Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
1.
BJU Int ; 93(1): 36-41, 2004 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-14678364

RESUMEN

OBJECTIVE: To report an interim clinical evaluation of combined external beam irradiation (EBRT) and interstitial or regional hyperthermia in the treatment of locally advanced prostate cancer. PATIENTS AND METHODS: From 1997 to 2001, 26 patients with T3-4/NX/0M0 prostate carcinoma were treated with a combination of conformal EBRT and hyperthermia. Fourteen patients received five weekly regional hyperthermia treatments within an optimization (phase II) study, using the coaxial transverse electrical magnetic system. Twelve patients received one interstitial hyperthermia treatment within a feasibility study (phase I), using the multi-electrode current source system. Irradiation was delivered using a conformal three-field technique, administering 70 Gy in 2-Gy fractions in 7 weeks. RESULTS: The mean initial prostate-specific antigen level was 26 ng/mL. Three patients had a T4 and 23 a T3 tumour; the tumours were classified as well (four), moderately (16) and poorly (six) differentiated. The mean follow-up was 36 months. In the combined treatments there was no toxicity of more than grade 2. In regional hyperthermia the mean index temperature (T90 and T50, i.e. exceeded by 90% and 50% of the measurements) was 40.2 degrees C and 40.8 degrees C, and for interstitial hyperthermia 39.4 degrees C and 41.8 degrees C, respectively. All patients survived; seven patients had a biochemical relapse (27%), three in the regional and four in the interstitial group. The actuarial probability of freedom from biochemical relapse was 70% at 36 months for all patients together, 79% for regional and 57% for interstitial. No factors were found that could be used to predict relapse. CONCLUSIONS: The clinical outcome in these patients with advanced localized prostate cancer seems to compare favourably with most series using irradiation alone, and the treatment caused no severe complications.


Asunto(s)
Hipertermia Inducida/métodos , Neoplasias de la Próstata/terapia , Anciano , Terapia Combinada/métodos , Supervivencia sin Enfermedad , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Hipertermia Inducida/efectos adversos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/radioterapia , Resultado del Tratamiento
2.
Int J Hyperthermia ; 19(5): 481-97, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12944164

RESUMEN

A study was performed on regional hyperthermia for patients with locally advanced prostate carcinoma. The primary objective was to analyse the thermometry data with an emphasis on the possibility of replacing invasive thermometry by tumour-related intra-luminal thermometry. Fourteen patients were treated with a combination of conformal external beam radiotherapy (70 Gy) and hyperthermia. Hyperthermia was delivered using the Coaxial TEM system, one treatment per week, to a total of five treatments. Thermometry was performed in bladder, urethra, rectum and esophagus. Invasive thermometry in the prostate was carried out during one or two treatments for each patient by placing transperineally a central and a peripheral catheter. Heterogeneous temperature distributions were measured in the prostate. The mean average invasive temperature range was 1.1 degrees C. Due to the temperature heterogeneity and a limited number of thermometry sensors (mean 7, range 2-13), large variability between treatments and patients existed regarding achieved temperatures and dose. The mean invasive T90 was 40.2 +/- 0.6 degrees C and T50 was 40.8 +/- 0.6 degrees C. The mean Cum min T90>40.5 degrees C per treatment was 22 (range 0-50). Importantly, intra-luminal temperatures did not reliably predict invasively measured temperatures. Invasive thermometry, therefore, remains compulsory to calculate a thermal dose for an individual patient. Changes in temperature during treatment, measured by the urethral sensors, corresponded well with changes in temperature measured by the individual invasive sensors. Similar comparison of rectal temperature changes with intra-prostatic temperature changes was not as predictive. The similarity in temperature changes between the urethral and interstial sites, suggests that urethral temperatures are sufficient for treatment optimization. The SAR profile did not correspond with the temperature profile indicating heterogeneous perfusion. Although regional hyperthermia in combination with external beam radiotherapy for locally advanced prostate carcinoma is clinically feasible, the question on the importance of invasive thermometry remains.


Asunto(s)
Hipertermia Inducida/métodos , Neoplasias de la Próstata/radioterapia , Radioterapia Conformacional , Termómetros , Anciano , Temperatura Corporal , Terapia Combinada , Esófago , Estudios de Factibilidad , Calor , Humanos , Masculino , Persona de Mediana Edad , Recto , Uretra
3.
Int J Hyperthermia ; 19(4): 402-13, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12850926

RESUMEN

INTRODUCTION: The aim of this prospective study was to describe quality of life (QoL) in patients with locally advanced prostate carcinoma treated with conventional radiotherapy and to evaluate the influence of adding regional or interstitial hyperthermia. MATERIALS AND METHODS: All patients were irradiated using a CT-planned conventional three field technique, administering 70 Gy to prostate and vesicles. In two different phase I studies, hyperthermia was added to the radiotherapy. Twelve patients were treated with one interstitial hyperthermia treatment, lasting 60 min. Fourteen patients have been treated with five regional hyperthermia treatments, lasting 75 min each. In both hyperthermia studies, the body, bladder and rectum temperatures remained below safety limits. Patients treated with radiotherapy alone (n = 58) or combined with regional (n = 8) or interstitial hyperthermia (n = 12) completed the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (C30 + 3), the EORTC prostate cancer module (PR25) and the Rand 36 health survey before treatment and 1 and 6 months after completion of treatment. Analysis of Variance (ANOVA) for repeated measurements has been performed to describe the data. RESULTS: All patient groups were comparable concerning patient characteristics. No significant interaction or difference in QoL has been noticed between the two hyperthermia patient groups and the patient group without hyperthermia. Therefore, all groups were analysed together (n = 78) to detect QoL changes in time. A deterioration of QoL has been measured from baseline to 1 month after treatment. Fatigue, pain, urinary symptoms, bowel symptoms and financial difficulties increased significantly. Social, physical and role functioning worsened significantly. No differences in QoL were measured 6 months after treatment compared to the baseline measurement, except for a decrease in sexual activity. CONCLUSIONS: After radiotherapy with or without hyperthermia only a temporary deterioration of QoL occurs, concerning social, psychological and disease related symptoms. Additional hyperthermia does not seem to decrease QoL.


Asunto(s)
Hipertermia Inducida , Neoplasias de la Próstata/fisiopatología , Neoplasias de la Próstata/terapia , Calidad de Vida , Radioterapia , Anciano , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/psicología , Encuestas y Cuestionarios
4.
Phys Med Biol ; 46(12): 3115-31, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11768495

RESUMEN

To determine the thermal dose of a hyperthermia treatment, knowledge of the three-dimensional (3D) temperature distribution is mandatory. The aim of this paper is to validate an interstitial hyperthermia treatment planning system with which the full 3D temperature distribution can be obtained in individual patients. Within a phase I study, 12 patients with prostate cancer were treated with interstitial hyperthermia using our multi electrode current source interstitial hyperthermia treatment (MECS IHT) system. The temperature distribution was measured from within the heating devices and by additional thermometry. The perfusion level was estimated and the heating implant reconstructed. The steady-state temperature distribution was calculated using our interstitial hyperthermia treatment planning system. The simulated temperature distribution was validated by individually comparing the measured and simulated thermo-sensors, both for the thermometry integrated with the heating applicators and the additional thermometry. The entire procedure was also performed on a no-flow agar-agar phantom. It was shown that the calculated temperature distribution of an individual patient during MECS interstitial hyperthermia is very heterogeneous. The validation indicates that the calculated temperature elevations match the measurements within approximately 1 degrees C. Possible improvements are more precise reconstruction, incorporation of discrete vasculature and using a temperature-dependent, heterogeneous perfusion distribution. Further technical improvements of the MECS-IHT system may also result in better temperature calculations.


Asunto(s)
Carcinoma/terapia , Hipertermia Inducida/métodos , Neoplasias de la Próstata/terapia , Agar/química , Calibración , Electrodos , Humanos , Masculino , Fantasmas de Imagen , Reproducibilidad de los Resultados , Temperatura , Factores de Tiempo
5.
Ned Tijdschr Geneeskd ; 142(20): 1146-51, 1998 May 16.
Artículo en Holandés | MEDLINE | ID: mdl-9623237

RESUMEN

OBJECTIVE: To evaluate the preliminary results of perineal implantation of I-125 seeds in patients with cancer of the prostate. DESIGN: Prospective descriptive cohort study. SETTING: Utrecht University Hospital, the Netherlands. METHODS: In the period from October 1989 to December 1996, a total of 149 patients with localized carcinoma of the prostate were treated with perineal implantation of I-125 seeds. One hundred of them could be evaluated. Results regarding progression and complications were collected prospectively. RESULTS: The median follow-up was 3 years (range 12-74 months). Progression of the disease was observed in 28 patients: local in eight, distant in four and both local and distant in one; 15 patients only showed a rise of prostate specific antigen level, without further symptoms. Fourteen patients were given supplementary treatment. No major complications were seen; four patients had persistent micturition problems and three, intestinal problems. CONCLUSION: Perineal I-125 implantation causes few complications and may constitute an alternative to external irradiation as well as to radical prostatectomy in the treatment of localized carcinoma of the prostate.


Asunto(s)
Braquiterapia/efectos adversos , Braquiterapia/métodos , Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Próstata/radioterapia , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Masculino , Metástasis de la Neoplasia , Perineo , Estudios Prospectivos , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Inducción de Remisión , Estadística como Asunto , Tasa de Supervivencia , Resultado del Tratamiento
6.
IEEE Trans Med Imaging ; 17(5): 729-36, 1998 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-9874296

RESUMEN

A new template technique has been developed for implanting hyperthermia catheters in the treatment of brain tumors. The technique utilizes an imaging template and a drill template which can be rigidly secured to the head with three skull screws. The anatomic and vascular information needed for hyperthermia treatment planning may be assessed with three-dimensional magnetic resonance (MR) imaging and angiography acquisitions which use a surface coil. In the companioning treatment planning system the catheter positions and lengths and the electrodes in the catheter can be interactively manipulated relative to the anatomy and vasculature. The visualization of the blood vessels relative to the template allows the minimization of the risk on intracranial hemorrhages. This template technique is useful for any brain tumor implants, especially when a large number of catheters are involved. A phantom test has shown that this procedure has an accuracy in the order of 1 mm provided that the MR-related geometry distortions are minimized.


Asunto(s)
Neoplasias Encefálicas/terapia , Catéteres de Permanencia , Hipertermia Inducida/instrumentación , Angiografía por Resonancia Magnética , Terapia Asistida por Computador , Neoplasias Encefálicas/irrigación sanguínea , Neoplasias Encefálicas/patología , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Técnicas Estereotáxicas
7.
Int J Hyperthermia ; 13(4): 365-85, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9278767

RESUMEN

The quality of temperature distributions that can be generated with the Multi Electrode Current Source (MECS) interstitial hyperthermia (IHT) system, which allows 3D control of the temperature distribution, has been investigated. For the investigations, computer models of idealised anatomies containing discrete vessels, were used. A 7-catheter hexagonal implant geometry with a nearest neighbour distance of 15 mm was used. In each interstitial catheter with a diameter of 2.1 mm a number of 1 up to 4 electrodes were placed along an 'active section' with a length of 50 mm. The electrode segments had lengths of 50, 20, 12 and 9 mm respectively. Both single vessel and vessel network situations were analysed. This study shows that even in situations with discrete vasculature and perfusion heterogeneity it remains possible to obtain satisfactory temperature distributions with the MECS IHT system. Due to its 3D spatial control the temperature homogeneity in the implant can be made quite satisfactory.


Asunto(s)
Hipertermia Inducida/métodos , Vasos Sanguíneos/anatomía & histología , Vasos Sanguíneos/fisiología , Simulación por Computador , Electrodos , Estudios de Evaluación como Asunto , Humanos , Hipertermia Inducida/instrumentación , Hipertermia Inducida/estadística & datos numéricos , Modelos Anatómicos , Modelos Cardiovasculares , Temperatura
8.
Phys Med Biol ; 41(3): 429-44, 1996 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-8778824

RESUMEN

The quality of temperature distributions that can be generated with the multi-electrode current source (MECS) interstitial hyperthermia system, which allows 3D control of the spatial SAR distribution, has been investigated. For the investigations, computer models of idealized anatomies were used. These anatomical models did not contain discrete vessels. Binary-media anatomies, containing media interfaces oriented parallel, perpendicular or oblique with respect to the long axis of the implant, represent simple anatomies which can be encountered in the clinic. The implant volume was about 40 cm3. A seven-catheter hexagonal implant geometry with a nearest-neighbor distance of 15 mm was used. In each interstitial probe between one and four electrodes with a diameter of 2.1 mm were placed along an "active section' with a length of 50 mm. The electrode segments had lengths of 50, 20, 12 and 9 mm. This study shows that even with high contrasts in electrical and thermal conductivity in the implant it remains possible to obtain satisfactory temperature distributions with the MECS system. Due to its 3D spatial control the temperature homogeneity in the implant can be made quite satisfactory, with T10-T90 of the order of 2-3 K. Treatment planning must ensure that the placement of the current source electrodes is compatible with the media configuration.


Asunto(s)
Hipertermia Inducida/métodos , Fenómenos Biofísicos , Biofisica , Simulación por Computador , Electrodos , Humanos , Hipertermia Inducida/normas , Hipertermia Inducida/estadística & datos numéricos , Modelos Anatómicos , Neoplasias/terapia , Control de Calidad , Temperatura
9.
Int J Hyperthermia ; 11(2): 173-86, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7790733

RESUMEN

Between August 1989 and July 1992 a total of 22 patients (64 treatments) with inoperable or recurrent deep seated pelvic tumours were treated with regional hyperthermia and radiotherapy. The 70 Mhz Coaxial TEM applicator with its characteristic open waterbolus was used as heating device. The main objective of this pilot study was to evaluate the feasibility, toxicity and temperature data. The results showed that the major treatment limiting factors were insufficient power and systemic stress. Local pain was observed in only 10% of all treatments. Most of the treatments resulted in elevated systemic temperatures with the overall mean maximum oesophagus temperature reaching 38.9 +/- 0.7 degrees C, however, in only 6% of these treatments this was found to be treatment limiting. From the measured data the following intratumoral temperatures were calculated: T90 = 39.9 +/- 1.0 degrees C; T50 = 40.7 +/- 1.0 degrees C; T10 = 41.4 +/- 1.0 degrees C. In addition, the overall mean average normal tissue temperatures were determined: Trectum = 40.8 +/- 0.7 degrees C; Tvagina = 41.3 +/- 0.9 degrees C; Turethra = 40.8 +/- 0.9 degrees C. The temperatures in normal tissue were frequently higher than in tumour, indicating that a large volume was heated. The open waterbolus allows strong cooling, but the strategy was changed during the study: higher systemic temperatures were allowed to improve the pelvic temperatures. This pilot study proved that the open waterbolus is clinically a success, because it offers patient comfort and SAR-steering by patient repositioning, and that regional hyperthermia with the Coaxial TEM is feasible.


Asunto(s)
Hipertermia Inducida/instrumentación , Neoplasias Pélvicas/terapia , Adulto , Anciano , Terapia Combinada , Femenino , Humanos , Hipertermia Inducida/efectos adversos , Masculino , Persona de Mediana Edad , Neoplasias Pélvicas/radioterapia , Temperatura
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA