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Utility of treatment planning for thermochemotherapy treatment of nonmuscle invasive bladder carcinoma.

Publication ,  Journal Article
Yuan, Y; Cheng, K-S; Craciunescu, OI; Stauffer, PR; Maccarini, PF; Arunachalam, K; Vujaskovic, Z; Dewhirst, MW; Das, SK
Published in: Med Phys
March 2012

PURPOSE: A recently completed Phase I clinical trial combined concurrent Mitomycin-C chemotherapy with deep regional heating using BSD-2000 Sigma-Ellipse applicator (BSD Corporation, Salt Lake City, UT, U.S.A.) for the treatment of nonmuscle invasive bladder cancer. This work presents a new treatment planning approach, and demonstrates potential impact of this approach on improvement of treatment quality. METHODS: This study retrospectively analyzes a subset of five patients on the trial. For each treatment, expert operators selected "clinical-optimal" settings based on simple model calculation on the BSD-2000 control console. Computed tomography (CT) scans acquired prior to treatment were segmented to create finite element patient models for retrospective simulations with Sigma-HyperPlan (Dr. Sennewald Medizintechnik GmbH, Munchen, Germany). Since Sigma-HyperPlan does not account for the convective nature of heat transfer within a fluid filled bladder, an effective thermal conductivity for bladder was introduced. This effective thermal conductivity value was determined by comparing simulation results with clinical measurements of bladder and rectum temperatures. Regions of predicted high temperature in normal tissues were compared with patient complaints during treatment. Treatment results using "computed-optimal" settings from the planning system were compared with clinical results using clinical-optimal settings to evaluate potential of treatment improvement by reducing hot spot volume. RESULTS: For all five patients, retrospective treatment planning indicated improved matches between simulated and measured bladder temperatures with increasing effective thermal conductivity. The differences were mostly within 1.3 °C when using an effective thermal conductivity value above 10 W/K/m. Changes in effective bladder thermal conductivity affected surrounding normal tissues within a distance of ∼1.5 cm from the bladder wall. Rectal temperature differences between simulation and measurement were large due to sensitivity to the sampling locations in rectum. The predicted bladder T90 correlated well with single-point bladder temperature measurement. Hot spot locations predicted by the simulation agreed qualitatively with patient complaints during treatment. Furthermore, comparison between the temperature distributions with clinical and computed-optimal settings demonstrated that the computed-optimal settings resulted in substantially reduced hot spot volumes. CONCLUSIONS: Determination of an effective thermal conductivity value for fluid filled bladder was essential for matching simulation and treatment temperatures. Prospectively planning patients using the effective thermal conductivity determined in this work can potentially improve treatment efficacy (compared to manual operator adjustments) by potentially lower discomfort from reduced hot spots in normal tissue.

Duke Scholars

Published In

Med Phys

DOI

ISSN

0094-2405

Publication Date

March 2012

Volume

39

Issue

3

Start / End Page

1170 / 1181

Location

United States

Related Subject Headings

  • Urinary Bladder Neoplasms
  • Temperature
  • Retrospective Studies
  • Nuclear Medicine & Medical Imaging
  • Hyperthermia, Induced
  • Humans
  • Electromagnetic Fields
  • 5105 Medical and biological physics
  • 4003 Biomedical engineering
  • 1112 Oncology and Carcinogenesis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Yuan, Y., Cheng, K.-S., Craciunescu, O. I., Stauffer, P. R., Maccarini, P. F., Arunachalam, K., … Das, S. K. (2012). Utility of treatment planning for thermochemotherapy treatment of nonmuscle invasive bladder carcinoma. Med Phys, 39(3), 1170–1181. https://doi.org/10.1118/1.3679839
Yuan, Yu, Kung-Shan Cheng, Oana I. Craciunescu, Paul R. Stauffer, Paolo F. Maccarini, Kavitha Arunachalam, Zeljko Vujaskovic, Mark W. Dewhirst, and Shiva K. Das. “Utility of treatment planning for thermochemotherapy treatment of nonmuscle invasive bladder carcinoma.Med Phys 39, no. 3 (March 2012): 1170–81. https://doi.org/10.1118/1.3679839.
Yuan Y, Cheng K-S, Craciunescu OI, Stauffer PR, Maccarini PF, Arunachalam K, et al. Utility of treatment planning for thermochemotherapy treatment of nonmuscle invasive bladder carcinoma. Med Phys. 2012 Mar;39(3):1170–81.
Yuan, Yu, et al. “Utility of treatment planning for thermochemotherapy treatment of nonmuscle invasive bladder carcinoma.Med Phys, vol. 39, no. 3, Mar. 2012, pp. 1170–81. Pubmed, doi:10.1118/1.3679839.
Yuan Y, Cheng K-S, Craciunescu OI, Stauffer PR, Maccarini PF, Arunachalam K, Vujaskovic Z, Dewhirst MW, Das SK. Utility of treatment planning for thermochemotherapy treatment of nonmuscle invasive bladder carcinoma. Med Phys. 2012 Mar;39(3):1170–1181.

Published In

Med Phys

DOI

ISSN

0094-2405

Publication Date

March 2012

Volume

39

Issue

3

Start / End Page

1170 / 1181

Location

United States

Related Subject Headings

  • Urinary Bladder Neoplasms
  • Temperature
  • Retrospective Studies
  • Nuclear Medicine & Medical Imaging
  • Hyperthermia, Induced
  • Humans
  • Electromagnetic Fields
  • 5105 Medical and biological physics
  • 4003 Biomedical engineering
  • 1112 Oncology and Carcinogenesis