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Open Access 01-12-2018 | Research

Dosimetric impact of tumor treating field (TTField) transducer arrays onto treatment plans for glioblastomas – a planning study

Authors: Christoph Straube, Markus Oechsner, Severin Kampfer, Sophia Scharl, Friederike Schmidt-Graf, Jan J. Wilkens, Stephanie E. Combs

Published in: Radiation Oncology | Issue 1/2018

Abstract

Background

Tumor-Treating Fields (TTFields) are a novel treatment strategy for glioblastoma (GBM) that is approved for the use concomitantly to adjuvant chemotherapy. Preclinical data suggest a synergistic interaction of TTFields and radiotherapy (RT). However, the dosimetric uncertainties caused by the highly dense arrays have led to caution of applying the TTF setup during RT.

Methods

In a RW3 slab phantom we compared the MV- and kV-CT based planned dose with the measured dose. VMAT-plans were optimized on MV-CTs of an Alderson head phantom without TTF arrays and then re-calculated on the same phantom equipped with TTF arrays. Dose at organs at risk (OAR) and target volumes (PTVs) were compared.

Results

Measurements at a depth of 2, 3 and 4 cm of a RW 3 slab phantom show an attenuation due to TTField arrays of 3.4, 3.7 and 2.7% respectively. This was in-line with calculated attenuations based on MV-CT (1.2, 2.5 and 2.5%) but not with the attenuation expected from kV-CT based calculations (7.1, 8.2 and 8.6%). Consecutive MV-CT based VMAT planning and re-calculation reveals, that the conformity and homogeneity are not affected by the presence of TTField arrays. The dose at organs at risk (OAR) can show increases or decreases by < 0.5 Gy, which should be considered especially in cases next to the scull base.

Conclusion

MV-CT based dose calculation results in reliable dose distributions also in the presence of TTField arrays. There is a small but clinically not relevant interaction between the TTField arrays and VMAT dose application. Thus, daily replacement of TTField arrays is not necessary in regard to deeply located OARs. RT is feasible, when a VMAT treatment plan is optimized to an array free planning CT. As the biologic effect of a concomitant treatment especially on OARs is currently unknown, a concomitant treatment should be performed only within clinical trials.

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Title: Dosimetric impact of tumor treating field (TTField) transducer arrays onto treatment plans for glioblastomas – a planning study
Authors: Christoph Straube
Markus Oechsner
Severin Kampfer
Sophia Scharl
Friederike Schmidt-Graf
Jan J. Wilkens
Stephanie E. Combs
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2018
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-018-0976-3

At a glance: The STEP trials

Springer Medicine

Dosimetric impact of tumor treating field (TTField) transducer arrays onto treatment plans for glioblastomas – a planning study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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