Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Int J Hyperthermia. 2021;38(1):38-54. doi: 10.1080/02656736.2020.1852324.
Hyperthermic intraperitoneal chemotherapy (HIPEC) is administered to treat residual microscopic disease after cytoreductive surgery (CRS). During HIPEC, fluid (41-43 °C) is administered and drained through a limited number of catheters, risking thermal and drug heterogeneities within the abdominal cavity that might reduce effectiveness. Treatment planning software provides a unique tool for optimizing treatment delivery. This study aimed to investigate the influence of treatment-specific parameters on the thermal and drug homogeneity in the peritoneal cavity in a computed tomography based rat model.
We developed computational fluid dynamics (CFD) software simulating the dynamic flow, temperature and drug distribution during oxaliplatin based HIPEC. The influence of location and number of catheters, flow alternations and flow rates on peritoneal temperature and drug distribution were determined. The software was validated using data from experimental rat HIPEC studies.
The predicted core temperature and systemic oxaliplatin concentration were comparable to the values found in literature. Adequate placement of catheters, additional inflow catheters and higher flow rates reduced intraperitoneal temperature spatial variation by -1.4 °C, -2.3 °C and -1.2 °C, respectively. Flow alternations resulted in higher temperatures (up to +1.5 °C) over the peritoneal surface. Higher flow rates also reduced the spatial variation of chemotherapy concentration over the peritoneal surface resulting in a more homogeneous effective treatment dose.
The presented treatment planning software provides unique insights in the dynamics during HIPEC, which enables optimization of treatment-specific parameters and provides an excellent basis for HIPEC treatment planning in human applications.
腹腔内热灌注化疗（HIPEC）用于治疗细胞减灭术后（CRS）残留的微观疾病。在 HIPEC 期间，通过有限数量的导管输入和排出（41-43°C）液体，这可能会导致腹腔内的热和药物不均匀，从而降低疗效。治疗计划软件为优化治疗提供了独特的工具。本研究旨在调查治疗特异性参数对基于 CT 的大鼠模型中腹腔内热和药物均匀性的影响。
我们开发了计算流体动力学（CFD）软件，模拟奥沙利铂 HIPEC 期间的动态流动、温度和药物分布。确定了导管位置和数量、流动交替和流速对腹腔温度和药物分布的影响。使用来自实验大鼠 HIPEC 研究的数据验证了该软件。
预测的核心温度和全身奥沙利铂浓度与文献中的值相当。适当放置导管、增加流入导管和提高流速可分别将腹腔内温度空间变化降低-1.4°C、-2.3°C 和-1.2°C。流动交替会导致腹膜表面温度升高（高达+1.5°C）。较高的流速还降低了腹膜表面上化疗浓度的空间变化，从而实现了更均匀的有效治疗剂量。
所提出的治疗计划软件提供了 HIPEC 过程中动态的独特见解，从而能够优化治疗特异性参数，并为人类应用中的 HIPEC 治疗计划提供了极好的基础。
