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Ze'ev Bomzon



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    EP1.18 - Treatment of Locoregional Disease - NSCLC (ID 208)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.18-18 - Body Shape and Tissue Composition Influences Uniform Distribution of Tumor Treating Fields Intensity Delivered to the Lungs (ID 2459)

      08:00 - 18:00  |  Author(s): Ze'ev Bomzon

      • Abstract
      • Slides

      Background

      Tumor Treating Fields (TTFields) are low intensity, alternating electric fields in the intermediate frequency range that disrupt mitosis. TTFields are approved for the treatment of glioblastoma. A Phase 3 study investigating the efficacy of TTFields in Non-Small Cell Lung Cancer is ongoing [LUNAR NCT02973789].

      TTFields are delivered through two pairs of transducer arrays placed on the patient's skin. Since the efficacy of TTFields increases with intensity, identifying factors that influence field intensity in the lungs is beneficial to understand how body shape and tissue composition influence the field intensity. We present a computer-simulation-based study investigating the effect of body size, shape, and composition on TTFields distribution in the lungs.

      Method

      This study was performed using the Sim4Life software package and realistic computational phantoms: female (ELLA), male (DUKE), and obese male (FATS). Various array layouts were placed on the models, and the distribution of TTFields within their lungs were calculated and compared.

      Result

      For all models, uniform field distributions within the lungs were obtained when the arrays were axially-aligned with the parenchyma as much as anatomically possible. The layouts that generated the highest average field intensities were those in which one pair of arrays delivered an electric field from the anterolateral to the posterior-contralateral aspect of the patient and the second pair inducing the field from the anterior-contralateral to the posterolateral aspect of the patient. In all models, these layouts led to average field intensities in the lungs above the therapeutic threshold (>1 V/cm). The highest field intensities were seen in DUKE's lungs and the lowest field intensities in FATS's lungs. Analysis suggests that field attenuation was caused primarily by layers of fat. Hence, the lower field intensities in the lungs of ELLA and FATS can be largely attributed to the thick layers of fat present in FATS and the fatty tissue in ELLA's breasts.

      Conclusion

      This study provides insights into how TTFields distribution in the lungs is influenced by body composition. These findings will help to optimize the placement and design of transducer array placement for the treatment of lung cancers.

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    P2.06 - Mesothelioma (ID 170)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.06-21 - Efficacy and Safety of Tumor Treating Fields Delivery to the Thorax by Computational Simulations (ID 2354)

      10:15 - 18:15  |  Author(s): Ze'ev Bomzon

      • Abstract
      • Slides

      Background

      Tumor Treating Fields (TTFields), an anti-mitotic therapy low intensity, intermediate frequency, alternating electric fields, are approved for glioblastoma. The STELLAR phase 2 registration trial recently demonstrated a significant extension in overall survival in mesothelioma patients treated with TTFields and standard of care chemotherapy vs historical control data on chemotherapy alone. The results highlight the potential benefit of TTFields to treat cancer located in the thorax.

      Preclinical studies show that efficacy increases with the intensity of the electric field. Optimizing treatment requires a thorough understanding of how TTFields distribute within the body. Simulations can be used to evaluate the treatment safety by assessing tissue heating associated with absorption of the electric field. We present a simulation based study on field distribution and associated heating when delivering TTFields to the thorax.

      Method

      We delivered TTFields to the thorax of realistic computational phantoms of a male, female, and obese male (ZMT, Zurich, Switzerland). The field was delivered to the computational phantoms using transducer arrays similar to those used to deliver TTFields to the thorax with the NovoTTF-100L. The field intensities within the lungs of the models were evaluated. Specific Absorption Rate (SAR), a metric for assessing heating due to electromagnetic absorption, was calculated.

      Result

      The highest field intensities within the lungs were obtained when the arrays were axially-aligned with the parenchyma as anatomically possible. Field intensities throughout the lungs exceeded the therapeutic threshold of 1 V/cm in all models. Within the internal organs, SAR values were below the allowed level of 10 W/kg set out in the ICNIRP guidelines for occupational exposure. Maximum SAR levels did not exceed 20 W/kg. Occupational exposure standards typically incorporate a safety factor of around 10 when setting basic restrictions, therefore this level of SAR is considered safe and unlikely to lead to heat-related tissue damage.

      Conclusion

      TTFields can be delivered to the lungs at therapeutic levels that do not cause damage through tissue heating.

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