A New Method for Optimal Placement of Tumor Treating Fields Electrodes.

Overview: Tumor Treating Fields (TTFields) provide a non-invasive treatment option for newly diagnosed glioblastoma. While optimization of electrode placement is important to increase treatment efficacy, clinical therapy planning is done using an undisclosed and proprietary software (NovoTAL®), which is clinically unvalidated. This study investigates a new computational approach for optimizing TTFields electrode placement and is compared to the current clinical standard. Methods: We developed a new computational pipeline integrating patient-specific anatomical data to optimize electrode configurations in five representative glioblastoma cases with diverse tumor locations and sizes. Two optimization strategies were employed: one maximizing electric field intensity at the tumor, and another enhancing coverage of the adjacent brain while maintaining sufficient tumor intensity. Results were compared to electrode placements generated by NovoTAL®. Additional simulations with artificial tumors assessed the effects of tumor size and location. Results: Optimized electrode placements improved electric field intensity in tumors by 18%-34% compared to the clinical standard. Coverage-weighted optimizations provided broader field coverage without significantly compromising tumor intensity. Smaller or surface-adjacent tumors benefited most from optimization, achieving precise targeting and enhanced coverage. Extensive randomized placement analyses highlighted the superior performance of the optimized configurations. Analysis of artificial models showed consistent improvements across varying tumor locations and sizes. Conclusion: Personalized optimization of TTFields electrode placement significantly improves electric field targeting of tumors and adjacent brain regions. This approach outperforms standardized planning software and clinical practices and supports future development of adaptive, automated strategies for individualized TTFields therapy in glioblastoma.