Abstract 3204: Transducer array configuration optimization for treatment of pancreatic cancer using Tumor Treating Fields (TTFields)
Authors: Naveh Ariel , Bomzon Ze'ev , Farber Ori , Urman Noa , Yesharim Ofir , Kirson Eilon , Weinberg Uri 
Published: August 2018

Abstract
Introduction: TTFields is an antimitotic cancer treatment that utilizes low intensity (1-3 V/cm) alternating electric fields in the intermediate frequency (100-300 kHz) that are delivered in two orthogonal directions using 2 pairs of transducer arrays. A phase II clinical trial (PANOVA, NCT01971281) showed that TTFields in combination with chemotherapy was safe in patients with locally advanced pancreatic cancer. Preclinical studies show that the effect of TTFields is intensity-dependent with a therapeutic threshold of 1 V/cm. The field distribution within the body is known to changes with array placement. Therefore, there is a need to develop principles for personalizing array placement to optimize TTFields delivery when treating pancreatic cancer. The aim of such guidelines should be to ensure delivery of maximal field intensities to the region of disease, whilst minimizing the size of the arrays placed on the body. Minimizing array size is important to enable periodic shifting of the arrays for potentially reducing skin irritation associated with TTFields therapy, as well as potentially improving overall patient comfort. Here we present a systematic study investigating how the location and size of the arrays on the abdomen influences the field distribution.
Methods: To simulate delivery of TTFields to the abdomen, we used 3 realistic computerized models (from ZMT_Zurich) of: a male (DUKE 3.0); b) , a female (ELLA 3.0); and an obese male (FATS 3.0). For each model, 6-8 different layouts utilizing combinations of arrays with either 13 or 20 disks per-array were tested. The arrays were placed over the upper 6 standard abdominopelvic, and field intensity distributions within these regions were evaluated. In order to generate TTFields, an alternating voltage at a frequency of 150 KHz was imposed on the outer surfaces of the disks of each pair of arrays. The voltage was set to deliver a current of 200 mA peak to peak per-disk (total current 2.6 A for 13-disk arrays, 4.0 A for 20-disk arrays). The simulations were performed using ZMT's Sim4Life V3.0 electro-quasi-static solver.
Results: In all simulations, the large arrays generated higher field intensities than the small arrays. However, On ELLA and DUKE, the large arrays covered most of the skin around the abdomen, leaving little to no room for shifting the arrays. FATs body surface is large enough so that even when large arrays are used, there is still ample space for shifting the arrays. On DUKE and ELLA, when using small arrays, the average field intensity in the abdominopelvic region over which the arrays were placed was above the therapeutic threshold of 1 V/cm.
Conclusion: This work shows that TTFields array placement can be optimized to deliver therapeutic field intensities to specific abdominopelvic regions. Tailoring the size and position of the arrays based on disease site and patient size may help to improve overall treatment outcome.
Citation Format: Ariel Naveh, Ze'ev Bomzon, Ori Farber, Noa Urman, Ofir Yesharim, Eilon Kirson, Uri Weinberg. Transducer array configuration optimization for treatment of pancreatic cancer using Tumor Treating Fields (TTFields) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3204.