Abstract

Background: Treatment quality is important in clinical hyperthermia. Guideline-based treatment protocols are used to determine system settings and treatment strategies to ensure effective tumor heating and prevent unwanted treatment-limiting normal tissue hot spots. Realizing both these goals can prove challenging using generic guideline-based and operator-dependent treatment strategies. Hyperthermia treatment planning (HTP) can be very useful to support treatment strategies. Although HTP is increasingly integrated into the standard clinical workflow, active clinical application is still limited to a small number of hyperthermia centers and should be further stimulated.

Purpose: This paper aims to serve as a practical guide, demonstrating how HTP can be applied in clinical decision making for both superficial and locoregional hyperthermia treatments.

HTP in clinical decision making: Seven problems that occur in daily clinical practice are described and we show how HTP can enhance insight to formulate an adequate treatment strategy. Examples use representative commercially available hyperthermia devices and cover all stages during the clinical workflow. Problems include selecting adequate phase settings, heating ability analysis, hot spot suppression, applicator selection, evaluation of target coverage and heating depth, and predicting possible thermal toxicity in case of an implant. Since we aim to promote a general use of HTP in daily practice, basic simulation strategies are used in these problems, avoiding a need for the application of dedicated advanced optimization routines that are not generally available.

Conclusion: Even fairly basic HTP can facilitate clinical decision making, providing a meaningful and clinically relevant contribution to maintaining and improving treatment quality.

摘要

背景：治疗质量在临床热疗中很重要。基于指南的治疗方案用于确定系统设置和治疗策略，以确保有效的肿瘤加热并防止有害的治疗限制正常组织热点。使用基于通用指南和依赖操作者的治疗策略，实现这两个目标可能会证明具有挑战性。热疗治疗计划（HTP）对于支持治疗策略可能非常有用。尽管HTP越来越多地集成到标准临床工作流程中，但是积极的临床应用仍然仅限于少数热疗中心，应该进一步加以鼓励。

目的：本文旨在作为实用指南，说明如何将HTP应用于浅表和局部热疗的临床决策。

临床决策中的HTP：描述了日常临床实践中出现的七个问题，我们展示了HTP如何增强洞察力以制定适当的治疗策略。实例使用代表性的可商购的热疗设备，并且涵盖了临床工作流程中的所有阶段。问题包括选择适当的相位设置，加热能力分析，热点抑制，施加器选择，目标覆盖率和加热深度的评估以及在植入物的情况下预测可能的热毒性。由于我们的目标是促进HTP在日常实践中的普遍使用，因此在这些问题中使用了基本的模拟策略，从而避免了通常无法使用的专用高级优化例程的应用。

结论：即使是相当基本的HTP都可以促进临床决策，为维持和改善治疗质量提供有意义且与临床相关的贡献。