Modeling of intracranial tumor treating fields for the treatment of complex high-grade gliomas
Abstract Increasing the intensity of tumor treating fields (TTF) within a tumor bed improves clinical efficacy, but reaching sufficiently high field intensities to achieve growth arrest remains challenging due in part to the insulating nature of the cranium. Using MRI-derived finite element models (...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-01-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-28769-9 |
| _version_ | 1797864874955505664 |
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| author | David J. Segar Joshua D. Bernstock Omar Arnaout Wenya Linda Bi Gregory K. Friedman Robert Langer Giovanni Traverso Sumientra M. Rampersad |
| author_facet | David J. Segar Joshua D. Bernstock Omar Arnaout Wenya Linda Bi Gregory K. Friedman Robert Langer Giovanni Traverso Sumientra M. Rampersad |
| author_sort | David J. Segar |
| collection | DOAJ |
| description | Abstract Increasing the intensity of tumor treating fields (TTF) within a tumor bed improves clinical efficacy, but reaching sufficiently high field intensities to achieve growth arrest remains challenging due in part to the insulating nature of the cranium. Using MRI-derived finite element models (FEMs) and simulations, we optimized an exhaustive set of intracranial electrode locations to obtain maximum TTF intensities in three clinically challenging high-grade glioma (HGG) cases (i.e., thalamic, left temporal, brainstem). Electric field strengths were converted into therapeutic enhancement ratios (TER) to evaluate the predicted impact of stimulation on tumor growth. Concurrently, conventional transcranial configurations were simulated/optimized for comparison. Optimized intracranial TTF were able to achieve field strengths that have previously been shown capable of inducing complete growth arrest, in 98–100% of the tumor volumes using only 0.54–0.64 A current. The reconceptualization of TTF as a targeted, intracranial therapy has the potential to provide a meaningful survival benefit to patients with HGG and other brain tumors, including those in surgically challenging, deep, or anatomically eloquent locations which may preclude surgical resection. Accordingly, such an approach may ultimately represent a paradigm shift in the use of TTFs for the treatment of brain cancer. |
| first_indexed | 2024-04-09T23:00:14Z |
| format | Article |
| id | doaj.art-0bbf624eb1ee45c0ae91a7b729ba1b12 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-09T23:00:14Z |
| publishDate | 2023-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-0bbf624eb1ee45c0ae91a7b729ba1b122023-03-22T11:00:57ZengNature PortfolioScientific Reports2045-23222023-01-0113111110.1038/s41598-023-28769-9Modeling of intracranial tumor treating fields for the treatment of complex high-grade gliomasDavid J. Segar0Joshua D. Bernstock1Omar Arnaout2Wenya Linda Bi3Gregory K. Friedman4Robert Langer5Giovanni Traverso6Sumientra M. Rampersad7Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical SchoolDepartment of Pediatrics, University of Alabama at BirminghamDavid H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of TechnologyDavid H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of TechnologyDepartment of Physics, University of MassachusettsAbstract Increasing the intensity of tumor treating fields (TTF) within a tumor bed improves clinical efficacy, but reaching sufficiently high field intensities to achieve growth arrest remains challenging due in part to the insulating nature of the cranium. Using MRI-derived finite element models (FEMs) and simulations, we optimized an exhaustive set of intracranial electrode locations to obtain maximum TTF intensities in three clinically challenging high-grade glioma (HGG) cases (i.e., thalamic, left temporal, brainstem). Electric field strengths were converted into therapeutic enhancement ratios (TER) to evaluate the predicted impact of stimulation on tumor growth. Concurrently, conventional transcranial configurations were simulated/optimized for comparison. Optimized intracranial TTF were able to achieve field strengths that have previously been shown capable of inducing complete growth arrest, in 98–100% of the tumor volumes using only 0.54–0.64 A current. The reconceptualization of TTF as a targeted, intracranial therapy has the potential to provide a meaningful survival benefit to patients with HGG and other brain tumors, including those in surgically challenging, deep, or anatomically eloquent locations which may preclude surgical resection. Accordingly, such an approach may ultimately represent a paradigm shift in the use of TTFs for the treatment of brain cancer.https://doi.org/10.1038/s41598-023-28769-9 |
| spellingShingle | David J. Segar Joshua D. Bernstock Omar Arnaout Wenya Linda Bi Gregory K. Friedman Robert Langer Giovanni Traverso Sumientra M. Rampersad Modeling of intracranial tumor treating fields for the treatment of complex high-grade gliomas Scientific Reports |
| title | Modeling of intracranial tumor treating fields for the treatment of complex high-grade gliomas |
| title_full | Modeling of intracranial tumor treating fields for the treatment of complex high-grade gliomas |
| title_fullStr | Modeling of intracranial tumor treating fields for the treatment of complex high-grade gliomas |
| title_full_unstemmed | Modeling of intracranial tumor treating fields for the treatment of complex high-grade gliomas |
| title_short | Modeling of intracranial tumor treating fields for the treatment of complex high-grade gliomas |
| title_sort | modeling of intracranial tumor treating fields for the treatment of complex high grade gliomas |
| url | https://doi.org/10.1038/s41598-023-28769-9 |
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