High-dose adaptive tumor treating fields (TTFields): Expanding the boundaries of electric field therapy

Introduction: Tumor treating fields (TTFields) are a non-invasive cancer therapy employing alternating electric fields in the 100-500 kHz range to disrupt mitosis. Current TTFields systems use four fixed transducer arrays positioned on the skin near the tumor. This static configuration imposes two critical limitations: (1) electric fields remain confined between arrays, precluding treatment of multifocal or metastatic disease. (2) Delivery of TTFields through the skin leads to localized heating of the skin below the transducers. To avoid thermal damage to tissue, the power delivered must be controlled in a manner that maintains skin temperature below a safety limit of around 105°F, and if skin temperature exceeds this threshold, the device must temporarily halt field delivery until the skin cools to a safe temperature, leading to a reduction in delivered dose. The LB10000 system was engineered to overcome these barriers. It comprises a large array of individually addressable transducers whose phases can be dynamically modulated between three states (0°, 180°, off). This enables adaptive field steering, effective heat dispersion, and targeted energy delivery across the body. We present experimental and computational evidence demonstrating that the LB10000 delivers TTFields to multiple targets at doses substantially exceeding those achievable with existing systems. Methods: The LB10000 was applied to six female Yucatan pigs for 30-40 days to assess sustained high-dose delivery. Arrays were removed daily between 7-9 a.m. and reapplied between 12-3 p.m., targeting ≥16 hours of treatment per day. Skin temperature, treatment duty cycle, and current-voltage output were continuously recorded. To assess dose-delivery in humans, simulations were performed using the Sim4Life (ZMT Zurich, Switzerland) platform. Virtual arrays were applied to the DUKE (adult male), ELLA (adult female), and FATS (obese male) anatomical phantoms, with power levels matched to those measured in vivo. Electric field distributions were computed for tumors in multiple organ sites. Results: In vivo, the LB10000 delivered continuous fields at 130 V and 6 A (≈100 W[SK1] ) with 78-90[SK2] [זב3] % on-time, maintaining skin temperatures within safety limits and confirming robust thermal control. Simulations demonstrated that the LB10000 achieved mean intratumoral field intensities exceeding 2 V/cm in lung and liver targets-representing at least a two-fold increase over reported values from existing TTFields devices. Conclusions: The LB10000 enables adaptive, high-dose TTFields delivery with effective thermal regulation and extended coverage, supporting treatment of disseminated or multifocal disease. This technology represents a new paradigm for TTFields therapy, with the potential to significantly broaden its clinical impact.