From September 16, 1981, through April 4, 1986, a total of 21 radiative electromagnetic (microwave and radiofrequency), ultrasound and interstitial radio-frequency hyperthermia applicators and three types of thermometry systems underwent extensive phantom and clinical testing at Stanford University. A total of 996 treatment sessions involving 268 separate treatment fields in 131 patients was performed. Thermal profiles were obtained in 847 of these treatment sessions by multipoint and/or mapping techniques involving mechanical translation. The ability of these devices to heat superficial, eccentrically located and deep-seated tumours at the major anatomical locations is evaluated and the temperature distributions, acute and subacute toxicities, and chronic complications compared. Average measured tumour temperatures between 42 degrees C and 43 degrees C were obtained with many of the devices used for superficial heating; average tumour temperatures of 39.6 degrees C to 42.1 degrees C were achieved with the three deep-heating devices. When compared to the goal of obtaining minimum tumour temperatures of 43.0 degrees C, all devices performed poorly. Only 14 per cent (118/847) of treatments with measured thermal profiles achieved minimum intratumoural temperatures of 41 degrees C. Fifty-six per cent of all treatments had associated acute toxicity; 14 per cent of all treatments necessitated power reduction resulting in maximum steady-state temperatures of less than 42.5 degrees C. Direct comparisons between two or more devices utilized to treat the same field were made in 67 instances, including 19 treatment fields in which two or more devices were compared at the same treatment session. The analyses from direct comparisons consistently showed that the static spiral and larger area scanning spiral applicators resulted in more favourable temperature distributions. Three fibreoptic thermometry systems (Luxtron single channel, four channel and eight channel multiple [four] probe array), the BSD Bowman thermistor system and a thermocouple system were evaluated with respect to accuracy, stability and artifacts. The clinical reliability, durability, and patient tolerance of the thermometry systems were investigated. The BSD Bowman and third generation Luxtron systems were found clinically useful, with the former meeting all of our established criteria.

Adult↗

PubMedDate not supplied

Noninvasive microwave phased arrays for local hyperthermia: a review.

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Biomedical Engineering↗

PubMedDate not supplied

Potential hazards of radiative electromagnetic hyperthermia in the presence of multiple metallic surgical clips.

Three-dimensional computer simulations of a patient under consideration for heating by the BSD Sigma 60 phased array applicator showed marked specific absorption rate (SAR) enhancement in the region where there was a concentration of metallic surgical clips. Subsequent tests in tissue-equivalent phantom material confirmed that metallic objects much shorter than the wavelength in tissue of the radiative electromagnetic field can cause significant changes in the power deposition near the implanted metal. The placement of extensive numbers of surgical clips may therefore hinder the ability to subsequently utilize radiative electromagnetic heating modalities.

Adult↗

PubMedDate not supplied

Automated mechanical thermometry probe mapping systems for hyperthermia.

In order to better assess temperature distribution patterns in patients, tissue equivalent phantoms, and experimental animals, mechanical devices and automated control systems for positioning temperature probes in implanted catheters and catheters laid on the skin surface have been developed. They employ stepper motor actuated roller and idler wheel drives to move the probes. Two devices incorporate positive positioners in addition to the drive rollers in order to obtain higher positioning accuracy where significant probe to catheter friction is present. Automated systems have been constructed which can simultaneously position, record and display data from up to 10 temperature sensors in a colour-coded position versus temperature format to produce a real time two-dimensional colour-coded pseudo isotherm display. These thermal mapping devices have been used for characterizing the power deposition patterns of several large area microwave applicators (on the surface and at depth within tissue equivalent phantoms), for intraorgan temperature mapping in experimental animals, and for surface and subcutaneous temperature mapping during clinical treatments.

Animals↗

PubMedDate not supplied

Influence of water bolus temperature on measured skin surface and intradermal temperatures.

Temperature measurements utilizing thermometry probes placed on the skin surface are often used clinically to assess temperatures for the purposes of power control and evaluating treatment efficacy. There is a question, however, as to what extent applicator temperature-controlled liquid coupling boluses can create temperature gradients which can cause significant differences between measurements taken by sensors placed on the skin surface and the actual temperature of the tissue beneath. To address this question, experiments were conducted with human subjects instrumented with surface and shallowly implanted temperature sensors. Microwave applicators with circulating bolus water set at 21 and 41 degrees C were used to induce a temperature gradient in depth in the superficial tissue by thermal conduction. No microwave energy was applied. The average measurement offset at 41 degrees C was 15% of the difference in temperature between the interstitially measured skin temperature and the coupling bolus temperature, towards the temperature of the coupling bolus. The corresponding offset with coupling boluses set near 21 degrees C was 32%. Different water bolus types and volumes were observed to induce different percentage offset errors.

Connective Tissue↗

PubMedDate not supplied

Red cell and plasma folate, folate consumption, and the risk of colorectal adenomatous polyps.

Epidemiological and experimental evidence suggests that dietary folate may protect against colorectal carcinogenesis. The epidemiological relationship between a biochemical measure of folate status and colorectal neoplasia in a sizeable and generally healthy population does not yet appear to have been reported. We conducted a case-control study of the relationships among red cell folate, plasma folate, folate intake, and adenomatous polyps, intermediate markers for colorectal cancer. During 1991-1993, fasting blood samples were assayed and dietary and nondietary risk factor questionnaires were administered to men and women ages 50-75 years who had a free sigmoidoscopy at a health maintenance organization. We analyzed data from 682 subjects (332 cases and 350 controls), controlling for potential confounding by sex, age, sigmoidoscopy date, and clinic. For red cell folate levels 160 ng/ml (363 nmol/liter) or more, compared to lower levels, the odds ratio was 0.76 [95% confidence interval (CI) = 0.53-1.08]. For men, the corresponding odds ratio was 0.53 (CI = 0.32-0.87); for women, it was 1.16 (CI = 0.67-2.00). Results were essentially unchanged when adjusted for levels of blood nutrients and other potential confounding variables. Plasma folate and folate intake results were similar to red cell folate results, but the associations with polyps were weaker. Results are consistent with a protective effect of red cell folate concentration against the development of colorectal polyps, at least in men. A folate effect may depend on sex-specific interactions with other nutritional or physiological factors.

Adenomatous Polyps↗