Implementation of treatment planning in the routine clinical procedure of regional hyperthermia treatment of cervical cancer: an overview and the Rotterdam experience.
OBJECTIVE
This manuscript provides an overview in the field of hyperthermia treatment planning (HTP) in cervical cancer. Treatment planning techniques: The workflow of an HTP assisted treatment generally consists of patient imaging, tissue segmentation, model generation, electromagnetic (EM) and thermal calculations, optimisation, and clinical implementation. A main role in HTP is played by numerical simulations, for which currently a number of software packages are available in hyperthermia. To implement these simulations, accurate applicator models and accurate knowledge of dielectric and thermal parameters is mandatory. Model validation is necessary to check if this is implemented well. In the translation from HTP models to the clinic, the main aspect is accurate representation of the actual treatment situation in the HTP models. Accurate patient positioning and organ-specific segmentation can be helpful in minimising the differences between model and clinic.
In the clinic, different approaches are possible: simple, i.e. target centre point (TCP) steering, often called 'target steering', or only pretreatment planning versus advanced, i.e. active HTP guided steering or image guided hyperthermia by non-invasive thermometry (NIT). The Rotterdam experience: To illustrate the implementation of HTP guided steering, the Rotterdam approach of complaint adaptive steering is elaborated, in which optimisation is adapted with increased constraints on tissues with heat-induced discomfort.


CONCLUSIONS
Many publications on HTP show that HTP can be considered a feasible method to optimise and control a hyperthermia treatment, with the objective to enhance treatment quality and documentation. Ultimately, after overcoming the various uncertainties, this may lead to dose prescription.
Department of Radiation Oncology, Daniel den Hoed Cancer Centre, Erasmus Medical Centre, Rotterdam, The Netherlands. r.canters@erasmusmc.nl
Richard A M
RA
Canters
Margarethus M
MM
Paulides
Martine F
MF
Franckena
Jacoba
J
van der Zee
Gerard C
GC
van Rhoon
D003198:Computer Simulation; D055590:Electromagnetic Phenomena; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D008953:Models, Anatomic; D010347:Patient Care Planning; D013813:Therapy, Computer-Assisted / Q000379:methods; D062125:Thermometry; D002583:Uterine Cervical Neoplasms / Q000628:therapy*