Integrated Software for Electrochemotherapy Treatment Planning of Deep-Seated Tumors

Abstract

In past years electrochemotherapy (ECT) has been successfully used as a method for treating small subcutaneous and cutaneous tumors. With such tumor nodules, it is enough to follow generally accepted standard operating procedures and general guidance on placement of electrodes for ECT to be successful. Results of the ESOPE study are encouraging, since they determined ECT is highly-effective with an 85% objective response rate. Currently, additional progress is being made by extending the reach of ECT for treating deep-seated solid tumors. Nevertheless, such tumors are very diverse in location, shape and size, and vary from patient to patient. Therefore, individual approach to each patient is needed. Patient-based numerical treatment planning involves interdisciplinary tasks from several fields (i.e. biomedical engineering, oncology, computer science, electrical engineering). To simplify the treatment planning procedure it should be feasible to develop integrated computer software that would allow the attending physician to safely generate a treatment plan. We developed new software that embeds all the procedures that are necessary for treatment planning: import of medical images (CT or MRI), preprocessing, segmentation (i.e. tissue marking), postprocessing, three-dimensional reconstruction, insertion of electrodes, and generation of optimized treatment plan. In order to develop a robust and safe solution, we separated the engine (core of treatment planning software) from the Graphical User Interface and, at this stage, developed two separate applications that will be merged together at the end of development. A clinical study has been started at Institute of Oncology (Ljubljana, Slovenia) where ECT was performed on five patients with colorectal liver metastases. ECT was performed by inserting long needle electrodes. Moreover, the delivery of ECT electric pulses was safe, and no side effects have been noticed in the post treatment period. The results demonstrate that ECT is feasible in treatment of deep-seated metastases; treatment planning proved helpful for successful ECT treatment. Therefore, development of integrated treatment planning software is required and will assist to a more widespread application of ECT.