Implant strategies for endocervical and interstitial ultrasound hyperthermia adjunct to HDR brachytherapy for the treatment of cervical cancer.
Implant strategies for endocervical and interstitial ultrasound hyperthermia adjunct to HDR brachytherapy for the treatment of cervical cancer.
复制标题
子宫颈内和间质超声热疗辅助 HDR 近距离放射治疗宫颈癌的植入策略。
DOI：
10.1088/0031-9155/56/13/014
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发表时间：
2011
影响因子：
3.5
通讯作者：
Diederich,ChrisJ
中科院分区：
文献类型：
--
作者：
Wootton,JefferyH;Prakash,Punit;Hsu,I-ChowJoe;Diederich,ChrisJ
基于导管的超声设备提供了一种与 HDR 近距离放射治疗相结合的 3D 舒适加热方法。对加热模式的理论表征是为了确定这些设备的植入策略，这些策略最适合用于对宫颈癌进行热疗。使用基于约束优化的热疗计划平台进行分析。热疗治疗体积中组织比例≥ 41 C 最大化，约束条件为 T max ≤ 47 C、T 直肠≤ 41.5 C 和 T 膀胱≤ 42.5 C。热疗治疗根据接受 HDR 近距离放射治疗的患者 (n = 14) 数据库中的一般植入物配置和复杂配置进行建模。对来自近距离治疗植入物的导管位置内的宫颈管（360 或 2× 180 输出；6 mm OD）和间质（180、270 或 360 输出；2.4 mm OD）施源器的各种组合进行建模，灌注常数（1 或 3 kg m−3 s−1）或随位置或温度而变化。设备定位、分区、有效长度和瞄准均根据经验进行了优化，以最大限度地提高热覆盖范围。使用多个扇形间质和宫颈内超声设备可以对相当大的体积（> 200 cm 3）进行适形加热。宫颈内膜装置可将直径加热至 4.6 厘米（大于 41°C），而间质直径为 3.6 厘米。扇形涂抹器可对加热进行严格控制，在大多数规则间隔配置中对灌注变化具有鲁棒性。示例患者病例中的 T 90 在 1 kg m− 3 s− 1 时为 40.5–42.7 C (1.9–39.6 EM 43 C)，其中 10/14 名患者≥ 41 C。提出了在初始手术期间植入导管的定位、超声探头配置的选择以及在临床实际植入配置中实现 T 90≥ 41 C 的定制电源方案的指南。基于导管的超声设备，在遵守指南的情况下，显示出产生适形治疗加热的潜力，范围从针对子宫颈局部小体积（< 2 cm 径向）的单个子宫颈管设备到侧周的 2× 180 子宫颈管和定向间质施用器的组合，以针对更大的体积（6 cm 径向），同时优先限制 加热膀胱和直肠。
Catheter-based ultrasound devices provide a method to deliver 3D conformable heating integrated with HDR brachytherapy delivery. Theoretical characterization of heating patterns was performed to identify implant strategies for these devices which can best be used to apply hyperthermia to cervical cancer. A constrained optimization-based hyperthermia treatment planning platform was used for the analysis. The proportion of tissue⩾ 41 C in a hyperthermia treatment volume was maximized with constraints T max⩽ 47 C, T rectum⩽ 41.5 C, and T bladder⩽ 42.5 C. Hyperthermia treatment was modeled for generalized implant configurations and complex configurations from a database of patients (n= 14) treated with HDR brachytherapy. Various combinations of endocervical (360 or 2× 180 output; 6 mm OD) and interstitial (180, 270, or 360 output; 2.4 mm OD) applicators within catheter locations from brachytherapy implants were modeled, with perfusion constant (1 or 3 kg m− 3 s− 1) or varying with location or temperature. Device positioning, sectoring, active length and aiming were empirically optimized to maximize thermal coverage. Conformable heating of appreciable volumes (> 200 cm 3) is possible using multiple sectored interstitial and endocervical ultrasound devices. The endocervical device can heat> 41 C to 4.6 cm diameter compared to 3.6 cm for the interstitial. Sectored applicators afford tight control of heating that is robust to perfusion changes in most regularly spaced configurations. T 90 in example patient cases was 40.5–42.7 C (1.9–39.6 EM 43 C) at 1 kg m− 3 s− 1 with 10/14 patients⩾ 41 C. Guidelines are presented for positioning of implant catheters during the initial surgery, selection of ultrasound applicator configurations, and tailored power schemes for achieving T 90⩾ 41 C in clinically practical implant configurations. Catheter-based ultrasound devices, when adhering to the guidelines, show potential to generate conformal therapeutic heating ranging from a single endocervical device targeting small volumes local to the cervix (< 2 cm radial) to a combination of a 2× 180 endocervical and directional interstitial applicators in the lateral periphery to target much larger volumes (6 cm radial), while preferentially limiting heating of the bladder and rectum.