Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands.
Int J Hyperthermia. 2023;40(1):2218627. doi: 10.1080/02656736.2023.2218627.
Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) aims to treat microscopic disease left after CytoReductive Surgery (CRS). Thermal enhancement depends on the temperatures achieved. Since the location of microscopic disease is unknown, a homogeneous treatment is required to completely eradicate the disease while limiting side effects. To ensure homogeneous delivery, treatment planning software has been developed. This study compares simulation results with clinical data and evaluates the impact of nine treatment strategies on thermal and drug distributions.
For comparison with clinical data, three treatment strategies were simulated with different flow rates (1600-1800mL/min) and inflow temperatures (41.6-43.6 °C). Six additional treatment strategies were simulated, varying the number of inflow catheters, flow direction, and using step-up and step-down heating strategies. Thermal homogeneity and the risk of thermal injury were evaluated.
Simulated temperature distributions, core body temperatures, and systemic chemotherapeutic concentrations compared well with literature values. Treatment strategy was found to have a strong influence on the distributions. Additional inflow catheters could improve thermal distributions, provided flow rates are kept sufficiently high (>500 mL/min) for each catheter. High flow rates (1800 mL/min) combined with high inflow temperatures (43.6 °C) could lead to thermal damage, with values of up to 27 min. Step-up and step-down heating strategies allow for high temperatures with reduced risk of thermal damage.
The planning software provides valuable insight into the effects of different treatment strategies on peritoneal distributions. These strategies are designed to provide homogeneous treatment delivery while limiting thermal injury to normal tissue, thereby optimizing the effectiveness of HIPEC.
腹腔内热化疗（HIPEC）旨在治疗细胞减灭术后（CRS）遗留的微观疾病。热增强取决于达到的温度。由于微观疾病的位置未知，需要进行均匀的治疗，以彻底消灭疾病，同时限制副作用。为了确保均匀的输送，已经开发出了治疗规划软件。本研究比较了模拟结果与临床数据，并评估了九种治疗策略对热和药物分布的影响。
为了与临床数据进行比较，模拟了三种不同流速（1600-1800mL/min）和入口温度（41.6-43.6°C）的治疗策略。还模拟了六种额外的治疗策略，改变了入口导管的数量、流动方向，并使用了逐步加热和逐步降温的策略。评估了热均匀性和热损伤风险。
模拟的温度分布、核心体温和全身化疗药物浓度与文献值比较吻合。治疗策略对分布有很大影响。增加入口导管可以改善热分布，但前提是每个导管的流速保持足够高（>500mL/min）。高流速（1800mL/min）与高入口温度（43.6°C）相结合可能导致热损伤，值高达 27 分钟。逐步加热和逐步降温策略允许使用高温，同时降低热损伤的风险。
规划软件提供了对不同治疗策略对腹膜分布影响的有价值的见解。这些策略旨在提供均匀的治疗输送，同时限制正常组织的热损伤，从而优化 HIPEC 的效果。
