On heating head and neck tumours using the novel clinical em applicator: the HYPERcollar

Abstract Purpose: Definition of all features and the potential of the novel HYPERcollar applicator system for hyperthermia treatments in the head and neck (H&N) region. Methods and Materials: The HYPERcollar applicator consists of 1) an antenna ring, 2) a waterbolus system and 3) a positioning system. The specific absorption rate (SAR) profile of this applicator is investigated by performing infra-red (IR) measurements in a cylindrical phantom. Mandatory patient-specific treatment planning is performed as an object lesson to a patient with a laryngeal tumour and an artificial lymph node metastasis. Results: The comfort tests with healthy volunteers have revealed that the applicator provides su±cient comfort to maintain in treatment position for an hour: in our center the standard hyperthermia treatment duration. We further established that a central focus in the neck can be obtained, with 50% iso-SAR lengths of 3.5cm in transversal directions and 9-11cm in the axial direction (z). Using treatment planning by detailed electromagnetic simulations, we showed that the SAR pattern can be optimized to enable simultaneous encompassing a primary laryngeal tumour and a lymph node metastasis at the 25% iso-SAR level. Conclusions: A site-specific H&N applicator was designed that enables good control and sufficient possibilities for optimizing the SAR pattern. In an ongoing clinical feasibility study we will investigate the possibilities of heating various target regions in the neck with this apparatus

IMRT for image-guided single vocal cord irradiation

Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose ± standard deviation to the planning target volume was 67 ± 1 Gy. The contralateral vocal cord dose was reduced from 66 ± 1 Gy in the conventional plans to 39 ± 8 Gy and 36 ± 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates