) and maximum (Tmax) temperature, as well as T90 and T10. Results: Eighty patients were included yielding a total of 400 hyperthermia sessions. Median ΔT was 50 sensors were used. Subsets of 50 sensors were used. Thermal profiles (8–21 probes) yielded a median ΔT < 0.01 °C for T90 and Tmax, with a 95%CI of −0.2 °C and 0.4 °C, respectively. The detection rate of Tmax≥43 °C is ≥85% while using >50 stationary sensors or thermal profiles. Conclusions: Adequate coverage of the skin temperature distribution during superficial hyperthermia treatment requires the use of >50 stationary sensors per 400 cm2applicator. Thermal mapping is a valid alternative.
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| 2. |
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| 3. |
- Belgrano, Valerio, et al.
(författare)
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BRAF status as a predictive factor for response in isolated limb perfusion.
- 2019
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Ingår i: International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group. - : Informa UK Limited. - 1464-5157. ; 36:1, s. 511-15
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Tidskriftsartikel (refereegranskat)abstract
- Isolated limb perfusion (ILP) is a treatment option for unresectable in-transit melanoma metastases of the extremities. Approximately two-thirds of the patients have a complete response, and known predictive factors mainly regard tumor burden. In an attempt to identify subgroups with higher response rates, we retrospectively analyzed the predictive value of the BRAF V600E/K mutation for response at our institution.Between January 2012 and December 2017, 98 consecutive patients underwent first-time ILP with melphalan for melanoma in-transit metastases and were included in the study. Data was retrieved from our prospectively kept database. Tumor burden was assessed preoperatively as number of lesions and largest tumor diameter. BRAF status was determined according to clinical routine. Response rates were classified according to WHO criteria.Of the 98 patients included in the analysis, 32 patients had a BRAF V600E/K mutation (33%) and 66 patients were BRAF wild type (wt). There was no difference in age, sex or tumor burden between the groups. Comparing response between BRAF V600E/K mutation and BRAF wt, the overall response rate was 69% vs. 77% (p=.36) and the complete response rate was 47% vs. 52% (p=.67). There was no difference in survival, with a median survival of 47 months.In this consecutive series of patients, BRAF V600E/K mutation was not found to be a significant factor for response or survival following ILP.
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| 4. |
- Belgrano, Valerio, et al.
(författare)
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Isolated limb perfusion as a treatment option for rare types of tumours
- 2016
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Ingår i: International Journal of Hyperthermia. - : Informa UK Limited. - 0265-6736 .- 1464-5157. ; 32:6, s. 595-599
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Tidskriftsartikel (refereegranskat)abstract
- Background: Isolated limb perfusion (ILP) is an established and effective treatment for advanced melanoma and soft tissue sarcomas of the extremities with a high overall response rate. The aim of this study was to describe our experience of ILP for more rare types of tumours. Methods: Patients with Merkel cell carcinoma (MCC) (n = 4), squamous cell carcinoma (SCC) (n = 2), B-cell lymphoma (n = 1), desmoid tumours (n = 3), pigmented villonodular synovitis (PVNS) (n = 1) and giant cell tumour (n = 1) were treated with ILP and analysed retrospectively. Results: The four patients with in-transit MCC had three complete responses (CR) and one partial response (PR); the two patients with SCC had one CR and one stable disease (SD); the patients with desmoid tumours had two PR and one SD. A CR was also observed for the patient with a giant cell tumour, but the patient with PVNS had a SD. The patient with cutaneous metastases of B-cell lymphoma showed a CR, however with rapid systemic progression. Local toxicity according to Wieberdink was grade II in 10 patients (83%) and grade III in two patients (17%). Conclusions: These results show that ILP can be used as a treatment option also for more rare disease entities when other treatments have failed.
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| 5. |
- Ben-Shabat, Ilan, et al.
(författare)
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The effect of perfusate buffering on toxicity and response in isolated hepatic perfusion for uveal melanoma liver metastases
- 2017
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Ingår i: International Journal of Hyperthermia. - : Informa UK Limited. - 0265-6736 .- 1464-5157. ; 33:4, s. 483-488
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Tidskriftsartikel (refereegranskat)abstract
- Background: Isolated hepatic perfusion (IHP) is a treatment option for patients with liver metastases. Previous studies have found that liver toxicity is one of the limiting factors, and in an attempt to reduce the toxicity a buffering agent was added to the perfusate. The aim was to retrospectively analyse if this buffering reduced toxicity and complication rates.Methods: A retrospective review of 52 consecutive patients with uveal melanoma liver metastases treated with IHP between 2005 and 2013. Patients were followed by daily liver function tests (LFT). Toxicity was graded according to Common Terminology Criteria for Adverse Events version 4.0 (CTCAE; United States Department of Health & Human Services, Washington, D.C), complications according to Clavien-Dindo and response according to RECIST-criteria.Results: Thirty-six patients were treated with a buffered perfusate and 16 patients without buffer. There was no difference in age, gender, largest tumour size or number of tumours between the groups. There was a significantly lower mean in peak ALT, AST, PK (INR) and bilirubin when comparing buffer with no-buffer. There were five major complications without a significant difference between the groups (8.3 vs. 12.5%, p=0.33). There was a lower complete response (CR) rate (11 vs. 44%, p=0.023) and a trend for shorter time to local progression (9.2 vs. 17.6 months, p=0.096); however, not significant in multivariate analysis. There was no difference in survival (24.2 vs. 26.0 months, p=0.43) between the two groups.Conclusions: Adding buffer to the perfusate during IHP significantly reduces postoperative LFTs; however, without a reduced complication rate. Interestingly, buffering also seems to reduce the response rate; however, this did not translate into a survival difference. To address if buffering adds any clinical benefit to the patients concerning toxicity, a larger prospective trial is necessary.
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| 6. |
- Blad, B., et al.
(författare)
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Quantitative assessment of impedance tomography for temperature measurements in hyperthermia
- 1992
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Ingår i: International Journal of Hyperthermia. - : Informa UK Limited. - 0265-6736 .- 1464-5157. ; 8:1, s. 33-43
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study is a non-invasive assessment of the thermal dose in hyperthermia. Electrical impedance tomography (EIT) has previously been given a first trial as a temperature monitoring method together with microwave-induced hyperthermia treatment, but it has not been thoroughly investigated. In the present work we have examined this method in order to investigate the correlation in vitro between the true spatial temperature distribution and the corresponding measured relative resistivity changes. Different hyperthermia techniques, such as interstitial water tubings, microwave-induced, laser-induced and ferromagnetic seeds have been used. The results show that it is possible to find a correlation between the measured temperature values and the tomographically measured relative resistivity changes in tissue-equivalent phantoms. But the uncertainty of the temperature coefficients, which has been observed, shows that the method has to be improved before it can be applied to clinical in vivo applications.
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| 7. |
- Carrapiço-Seabra, Carolina, et al.
(författare)
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Application of the ESHO-QA guidelines for determining the performance of the LCA superficial hyperthermia heating system
- 2023
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Ingår i: International Journal of Hyperthermia. - 0265-6736 .- 1464-5157. ; 40:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to assess the quality of the lucite cone applicator (LCA), the standard applicator for superficial hyperthermia at the Erasmus MC Cancer Institute, using the most recent quality assurance guidelines, thus verifying their feasibility. Materials and methods: The assessment was conducted on each of the six LCAs available for clinical treatments. The temperature distribution was evaluated using an infrared camera across different layers of a fat-muscle mimicking phantom. The maximum temperature increase, thermal effective penetration depth (TEPD), and thermal effective field size (TEFS) were used as quality metrics. The experimental results were validated through comparison with simulated results, using a canonical phantom model and a realistic phantom model segmented from CT imaging. Results: A maximum temperature increase above 6 °C at 2 cm depth in the fat-muscle phantom for all the experiments was found. A mean negative difference between simulated and experimental data was of 1.3 °C when using the canonical phantom model. This value decreased to a mean negative difference of 0.4 °C when using the realistic model. Simulated and measured TEPD showed good agreement for both in silico scenarios, while discrepancies were present for TEFS. Conclusions: The LCAs passed all QA guidelines requirements for superficial hyperthermia delivery when used singularly or in an array configuration. A further characterization of parameters such as antenna efficiency and heat transfer coefficients would be beneficial for translating experimental results to simulated values. Implementing the QA guidelines was time-consuming and demanding, requiring careful preparation and correct setup of antenna elements.
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| 8. |
- Corderfeldt, Anna, et al.
(författare)
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Is blood a necessary component of the perfusate during isolated limb perfusion - a randomized controlled trial
- 2019
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Ingår i: International Journal of Hyperthermia. - : Informa UK Limited. - 0265-6736 .- 1464-5157. ; 36:1, s. 794-800
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Tidskriftsartikel (refereegranskat)abstract
- Background: Isolated limb perfusion (ILP) is a treatment option for malignancies localized to an extremity and is performed by surgical isolation of the limb which is connected to an extracorporeal circulation system. A high concentration of a chemotherapeutic agent is perfused through the limb, while systemic toxicity is avoided. Currently, the use of packed red blood cells in the priming solution is the norm during ILP. The aim of this study was to investigate the possibility to replace an erythrocyte-based prime solution with a crystalloid-based prime solution while maintaining the regional metabolic oxygen demand during ILP. Methods: In a single-center, randomized controlled, non-blinded, non-inferiority clinical trial, 21 patients scheduled for treatment with ILP were included and randomized 1:1 to either an erythrocyte-based prime solution (control) or a crystalloid-based prime solution (intervention). Results: There was a significant difference in lactate level (mmol/L) during the perfusion between the intervention group and the control group (1.6 +/- 0.4 vs. 3.6 +/- 0.7, p = .001). No significant differences in oxygen extraction (%) (22 +/- 11 vs. 14 +/- 4, p = .06), oxygen delivery (ml/min) (90 +/- 49 vs. 108 +/- 38, p = .39), oxygen consumption (ml/min) (14 +/- 2 vs. 14 +/- 5, p = .85), regional central venous saturation (%) (83 +/- 10 vs. 91 +/- 4, p = .07) or INVOS (%) (76 +/- 14 vs. 81 +/- 11, p = .42) were found between the intervention group and the control group. Conclusion: This study showed no significant improvement with the addition of packed red blood cells into the prime solution in ensuring the metabolic oxygen demand in the treated extremity during ILP, and we, therefore, recommend that a crystalloid-based prime solution should be used.
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| 9. |
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| 10. |
- de Lazzari, Mattia, 1996, et al.
(författare)
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Ethylcellulose-stabilized fat-tissue phantom for quality assurance in clinical hyperthermia
- 2023
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Ingår i: International Journal of Hyperthermia. - 0265-6736 .- 1464-5157. ; 40:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Phantoms accurately mimicking the electromagnetic and thermal properties of human tissues are essential for the development, characterization, and quality assurance (QA) of clinically used equipment for Hyperthermia Treatment (HT). Currently, a viable recipe for a fat equivalent phantom is not available, mainly due to challenges in the fabrication process and fast deterioration. Materials and methods: We propose to employ a glycerol-in-oil emulsion stabilized with ethylcellulose to develop a fat-mimicking material. The dielectric, rheological, and thermal properties of the phantom have been assessed by state-of-the-art measurement techniques. The full-size phantom was then verified in compliance with QA guidelines for superficial HT, both numerically and experimentally, considering the properties variability. Results: Dielectric and thermal properties were proven equivalent to fat tissue, with an acceptable variability, in the 8 MHz to 1 GHz range. The rheology measurements highlighted enhanced mechanical stability over a large temperature range. Both numerical and experimental evaluations proved the suitability of the phantom for QA procedures. The impact of the dielectric property variations on the temperature distribution has been numerically proven to be limited (around 5%), even if higher for capacitive devices (up to 20%). Conclusions: The proposed fat-mimicking phantom is a good candidate for hyperthermia technology assessment processes, adequately representing both dielectric and thermal properties of the human fat tissue while maintaining structural stability even at elevated temperatures. However, further experimental investigations on capacitive heating devices are necessary to better assess the impact of the low electrical conductivity values on the thermal distribution.
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