Andre A. Abitbol

Interstitial microwave hyperthermia applicators having submillimetre diameters

Using microscopic techniques we have fabricated interstitial hyperthermia applicators having diameters of 0.20, 0.33 and 0.58 mm, which will fit through catheters of 30, 26 and 22 gauge, respectively. Existing commercial applicators having a diameter of 1.1 mm required 17 gauge (or larger) catheters. Our new applicators, which operate at 915 MHz, are a smaller version of a design used by others. We have characterized our applicators by determining the energy deposition patterns (SAR) in muscle-simulating phantoms. These patterns were determined by measuring the electric field intensity using a miniature implantable isotropic probe having a diameter of 3 mm. Contours of the SAR data for our applicators, as well as a larger commercial applicator, show that all of these applicators exhibit similar heating patterns. Test results suggest that the durability and power handling capability of our submillimetre applicators are adequate for use in patients. Our new applicators should be useful in the percutaneous treatment of deep-seated tumours, intraoperative treatments, and also permit intraluminal or intravascular access to tumours.

Complete hypopharyngeal obstruction by mucosal adhesions: a complication of intensive chemoradiation for advanced head and neck cancer.

Severe swallowing dysfunction is the dominant long‐term complication observed in patients treated for head and neck squamous cell carcinoma (HNSCC) with treatment protocols using intensive concurrent chemotherapy with radiation therapy (chemo/XRT). We identified a subset of these patients, who were seen with complete obstruction of the hypopharynx distal to the site of the primary cancer, and in whom we postulate that the obstruction was caused by separable mucosal adhesions rather than obliteration by a mature fibrous stricture.

Stereotactic target point verification of an X ray and CT localizer

Stereotactic radiosurgery with a linear accelerator requires the accurate determination of a target volume and an accurate match of the therapeutic radiation dose distribution to the target volume. X ray and CT localizers have been described that are used to define the target volume or target point from angiographic or CT data. To verify the accuracy of these localizers, measurements were made with a target point simulator and an anthropomorphic head phantom. The accuracy of determining a known, high contrast, target point with these localizers was found to be a maximum of +/- 0.5 mm and +/- 1.0 mm for the X ray and CT localizer, respectively. A technique using portal X rays taken with a linear accelerator to verify the target point is also described.

Hyperfractionated radiation therapy and 5-fluorouracil, cisplatin, and mitomycin-C (+/- granulocyte-colony stimulating factor) in the treatment of patients with locally advanced head and neck carcinoma.

The authors had previously reported preliminary results of a treatment regimen of concurrent hyperfractionated radiation therapy and chemotherapy in patients with locally advanced head and neck carcinoma that demonstrated both feasibility and high local control. In an attempt to reduce acute mucosal and hematologic toxicity, granulocyte‐colony stimulating factor (G‐CSF) was added during the second phase of this study.

Radiation induced failures of complementary metal oxide semiconductor containing pacemakers: A potentially lethal complication

New multi-programmable pacemakers frequently employ complementary metal oxide semiconductors (CMOS). This circuitry appears more sensitive to the effects of ionizing radiation when compared to the semiconductor circuits used in older pacemakers. A case of radiation induced runaway pacemaker in a CMOS device is described. Because of this and other recent reports of radiation therapy-induced CMOS type pacemaker failure, these pacemakers should not be irradiated. If necessary, the pacemaker can be shielded or moved to a site which can be shielded before institution of radiation therapy. This is done to prevent damage to the CMOS circuit and the life threatening arrythmias which may result from such damage.

Radiosurgery target point alignment errors detected with portal film verification.

Stereotactic radiosurgery with a linear accelerator requires an accurate match of the therapeutic radiation distribution to the localized target volume. Techniques for localization of the target volume using CT scans and/or angiograms have been described. Alignment of the therapeutic radiation distribution to the intended point in stereotactic space is usually accomplished using precision mechanical scales which attach to the head ring. The present work describes a technique used to verify that the stereotactic coordinates of the center of the intended radiation distribution are in agreement with the localized target point coordinates. This technique uses anterior/posterior and lateral accelerator portal verification films to localize the stereotactic coordinates of the center of the radiation distribution with the patient in the treatment position. The results of 26 cases have been analyzed. Alignment errors of the therapeutic radiation distribution in excess of 1 mm have been found using the portal film verification procedure.

Improved linac dose distributions for radiosurgery with elliptically shaped fields

Stereotactic radiosurgery techniques for a linear accelerator typically use circular radiation fields to produce an essentially spherical radiation distribution with a steep dose gradient. Target volumes are frequently irregular in shape, and circular distributions may irradiate normal tissues to high dose as well as the target volume. Improvements to the dose distribution have been made using multiple target points and optimizing the dose per arc to the target. A retrospective review of 20 radiosurgery patients has suggested that the use of elliptically shaped fields may further improve the match of the radiation distribution to the intended target volume. This hypothesis has been verified with film measurements of the radiation distribution obtained using elliptical radiation beam in a head phantom. Reductions of 40% of the high dose volume have been obtained with elliptical fields compared to circular fields without compromising the dose to the target volume.

Stereotactic radiosurgery: Dose‐volume analysis of linear accelerator techniques

Stereotactic radiosurgery of the brain may be accomplished with a linear accelerator by performing several noncoplanar arcs of a highly collimated beam focused at a point. The shape of the radiation distribution produced by this technique is affected by the beam energy, field size, and the number and size of the arcs. The influence of these parameters on the resulting radiation distributions was analyzed by computing dose volume histograms for a typical brain. Dose volume functions were computed for: (a) the energy range of 4-24 MV x rays; (b) target sizes of 1-4 cm; and (c) 1-11 arcs and dynamic rotation. The dose volume histograms were found to be dependent on the number of arcs for target sizes of 1-4 cm. However, these differences were minimal for techniques with 4 arcs or more. The influence of beam energy on the dose volume histogram was also found to be minimal.

Computer controlled stereotaxic radiotherapy system

A computer-controlled stereotaxic radiotherapy system based on a low-frequency magnetic field technology integrated with a single fixation point stereotaxic guide has been designed and instituted. The magnetic field, generated in space by a special field source located in the accelerator gantry, is digitized in real time by a field sensor that is six degree-of-freedom measurement device. As this sensor is an integral part of the patient stereotaxic halo, the patient position (x, y, z) and orientation (azimuth, elevation, roll) within the accelerator frame of reference are always known. Six parameters--three coordinates and three Euler space angles--are continuously transmitted to a computer where they are analyzed and compared with the stereotaxic parameters of the target point. Hence, the system facilitates rapid and accurate patient set-up for stereotaxic treatment as well as monitoring of patient during the subsequent irradiation session. The stereotaxic system has been developed to promote the integration of diagnostic and therapeutic procedures, with the specific aim of integrating CT and/or MR aided tumor localization and long term (4- to 7-week) fractionated radiotherapy of small intracranial and ocular lesions.

Dose determination in high dose-rate brachytherapy

Although high dose-rate brachytherapy with a single, rapidly moving radiation source is becoming a common treatment modality, a suitable formalism for determination of the dose delivered by a moving radiation source has not yet been developed. At present, brachytherapy software simulates high dose-rate treatments using only a series of stationary sources, and consequently fails to account for the dose component delivered while the source is in motion. We now describe a practical model for determination of the true, total dose administered. The algorithm calculates both the dose delivered while the source is in motion within and outside of the implanted volume (dynamic component), and the dose delivered while the source is stationary at a series of fixed dwell points. It is shown that the dynamic dose element cannot be ignored because it always increases the dose at the prescription points and, in addition, distorts the dose distribution within and outside of the irradiated volume. Failure to account for the dynamic dose component results in dosimetric errors that range from significant (> 10%) to negligible (< 1%), depending on the prescribed dose, source activity, and source speed as defined by the implant geometry.