Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 4. P. 48–55

DOI: 10.12737/article_5d110f04375033.57581297

B.Ya. Narkevich^1,2, S.V. Shiryaev², I.V. Lagutina^1,2, Yu.V. Buydenok², T.K. Kharatishvili², N.S. Petrochenko²

Leakage Radiometric Control of Chemical Drugs with Regional Perfusion of Surgical Isolated Limbs

1. Association of Medical Physicists of Russia, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia

B.Ya. Narkevich – President of the AMPR, Leading Researcher, Dr. Sci. Tech., Prof., Academician of International Academy of Engineering;
S.V. Shiryaev – Head of Lab., Dr. Sci. Med., Prof., Member of the European Association of Nuclear Medicine and Molecular Imaging, Member of the American College of Nuclear Medicine and Molecular Imaging, Member of the Society of Nuclear Medicine and Molecular Imaging;
I.V. Lagutina – Medical Physicist;
Yu.V. Buydenok – Perfusiologist, Leading Researcher, Dr. Sci. Med.;
T.K. Kharatishvili – Surgeon, Leading Researcher, Dr. Sci. Med., Prof.;
N.S. Petrochenko – Surgeon, PhD Med.

Abstract

Purpose: Modernization and evaluation of the clinical effectiveness of the technology of continuous radiometric monitoring carried out during high-dose chemotherapy of a surgically isolated limb with tumor foci.

Material and methods: A modernized radiometric control technology for regional limb perfusion is proposed. It is based on in vivo labeling of erythrocytes with ^99mTc eluate followed by continuous monitoring of the activity of labeled erythrocytes as a simulator of a chemotherapy drug over the heart region. Its distinctive features are intravenous injection of a pyrfotech slice after giving inhalation anesthesia to ensure a sufficient level of red blood cell chelation, as well as using ^99mTc activity less than its minimum significant level, which allows working with an open source of ionizing radiation without violating the requirements of radiation safety regulations.

Results: The developed technology was successfully used with 106 regional perfusion of the upper and lower extremities in patients with melanoma or sarcoma of soft tissues. In 4 cases, according to the results of radiometric control, the intervention of the surgical team was required to reduce the chemical preparation leakage that was occurring.

Conclusion: The technology upgraded by us is characterized by ease of implementation, the ability to take timely measures to prevent or reduce the leakage of a chemotherapy drug from an isolated limb according to the results of continuous in vivo radiometric monitoring of ^99mTc-labeled red blood cells over the heart, as well as low radiation load on the patient and staff.

Key words: high-dose chemotherapy, surgically isolated limb, regional perfusion, chemotherapy leaks, radiometric monitoring

REFERENCES

1. Gargon GI, Pkhakadze NR, Senchik KYu, Gelfold VM. Perspective methods for treating patients with soft-tissue sarcomas of the extremities (isolated regional perfusion, local hyperthermia). Practical Oncology. 2004;5(4):276-84. (Russian).
2. Zwavelig JH, Maring JK, Mulder AB, et al. Effects of hyperthermic isolated limb perfusion with recombinant tumor necrosis factor α and melphalan on the human fibrinolytic system. Cancer Res. 1996;56: 3948-53.
3. Goldberg ME, Rosenblum HM, Seltzer JL, Rosato FE. Isolated regional perfusion: anesthetic technique, monitoring and blood replacement. Canad J Anesthesia. 1984. Sep;512-58. DOI: 10.1007 / BF03009542
4. Kroon HM. Treatment of locally advanced limb infusion with citotoxic drugs. J Skin Cancer. 2011;Article ID 106573. 7 pp.
5. Tatyanicheva NV. Evaluation of the effectiveness of the method of isolated regional perfusion in the combined treatment of patients with soft tissue sarcomas and skin melanoma of the extremities. Author. PhD Med. S.-Pb. 2012. 24 p. (Russian).
6. Shiryaev SV, Goncharov MO, Narkevich BYa. Development of radionuclide semiotics of liver hemangiomas using single-photon emission computed tomography with labeled red blood cells in the differential diagnosis of liver tumors. Med Fizika. 2009;3(43): 44-55 (Russian).
7. Basic Sanitary Rules for Radiation Safety OSPORB-99/2010. SP 2.6.1.2612–10. (as amended by change No. 1, approved by the resolution of the Chief State Sanitary Doctor of the Russian Federation of September 16, 2013 No. 43). (Russian).
8. Vidal-Sicart S, Rull R, Barriuso C, Nieweg OE. Monitoring for systemic leakage during limb perfusion for melanoma. In: Radioguided Surgery. Ed. by Herrmann K, Nieweg OE, Povoski SP. Springer. 2016;359-69.
9. Vrouenraets BC, Eggermont .M, Hart AA, et al. Limb perfusion with melphalan and tumor necrosis factor-alpha versus toxicity after melphalan alone. Regional Eur J Surg Oncol. 2001;24(4):390-5.
10. Di Filippo F, Rossi CR, Santinami M, Di Filippo S. Hyperthermic isolation limb perfusion with TNFα in the treatment of in-transit melanoma metastasis. In vivo. 2006;20:739-42.
11. National Radionuclide Diagnosis Manual. Lishmanov YuB, Chernov VI (Ed.) Vol. 2. Tomsk: STT. 2010;73-4. (Russian).
12. Wierts R, Lazarenko SV, de Jong JR, Willemsen AT. Characteristics of the leakage factor during regional hyperthermic isolated limb perfusion. Nucl Med Commun. 2011;32(9):858-62.
13. Paulsen IF, Chakera AH, Schmidt G, Drjøe J, Klyver H, Oturai PS, et al. Radionuclide leakage monitoring during hyperthermic isolated limb perfusion for local melanoma metastasis in an extremity. Clin Physiol Funct Imaging. 2014;6(6). DOI:  10.1111/cpf.12164
14. Fiz F, Villa G, Ferrari E, Pomposelli E, Morbelli S, Alloisio A. Prevention of systemic toxicity in hyperthermic isolated lung perfusion using radioisotopic leakage monitoring. Int J Hypertherm. 2007;1-10. DOI: 10.1080/02656736.2017.1355485
15. Villa G, De Cian F, Pomposelli E, et al. Continuous leakage monitoring with Sn-medronat-^99mTc-labeled RBC and hand-held gamma-probe during hyperthermic limb and lung perfusion. Il Giornale di Chirurgia. 2009;30(5 suppl.): 240-1.
16. Lipanova NN, Narkevich BYa. Evaluation of the patient and staff radiation dose at radiometric monitoring of open sources in diagnostics. Med Fizika. 2011;3(51):81-5. (Russian).
17. Orero A, Vidal-Sicart S, Roé N. Monitoring system for isolated limb perfusion based on a portable gamma camera. Nuklearmedizine. 2009;48(4): 166-72.
18. MedicalView >> Product. 3 sense. https: // www. medicalview.ea /? page_id = 31

For citation: Narkevich BYa, Shiryaev SV, Lagutina IV, Buydenok YuV, Kharatishvili TK, Petrochenko NS. Leakage Radiometric Control of Chemical Drugs with Regional Perfusion of Surgical Isolated Limbs. Medical Radiology and Radiation Safety. 2019;64(4):48–55. (Russian).

DOI: 10.12737/article_5d110f04375033.57581297

PDF (RUS) Full-text article (in Russian)

Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 4. P. 64–75

DOI: 10.12737/1024-6177-2019-64-4-64-75

O.K. Kurpeshev¹, J. Van der Zee², M. Cavagnaro³

Hyperthermia for Deep Seated Tumours – Possibilities of Heating with Capacitive Devices

1. Siberian Scientific Research Institute of Hyperthermia, Novosibirsk region, Iskitim-5, Russia;
2. Erasmus Medical Centre, University Medical Center Rotterdam, Rotterdam, Netherlands;
3. Sapienza University, Rome, Italy

O.K. Kurpeshev – PhD, MD, consultant;
J. Van der Zee – PhD, MD, member of European Society for Hyperthermic Oncology (ESHO);
M. Cavagnaro – Prof., PhD, Member of the Societies of the Institute of Electrical and Electronics Engineers (IEEE), the European Society for Hyperthermic Oncology (ESHO) and the European Association of BioElectromagnetics (EBEA)

Abstract

The review examines the general principles of capacitive electromagnetic hyperthermia (EMHT), the distribution of electromagnetic energy in various experimental models and in patients’ tumors, the design features of applicators from various capacitive hyperthermic systems and their role in achieving hyperthermic mode in tumors of deep localization. In classical capacitive EMHT, the main obstacle in achieving the required temperature in such tumors is overheating of the subcutaneous fatty tissue under the electrodes. For some capacitive hyperthermic systems, the heating of adipose tissues is enhanced due to the fact that the applicator design does not conform to certain technical requirements. In capacitive EMHT at frequencies of 8–13.56 MHz, obtaining the minimum hyperthermic mode is possible with output powers of 500–800 W, maximum – 1000–1200 W and above.

The results of the use of various hyperthermic capacitive systems in patients with malignant tumors of internal organs are analyzed.

Key words: radiation therapy, chemotherapy, thermoradiotherapy, thermochemotherapy, thermochemoradiation therapy, electromagnetic fields, hyperthermia, capacitive devices

REFERENCES

1. Berdov BA, Kurpeshev OK, Mardynsky YuS. Influence of hyperthermia and hyperglycemia on the efficacy of radiotherapy for cancer patients. Russian Oncol J. 1996;(1):12-6. (Russian).
2. Pankratov VA, Andreev VG, Rozhnov VA, et al. Simultaneous use of chemo- and radiotherapy with independent conservative and combined treatment of patients with locally advanced cancer of the larynx and the laryngopharynx. Siberian Oncol J. 2007;(1):18-22. (Russian).
3. Van der Zee J, Vujaskovic Z, Kondo M, Sugahara T. Part I. Clinical Hyperthermia. The Kadota Fund International Forum 2004 - Clinical group consensus. Int J Hyperterm. 2008;24(2):111-22.
4. Westermann A, Mella O, Van der Zee J, et al. Long-term survival data of triple modality treatment of stage IIB-III-IVA cervical cancer with the combination of radiotherapy, chemotherapy and hyperthermia – an update. Int J Hyperterm. 2012;28(6):549-53. DOI: 10.3109/02656736.2012.673047.
5. Kurpeshev OK, Mardinsky YuS, Maksimov SA. Combined treatment of patients with oral cancer using the “conditionally-dynamic” mode of fractionation of radiation therapy and locoregional hyperthermia. Siberian Medical Review. 2011;67(1):80-4. (Russian).
6. Ohguri T. Current Status of Clinical Evidence for Electromagnetic Hyperthermia on Prospective Trials. Thermal Med. 2015;31(2):5-12.
7. Van der Zee J, Van Rhoon GC. Hyperthermia with radiotherapy and with systemic therapies. In.: Breast Cancer: Innovations in Research and Management (Eds: U. Veronesi A. Goldhirsch P. Veronesi OD. Gentilini MCL). Springer Int. Publ. 2017:855-62. DOI: 10.1007/978-3-319-48848-6_75.
8. Kurpeshev OK, van der Zee J. Analysis of results of randomized studies on hyperthermia in Oncology. Medical Radiology and Radiation Safety. 2018; 63(2):52-67. (Russian). DOI: 10.12737/article_5b179d60437d54.24079640.
9. Konoplyannikov AG, Dedenkov AN, Kurpeshev OK, et al. Local hyperthermia in radiation therapy of malignant neoplasms. Scientific review. Ed. A.F. Tsyb. Series overview information in medicine and health. Moscow: The Medicine. Oncology. 1983. 72 p. (Russian).
10. Kurpeshev OK. Patterns of radiosensitizing and damaging effects of hyperthermia on normal and tumor tissues (experimental clinical study): – Author’s abstract. diss. PhD Med. Obninsk, 1989. 35 p. (Russian).
11. Kurpeshev OK. Possibilities and prospects for the use of hyperthermia in medicine. Clinical Medicine. 1996. (1):14-6. (Russian).
12. Pankratov VA, Andreev VG, Kurpeshev OK, et al. Application of thermochemical treatment in patients with locally advanced cancer of the larynx and hypopharynx. Russian Oncol J. 2006;(4):20-3. (Russian).
13. Wainson AA, Mescherikova VV, Lavrova Yu E, Mazokhin VN. The efficacy of simultaneous and sequential irradiation and hyperthermic treatment of tumor cells in vitro and transplantable tumors in vivo. Radiat Biol Radioecol. 2012;52(5):510-6. (Russian).
14. Wainson AA, Mescherikova VV, Tkachev SI. Radio-thermomodifying effect of Cisplatin, Gemzar and Paclitaxel on tumor cells in vitro. Medical Radiology and Radiation Safety. 2016; 61(2):25-9. Russian
15. Kurpeshev OK, Tsyb AF, Mardynsky YuS, Berdov BA. Mechanisms of development and ways of overcoming chemo-resistance of tumors. Part 3. Possible ways to overcome the chemoresistance of tumors. Russian Oncol J. 2003;(2):50-2. (Russian).
16. Toraya-Brown S, Sheen MR, Zhang P, et al. Local hyperthermia treatment of tumors induces CD8+ T cell-mediated resistance against distal and secondary tumors. Nanomedicine. 2014;10(6):1273-85. DOI: 10.1016/j.nano.2014.01.011.
17. Van der Heijden AG, Dewhirst MW. Effects of hyperthermia in neutralizing mechanisms of drug resistance in non-muscleinvasive bladder cancer. Int J Hyperterm. 2016;32(4):434-45.  DOI: 10.3109/02656736.2016.1155761
18. Franckena M, Fatehi D, de Bruijne M, et al. Hyperthermia dose-effect relationship in 420 patients with cervical cancer treated with combined radiotherapy and hyperthermia. Eur J Cancer. 2009; 45:1969-78. DOI: 10.1016/j.ejca.2009.03.009.
19. Dewhirst MW, Sim DA, Sapareto S, Connor WG. Importance of minimum tumor temperature in determining early and long-term responses of spontaneous canine and feline tumors to heat and radiation. Cancer Res. 1984;44(1):43-50.
20. Sherar M, Liu FF, Pintilie M, et al. Relationship between thermal dose and outcome in thermoradiotherapy treatments for superficial recurrences of breast cancer: data from a phase III trial. Int J Radiat Oncol Biol Phys. 1997;39(2):371-80.
21. Jones EL, Oleson JR, Prosnitz LR, et al. Randomized trial of hyperthermia and radiation for superficial tumors. J Clin Oncol. 2005; 23:3079-85.
22. Hand JW, Machin D, Vernon CC, Whaley JB. Analysis of thermal parameters obtained during phase III trials of hyperthermia as an adjunct to radiotherapy in the treatment of breast carcinoma. Int J Hyperterm. 1997;13(4):343-64.
23. Xia T, Sun Q, Shi X, et al. Relationship between thermal parameters and tumor response in hyperthermia combined with radiation therapy. Int J Clin Oncol. 2001; 6(3):138-42.
24. Canters RAM, Wust P, Bakker JF, Van Rhoon G. A literature survey on indicators for characterization and optimization of SAR distributions in deep hyperthermia, a plea for standardization. Int J Hyperterm. 2009;25:593-608.
25. Bruggmoser G, Bauchowitz S, Canters R, et al. Guideline for the clinical application, documentation and analysis of clinical studies for regional deep hyperthermia. Strahlenther Onkol. 2012;188(Suppl. 2):198-211. DOI: 10.1007/s00066-012-0176-2.
26. Abe M, Hiraoka M, Takahashi M.I, et al. Multi-Institutional Studies on Hyperthermia Using an 8-MHz Radiofrequency Capacitive Heating Device (Thermotron RF-8) in Combination With Radiation for Cancer Therapy. Cancer 1986;58(8):1589-95.
27. Sidi J, Jasmin C, Convert G, et al. Shortwave regional hyperthermia of the pelvis. Biomed Thermol. 1982;107:739-44.
28. Van Rhoon GC, Sowinski MJ, Van Den Berg et al. A ring capacitor applicator in hyperthermia: energy distributions in a fat-muscle layered model for different ring electrode configurations. Int J Radiat Oncol BioL Phys. 1990;18:77-85.
29. Kim KS, Hernandez D, Lee SY. Time-multiplexed two-channel capacitive radiofrequency hyperthermia with nanoparticle mediation. BioMed Eng OnLine. 2015;14:95. DOI: 10.1186/s12938-015-0090-9.
30. Brezovich I. A. Heating of subcutaneous fat in localized current field hyperthermia with external electrodes. Med Phys. 1979;6(4):352-8.
31. Brezovich I.A, Lilly M.B, Durant J.R, et al. A practical system for clinical hyperthermia radiofrequency. Int J Radiat Oncol Biol Phys.1981;7(3):423-30.
32. Yanagawa S, Sone Y, Doi H, Yamamoto G. A new procedure for the prevention of surface overheating in deep hyperthermia using RF capacitive heating equipment. Jpn J Hyperterm Oncol. 1985;1:187-91.
33. Van Rhoon GC, Van der Zee J, Broekmeyer-Reurink MP, et al. Radiofrequency capacitive heating of deep-seated tumours using pre-cooling of the subcutaneous tissues: results on thermometry in Dutch patients. Int J Hyperterm. 1992; 8:843-54.
34. Kato H, Hiraoka M, Nakajima T, Ishida T. Deep heating characteristics of an RF capacitive heating device. Int J Hyperterm. 1985;1:15-28.
35. Rhee JG, Lee CKK, Osborn J, et al. Precooling prevents overheating of subcutaneous fat in the use of RF capacitive heating. Int J Radiat Oncol Biol Phis. 1991;20(5):1009-15. DOI:  10.1016/0360-3016(91)90198-D.
36. Kumagae K, Saito К. Air Gap Filler Material for Hot Spot Reduction in the Capacitive Heating Device. Thermal Med. 2016;32(2):5-11.
37. Tanaka H, Kato H, Nishida T, et al. Physical basis of RF hyperthermia for cancer therapy (2). Measurement of distribution of absorbed power from radiofrequency exposure in agar phantom. J Radiat Res. 1981;22:101-8.
38. Lee CКК, Song CW, Rhee JG, Levitt SH. Clinical Experience with Thermotron RF-8 Capacitive Heating for Bulky Tumors: University of minnesota Experience. Radiol Clin of North America. 1989;27(3):543-58.
39. Chen C-C, Kiang J-F. Efficacy of Magnetic and Capacitive Hyperthermia on Hepatocellular Carcinoma. Progress Electromagn Res. 2018;64:181-92.
40. Frija E, Cavagnaro M. А comparison between radiative and capacitive systems in deep hyperthermia treatments. 31st An Meet of the Eur Soc for Hyperterm Oncol. Greece, Athens, 21-23 June 2017:62-3. OP-07.
41. Beck M, Chrozon B, Lim A, et al. SAR profiles generated with a capacitive hyperthermia system in a porcine phantom. Strahlenther Onkol. 2018;194:493-4.
42. Kok HP, Navarro F, Strigari L, et al. Locoregional hyperthermia of deep-seated tumors applied with capacitive and radiative systems: a simulation study. Int J Hyperterm. 2018.  DOI: 10.1080/02656736.2018.1448119
43. Lopatin VF. Method of local UHF hyperthermia.  Med Fizika. 2011;(4):85-95. (Russian).
44. Seong J, Lee HS, Han KH, et al. Combined treatment of radiotherapy and hyperthermia for unresectable hepatocellular carcinoma. Yonsei Medical J. 1994;35(3):252-9.
45. Kim SW, Yea JW, Kim· JH. et al. Selecting patients for hyperthermia combined with preoperative chemoradiotherapy for locally advanced rectal cancer. Int J Clin Oncol. 2018;23(2);287-97. DOI: 10.1007/s10147-017-1213-z.
46. Lee S-Y, Kim J-H, Han Y-H, Cho D-H. The effect of modulated electro-hyperthermia on temperature and blood flow in human cervical carcinoma. Int J Hyperterm. 2018.  DOI: 10.1080/02656736.2018.1423709
47. Rusakov SV, Sas A, Sas O, Sas N. A method for the treatment of solid malignant tumors by the method of Oncothermia (medical technology). Moscow. 2011:96 p. (Russian).
48. Noh JM, Kim HY, Park HC, et al. In vivo verification of regional hyperthermia in the liver. Radiat Oncol J. 2014;32(4):256-61.
49. Yu JI, Park HC, Choi DH. Prospective phase II trial of regional hyperthermia and whole liver irradiation for numerous chemorefractory liver metastases from colorectal cancer. Radiat Oncol J. 2016;34(1):34-44. DOI: 10.3857/roj.2016.34.1.34.
50. Park JS, Park HC, Choi DH, et al. Prognostic and predictive value of liver volume in colorectal cancer patients with unresectable liver metastases. Radiat Oncol J. 2014;32(2):77-83.
51. Yeo SG, Kim DY, Kim TH, et al. Whole-liver radiotherapy for end-stage colorectal cancer patients with massive liver metastases and advanced hepatic dysfunction. Radiat Oncol. 2010;5:97.
52. Borgelt BB, Gelber R, Brady LW, Griffin T, Hendrickson FR. The palliation of hepatic metastases: results of the Radiation Therapy Oncology Group pilot study. Int J Radiat Oncol Biol Phys. 1981;7(5):587-91.
53. Ohguri T, Imada H, Yahara K, et al. Radiotherapy with 8-MHz radiofrequency-capacitive regional hyperthermia for stage III non–small-cell lung cancer: the radiofrequency-output power correlates with the intraesophageal temperature and clinical outcomes. Int J Radiat Oncol Biol Phys. 2009;73(1):128-35. DOI: 10.1016/j.ijrobp.2008.03.059.
54. Harima Y, Nagata K, Harima K, et al. A randomized clinical trial of radiation therapy versus thermoradiotherapy in stage IIIB cervical carcinoma. Int J Hyperterm. 2001;17(2):97-105. DOI: 10.1080/02656730010001333.
55. Harima Y, Ohguri T, Imada H, et al. A multicentre randomised clinical trial of chemoradiotherapy plus hyperthermia versus chemoradiotherapy alone in patients with locally advanced cervical cancer. Int J Hyperterm. 2016;32(7):801-8.
56. Gordeev SS. Master class on the use of local hyperthermia in patients with rectal cancer in Krasnodar. Onkol Coloproctology J. 2013; 3(2):9-10. (Russian).
57. Startseva JA, Choynzonov ET. Local hyperthermia in the combined treatment of patients with malignant neoplasms. Russian Cancer J. 2015;(4):47-8. (Russian). http://www.studmedlib.ru/ru/doc/1028-99844-SCN0030.html
58. Hiraoka M, Jo S, Akuta K. Radiofrequency capacitive hyperthermia for deep-seated tumors. I. Studies on thermometry. Cancer. 1987; (60):121-7.
59. Hiraoka M, Jo S, Akuta K, et al. Radiofrequency capacitive hyperthermia for deep-seated tumors II. Effects of thermoradiotherapy. Cancer. 1987;60:128-35.
60. Vasanthan A, Mitsumori M, Park JH, et al. Regional hyperthermia combined with radiotherapy for uterine cervical cancers: a multi-institutional prospective randomized trial of the international atomic energy agency. Int J Radiat Oncol Biol Phys. 2005;61(1):145-53.
61. Konishi F, Furuta K, Kanazawa K, et al. The effect of hyperthermia in the preoperative combined treatment of radiation, hyperthermia and chemotherapy for rectal carcinoma. Jpn J Gastroenterol Surg. 1994;(27):789-796.
62. Yoshida M, Shioura H, Tomi M, et al. Multimodal combination therapy including hyperthermia for inoperable pancreatic cancer. Proc 7th Int Cong Hypertherm Oncol. Rome. 1996;2:38-9.
63. Nagata Y, Hiraoka M, Akuta K, et al. Radiofrequency thermotherapy for malignant liver tumors. Cancer. 1990; 65(8):1730-6.
64. Nagata Y, Hiraoka M, Nishimura Y, et al. Clinical results of radiofrequency hyperthermia for malignant liver tumors. Int J Radiat Oncol Biol Phys. 1997;38(2):359-5.
65. Hamazoe R, Maeta M, Murakami A, et al. Heating efficiency of radiofrequency capacitive hyperthermia for treatment of deep-seated tumors in the peritoneal cavity. J Surg Oncol.1991;48:176-9.
66. Nakajima K, Hisazumi H, Yamamoto H, et al. A study of regional temperature rise in bladder cancer patients during RF-hyperthermia. Jpn J Hyperterm Oncol. 1986(2):43-8.
67. Nakajima K, Hisazumi H. Studies of temperature rise in subcutaneous fat tissue during RF-hyperthermia. Jpn J Hyperterm Oncol. 1987;(3):87-91.
68. Kubota Y, Sakai N, Watai K, et al. Hyperthermia by regional capacitive heating. In: Hyperthermic oncology. 1988, Vol. 2. Sugahara T, Saito M. (Eds.). Taylor & Francis, London, 1989, 605-8.
69. Masunaga S-I, Hiraoka M, Akuta K. Non-randomized trials of thermoradiotherapy versus radiotherapy for preoperative treatment of invasive urinary bladder cancer. J Jpn Soc Ther Radiol Oncol. 1990;2:313-20.
70. Lee CK, Song CW, Rhee JG, et al. Clinical experience using 8 MHz radiofrequency capacitive hyperthermia in combination with radiotherapy: results of a phase I/II study. Int J Radiat Oncol Biol Phys. 1995;32(3):733-45. DOI: 10.1016/0360-3016(94)00608-N.

For citation: Kurpeshev OK, Van der Zee J, Cavagnaro M. Hyperthermia for Deep Seated Tumours – Possibilities of Heating with Capacitive Devices. Medical Radiology and Radiation Safety. 2019;64(4):64–75. (English and Russian).

DOI: 10.12737/1024-6177-2019-64-4-64-75

PDF (RUS) Full-text article (in Russian)

PDF (ENG) Full-text article (in English)

Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 4. P. 56–63

DOI: 10.12737/article_5d1b46c9133942.84705406

Е.S. Sukhikh^1,2, L.G. Sukhikh², E.L. Malikov², P.V. Izhevsky³, I.N. Sheino³, A.V. Vertinsky^1,2, A.A. Baulin^2,4

Uncertainty of Measurement Absorbed Dose by Gafchromic EBT3 Dosimeter for Clinical Electron and Photon Beams of Medical Accelerators

1. Tomsk Regional Oncology Centre, Tomsk, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. National Research Tomsk Polytechnic University, Tomsk, Russia;
3. A.I. Burnasyan Federal Medical Biophysical Center, Moscow, Russia;
4. Gamma Clinic High-Precision Radiology Centre (Gamma Medtechnology Ltd)., Obninsk, Russia

Е.S. Sukhikh – Head of Department, Assistant Professor, PhD Phys.-Math., Member of ESTRO, Member of EFOMP, Member of ISRS;
L.G. Sukhikh – Director of Research School of Physics, Dr. Sci. Phys-Math.;
E.L. Malikov – Researcher;
P.V. Izhevsky – Leading Researcher, Assistant Professor, PhD Med.;
I.N. Sheino – Head of the Lab., PhD Phys-Math.;
A.V. Vertinsky – Medical Physicist, PhD student;
A.A. Baulin – Medical Physicist, PhD student, Member of ISRS

Abstract

Purpose: Investigation of the relative errors of absorbed dose measurement based on polymer films Gafchromic EBT3 for clinical electron and photon beams of medical accelerators.

Material and methods: Polymer Gafchromic EBT3 films were calibrated using different radiation beams, namely photon and electron beams of Elekta Axesse medical accelerator with beam energy equal to 10 MV and 10 MeV, correspondingly, and electron beam of a betatron for intraoperative radiotherapy with beam energy equal to 6 MeV. The film pieces were irradiated by the uniform dose field in the dose range from 0.5 to 40 Gy. The dose value was controlled by cylindrical ionization chamber on Elekta Axesse accelerator and by the Markus parallel-plate ionization chamber on betatron. The irradiated films were scanned using Epson Perfection V750 Pro flatbed scanner in 16 bit RGB color mode with 150 dpi resolution. The red and green channels were used for further analysis. The central part of each film was used for calculation of average values of net optical density and its root-mean-square. As a result, the calibration curves, i.e. dependence on the reference absorbed dose measured by ionization chamber on the net optical density were constructed taking into account uncertainties of dose measurement and optical density measurement.

Results: The relative uncertainty for the dose measurement lies within 7 % for low doses (less than 1 Gy) and within 4 % for higher doses. The green channel is less sensitive to the radiation, but its relative uncertainty values are in general 1–2 % lower than the ones for the red channel. The use of different calibration sources results in different calibration curves with difference up to ± 6 % for the green channel.

Conclusion: The polymer Gafchromic EBT3 films can be used for absorbed dose measurement for the doses not less than 0.5 Gy. For lower dose values the dose measurement uncertainty caused by statistical reasons amounts 15 %. For dose values of about 1 Gy and higher the dose measurement uncertainty amounts 5 % that allows to use the films for transverse and longitudinal prescription treatment dose distribution measurement with very high spatial resolution.

Key words: radiation therapy, Gafchromic EBT3 film, clinical dosimetry, medical accelerators, absorbed dose, uncertainties

REFERENCES

1. Syed YA, Petel-Yadav AK, Rivers C, Singh AK. Stereotactic radiotherapy for prostate cancer: A review and future directions. World J Clin Oncol. 2017;8(5):389-97. DOI: 10.5306/wjco.v8.i5.389.
2. Diot Q, Kavanagh B, Timmerman R, Miften M. Biological-based optimization and volumetric modulated arc therapy delivery for stereotactic body radiation therapy. Med Phys. 2012;39(1):237-45. DOI: 10.1118/1.3668059.
3. Fiorentino A, Giaj-Levra N, Tebano U, et al. Stereotactic ablative radiation therapy for brain metastases with volumetric modulated arc therapy and flattening filter free delivery: feasibility and early clinical results. Radiol Med. 2017;122(9):676-82. DOI: 10.1007/s11547-017-0768-0.
4. Gafchromic. Gafchromic EBT3 film specifications. [Internet]. 2017 [cited 2019 Feb. 20]. Available from: http://www.gafchromic.com/documents/EBT3_Specifications.pdf.
5. Andreo P, Burns D, Hohlfeld K, et al. Absorbed dose determination in external beam radiotherapy: An international code of practice for dosimetry based on standards of absorbed dose to water. Technical Report Series no. 398. IAEA. 2000:251.
6. Almond P, Biggs P, Coursey B, et al. AAPM’s TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams. Med. Phys. 1999;26(9):1847-70.
7. Sorriaux J, Kacperek A, Rossomme S, et al. Evaluation of gafchromic ebt3 films characteristics in therapy photon, electron and proton beams. Physica Medica. 2013;29.Suppl.6:599-606. DOI: 10.1016/j.ejmp.2012.10.001.
8. Hartmann B. Martisikova M, Jakel O. Technical note: Homogeneity of Gafchromic EBT2 film. Med Phys. 2010;37.Suppl.4:1753-6. DOI: 10.1118/1.3368601.
9. Niewald M, Fleckenstein J, Licht N, et al. Intraoperative radiotherapy (IORT) combined with external beam radiotherapy (EBRT) for soft-tissue sarcomas – a retrospective evaluation of the homburg experience in the years 1995-2007. Radiat Oncol. 2009;4. Suppl.32:1-6. DOI: 10.1186/1748-717X-4-32.
10. Niroomand-Rad A, Blackwell C, Coursey B, et al. Radiochromic film dosimetry: Recommendations of AAPM radiation therapy committee task group 55. Med Phys. 1998;25. Suppl.11:2093-115. DOI: 10.1118/1.598407.
11. Devic S, Seuntjens J, Hegyi G, et al. Dosimetric properties of improved gafchromic films for seven dierent digitizers. Med Phys. 2004;31. Suppl.9:2392-401. DOI: 10.1118/1.1776691.
12. Butson M, Yu P, Cheung T, Alnawaf H. Energy response of the new EBT2 radiochromic film to x-ray radiation. Radiat Measur. 2010;45. Suppl.7:836-9. DOI: 10.1016/j.radmeas.2010.02.016.
13. Micke A, Lewis D, Yu X. Multichannel film dosimetry with nonuniformity correction. Med Phys. 2011;38. Suppl.5:2523-34. DOI: 10.1118/1.3576105.
14. Devic S. Radiochromic film dosimetry: Past, present, and future. Physica Medica. 2011;27. Suppl.3:122-34. DOI: 10.1016/j.ejmp.2010.10.001.
15. Soares C. Radiochromic film dosimetry. Radiat Measur. 2006;41. Suppl.1:S100-S116.
16. Reinhardt S, Hillbrand M, Wilkens J, Assmann W. Comparison of gafchromic EBT2 and EBT3 films for clinical photon and proton beams. Med Phys. 2012;39 Suppl.8:5257-62. DOI: 10.1118/1.4737890.
17. Wolfram. [Internet]. 2019. [cited 2019, Feb. 20]. Available from: https://www.wolfram.com/mathematica.
18. IBA. Description of dosimetric system iba matrix. [Internet]. 2019. [cited 2019, Feb. 20]. Available from: http://www.iba-dosimetry.com/complete-solutions/radiotherapy/imrt-igrt-rotational-qa/matrixxes.
19. IBA, Description of clinical dosimeter dose-1. [Internet]. 2017. [cited 2019, Feb. 20]. Available from: http://www.iba-dosimetry.com/sites/default/files/resources/RT-BR-E-DOSE1_Rev.1_0211_0.pdf.
20. PTW, Description of dosimeter ptw unidos E. [Internet]. 2017. [cited 2019, February 20]. Available from: http://www.ptw.de/unidos_e_dosemeter_ad0.html.
21. PTW, Description of electron cionization chamber PTW23343. [Internet]. 2017. [cited 2019, Feb. 20]. Available from: http://www.ptw.de/advanced_markus_electron_chamber.html.
22. PTW, Description of solid state phantom ptw rw3 SLAP phantom T29672. [Internet] 2017. [cited 2019, February 20]. Available from: http://www.ptw.de/acrylic_and_rw3_slab_phantoms0.html.
23. Epson, Technical characteristics of EPSON Perfection V750 scanner. [Internet]. 2017. [cited 2019, Feb. 20]. Available from: http://epson.ru/catalog/scanners/epson-perfection-v750-pro/?page=characteristics.

For citation: Sukhikh ЕS, Sukhikh LG, Malikov EL, Izhevsky PV, Sheino IN, Vertinsky AV, Baulin AA. Uncertainty of Measurement Absorbed Dose by Gafchromic EBT3 Dosimeter for Clinical Electron and Photon Beams of Medical Accelerators. Medical Radiology and Radiation Safety. 2019;64(4):56–63. (English and Russian).

DOI: 10.12737/article_5d1b46c9133942.84705406

PDF (RUS) Full-text article (in Russian)

PDF (ENG) Full-text article (in English)

Medical Radiology and Radiation Safety. 2019. Vol. 64. No. 4. P. 76–88

DOI: 10.12737/1024-6177-2019-64-4-76-88

A.D. Ryzhkov¹, A.S. Krylov¹, G.N. Machak², S.M. Kaspshik¹, A.B. Bludov¹, Y.A. Shchipakhina¹, N.V. Kochergina¹

Monitoring the Therapy of Osteosarcoma Metastases with SPECT/CT

1. N.N. Blokhin National Medical Research Center, Moscow, Russia. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ;
2. Central Research Institute of Traumatology and Orthopaedicsof N.N. Priorov, Moscow, Russia

A.D. Ryzhkov – Leading Researcher, Dr. Sci. Med.;
A.S. Krylov – Radiologist, PhD Med.;
G.N. Machak – Dr. Sci. Med., Member of EMSOS;
S.M. Kaspshik – Clinical Intern;
А.B. Bludov – Researcher, PhD Med;
Y.A. Shchipakhina – Researcher, PhD Med.;
N.V. Kochergina – Leading Researcher, Dr. Sci. Med., Prof.

Abstract

A 43-year-old man presented with a history of osteogenic sarcoma of lower third of the right femur bone. In dynamic monitoring (2011–2018) in the Nuclear Medicine Department of N.N. Blokhin National Medical Research Centre of oncology, Moscow, Russia a total of 48 radionuclide diagnostic studies were performed: 24 bone scans, 19 SPECT/CT (areas of interest) and 5 dynamic scintigraphies. The results of radionuclide diagnostics allowed to identify 6 episodes of progression of the underlying condition earlier than X-ray methods of imaging in the form of appearance of new metastases in bones, right lung and continued growth of some previously identified metastases in different periods of observation. Time between relapse detection and treatment ranged from 1 to 12 months. First of all it was because of the clinicians distrust to the results of radionuclide studies that were not confirmed by X-Ray at early stages. During the relapse treatment process patient received standard and innovative therapies: 10 courses of polychemotherapy, two surgeries for endoprosthesis replacement of the right knee and femur, upper lobectomy of the right lung, radiation therapy for metastasis in the left iliac bone (total boost dose – 52 Gy), radiation therapy on the CyberKnife device on metastases in the head of the 7th right rib and metastasis in the right lung, 2 sessions of ultrasonic thermal ablation on the HIFU in the area of metastases in the neck of the right femur, 5 courses of bisphosphonates. The method of hybrid imaging of SPECT/CT allowed us to reliably monitor the effectiveness of the therapy. Postradiation changes in osteosarcoma metastases consisted in a decrease bone (pathological) metabolism, while radio-intensity indices did not change. For the first time we observed the effect of ultrasonic thermal ablation in the treatment of bone metastases. The effect of the treatment manifested very quickly and we visualized it as a defect of accumulation of radiopharmaceutical, which is a consequence of damage to the tumor vessels and tissue necrosis. In the observation of osteosarcoma recurrence SPECT with osteotropic radiopharmaceuticals demonstrates advantages over PET with ¹⁸F-FDG. Bone scan and SPECT/CT have proven to be reliable methods of dynamic control of a patient with osteosarcoma.

Key words: SPECT/CT, bone scan, osteosarcoma, CyberKnife, HIFU

REFERENCES

1. Krzhivitsky PI, Kanaev SV, Novikov SN,  Zhukova LA, Ponomareva OI, Negustorov YuF. SPECT-CT in the diagnosis of metastatic skeletal lesion. Problems in Oncology. 2014;60(1):56-63. (Russian).
2. Ryzhkov AD, Ivanov SM, Shiryaev SV, Krylov AS, Stanyakina EE, Kochergina NV, et al. SPECT/CT radiation in treatment of bone metastases of osteosarcoma. Problems in Oncology. 2016; 62(5):654-9. (Russian).
3. Ryzhkov AD, Shiryaev SV, Machak GN, Kochergina NV, ShchipakhinaYaA, Krylov AS, et al. SPECT/CT in Treatment Monitoring of  Bone Metastases of Osteosarcoma with Ultrasound Thermal Ablation Method. Medical Radiology and Radiation Safety. 2016;61(5):54-8. (Russian).
4. Mebarki M, Medjahedi A, Menemani A, Betterki S, Terki S, Berber N. Osteosarcoma pulmonary metastasis mimicking abnormal skeletal uptake in bone scan: utility of SPECT/CT. Clin Nucl Med. 2013;38(10):392-4. DOI: 10.1097/RLU.0b013e318266cdcb.
5. TerHaar G. HIFU Tissue Ablation: Concept and Devices. Adv Exp Med Biol. 2016;880:3-20. DOI: 10.1007/978-3-319-22536-4_1.
6. Nasarenko AV, Ter-Arutyunyants SA Stereotactic radiation  therapy (SRT) in the treatment of primary and metastatic bonelesions. Bone and Soft Tissue Sarcomas, Tumors of the Skin. 2016(1):36-44. (Russian).

For citation: Ryzhkov AD, Krylov AS, Machak GN, Kaspshik SM, Bludov AB, Shchipakhina YA, Kochergina NV. Monitoring the Therapy of Osteosarcoma Metastases with SPECT/CT. Medical Radiology and Radiation Safety. 2019;64(4):76–88. (English and Russian).

DOI: 10.12737/1024-6177-2019-64-4-76-88

PDF (RUS) Full-text article (in Russian)

PDF (ENG) Full-text article (in English)