Abstract
Tumor Treating Fields (TTFields) therapy is an approved treatment that has known clinical efficacy against recurrent and newly diagnosed glioblastoma. However, the distribution of the electric fields and the corresponding pattern of energy deposition in the brain are poorly understood. To evaluate the physical parameters that may influence TTFields, postacquisition MP‐RAGE, T1 and T2 MRI sequences from a responder with a right parietal glioblastoma were anatomically segmented and then solved using finite‐element method to determine the distribution of the electric fields and rate of energy deposition at the gross tumor volume (GTV) and other intracranial structures. Electric field–volume histograms (EVH) and specific absorption rate–volume histograms (SARVH) were constructed to numerically evaluate the relative and/or absolute magnitude volumetric differences between models. The electric field parameters EAUC, VE 150, E95%, E50%, and E20%, as well as the SAR parameters SARAUC, VSAR 7.5, SAR 95%, SAR 50%, and SAR 20%, facilitated comparisons between models derived from various conditions. Specifically, TTFields at the GTV were influenced by the dielectric characteristics of the adjacent tissues as well as the GTV itself, particularly the presence or absence of a necrotic core. The thickness of the cerebrospinal fluid on the convexity of the brain and the geometry of the tumor were also relevant factors. Finally, the position of the arrays also influenced the electric field distribution and rate of energy deposition in the GTV. Using EVH and SARVH, a personalized approach for TTFields treatment can be developed when various patient‐related and tumor‐related factors are incorporated into the planning procedure.
Highlights
Tumor treating fields (TTFields) are alternating electric fields, tuned to a frequency between 100 and 300 kHz, that have antimitotic properties against rapidly dividing cancer cells
In past randomized clinical trials, TTFields was shown to have comparable efficacy against recurrent glioblastoma when compared to chemotherapies and, when added to maintenance temozolomide, it had a superior benefit in newly diagnosed glioblastoma patients when compared to maintenance temozolomide alone [4, 5]
We found that there is heterogeneity in the electric field intensity and the rate of energy absorbed at the gross tumor volume (GTV) depending on the placement of the transducer arrays, the presence or absence of a necrotic core within the glioblastoma, the thickness of the cerebrospinal fluid on the convexity of the brain and tumor geometry
Summary
Tumor treating fields (TTFields) are alternating electric fields, tuned to a frequency between 100 and 300 kHz, that have antimitotic properties against rapidly dividing cancer cells. When properly applied, these fields disrupt macromolecular protein structures thought to possess large dipole moments, such as Tubulin and Septin, which are critical for proper cytokinesis [1,2,3]. The clinical efficacy against glioblastoma is apparent, the intracranial distribution of the electric fields and to what extent the dose of these fields retard tumor growth remain largely unknown. As the electric conductivity and relative permittivity of tissues vary, the absorption
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