MR Image Guided Hyperthermia Gerhard Sennewald PhD, Munich, Germany Kazakh Medical Diagnostic Forum...

MR Image Guided Hyperthermia

Gerhard Sennewald PhD, Munich, Germany Kazakh Medical Diagnostic Forum “Technological Innovations in radiology & functional diagnosis“Astana, Kazakhstan, September 23 & 24, 2014

Agenda

Agenda

BSD 2000•3D Deep Regional HyperthermiaBSD 2000•3D-MR Image Guided Hyperthermia SigmaHyperPlan / SigmaVision

capacitive systems radiative multi antenna systems

Regional Hyperthermia

Upper (front ) plate

Lower (back ) plate

Antennas

Antennas

Image courtesy of Dughiero et al. Image courtesy of Gellermann et al.

capacitive systems

Image courtesy of Dughiero et al. Image courtesy of Gellermann et al.

Regional Hyperthermia

radiative multi antenna systems

Direction of the E-Fields

capacitive systems

Image courtesy of Dughiero et al. Image courtesy of Gellermann et al.

Regional Hyperthermia

radiative multi antenna systems

BSD-2000 System Family

BSD-2000-3D/MR System:

• 3 Rings with 8 Antenna each• MRI Image Guided Thermometry

BSD 2000 Basic System

BSD 2000 3D System

8 Antennas in 4 pairs

Functional Principle:

Regional Hyperthermia

Sigma 60 Applicator: • 8 Antenna Array surrounding the Patient

BSD 2000 Concept: Antenna Arrays

24 Antennae in

3 Rings of 8 Antennas each

BSD 2000 3D Applicator

Lamp phantom

Regional Hyperthermia

BSD 2000 3D Hyperthermia Treatment Suite

• Cervix• Rectal• Bladder• Sarcoma

BSD-2000 Clinical Indications:

• Pancreas• Abdominal• Prostate• Pelvic • Lung• etc….

Temperature Monitoring

• Invasive Thermometry– Intratumoral

• Min. Invasive Thermometry– Intraluminal

• Image Guided Thermometry– MRI-Thermometry

MR Image Guided Hyperthermia

MR Image Guided Hyperthermia

MR Image Guided Hyperthermia

MR Image Guided HyperthermiaDockable Patient Cart & 70 cm Bore

Thermometry – MR Controlled Hyperthermia

Hyperthermia MRI Diagnostics

MR Hyperthermia Treatment Suite

MR Imaging Compatible Applicators

Sigma Eye MR:

• 24 antennae• 12 channels• 3 antenna rings• 37 x 54 x 48 cm long

Sigma 40 MR:

• 16 antennae• 8 channels• 2 antenna rings• 42 x 38 cm long

Sigma 30 MR

• 8 antennae• 4 channels• 1 antenna ring• 27 x 25 cm long

The new user-friendly software for MR-Thermometry

• Color overlay to display the temperature changes

• Total and Difference PRFS • Timeline feature to monitor the chronological

sequence of the treatment• T90 temperature calculation• Timeline documentation for each step

Thermometry

MR Guided Pediatric Hyperthermia

Wessalowski et al.: The Lancet Oncology 2013 on Germ Cell TumorsDepartment of Pediatric Oncology UMS Düsseldorf - Germany

Wessalowski et al. Lancet Oncol. 2013

MR Guided Pediatric Hyperthermia

Wessalowski et al. Lancet Oncol. 2013

MR Guided Pediatric Hyperthermia

Applicators of Various Sizes Optimize Pediatric Treatments

Wessalowski et al. Lancet Oncol. 2013

MR Guided Pediatric Hyperthermia

Pediatric Abdominal Treatment in Sigma 40 Applicator

Wessalowski et al. Lancet Oncol. 2013

MR Guided Pediatric Hyperthermia

• 44 Patients, All Non-Responders to Standard Chemo Treatment, Treated in HyperPei Protocol Resulting in 25 Complete and 14 Partial Remissions

Combining Hyperthermia & Chemo for Recurrent Germ Cell Tumors:

Wessalowski et al. Lancet Oncol. 2013

MR Guided Pediatric Hyperthermia

Editorial T. Olson in „The Lancet Oncology“ 2013:Hyperthermia in Pediatric Germ Cell Tumors – a New Treatment Standard ?

Wessalowski et al. Lancet Oncol. 2013

The Atzelsberg Clinical Trial Circle

Ott OJ et al., 2009

The Atzelsberg Clinical Trial Circle

Ott OJ et al., 2009

The Atzelsberg Clinical Trial Circle

Ott OJ et al., 2009

The Atzelsberg Clinical Trial Circle

• Development of Guidelines and Clinical Trials

Ott OJ et al., 2009

The Atzelsberg Clinical Trial Circle

42

O. Ott: Rectal Cancer HyRec Trial - Treatment Schedule - Trial is RecrutingRecurrent & Locally Advanced Rectal Cancer

1 2 3 4 5 6

Week

d2 d9 d23 d30

d 1-14 d 22-35

Radiotherapy PTV: depending on former Tx Dose: 45 Gy

5-FU CIV (250 mg/m²/d)

Oxaliplatin Bolus (50 mg/m²/d)

Deep Regional Hyperthermia

R

E

S

E

C

T

I

O

N

d2 d9 d23 d30 d5 d12 d26 d33 d16 d19

Ott OJ et al., 2009

Required Cases n =59

The Atzelsberg Clinical Trial Circle

R.D.Issels MD PhD: Randomized Phase III Trial on Postoperative Pancreas Cancer

Thank you!

MR Guided Hyperthermia in Soft Tissue Sarcomas