Trilogy For Radiation New Device available

[RandyW]

PEORIA - After suffering with several bouts of "bad pneumonia," Joan Walkerhurst thought it was back.

"I felt kind of lousy, and because I had the history of pneumonia, (the doctor) sent me for an X-ray and an EKG. And that is when they saw the spot," she said.

That tiny spot was lung cancer, and doctors quickly reviewed her options.

"At first he thought I was a candidate for surgery, but my breathing wasn't efficient," said Walkerhurst, 82. "Then it was the business between deciding between traditional chemotherapy and Trilogy, this new radiation system they had."

The decision was made by Walkerhurst and her doctor to go with Trilogy, the latest radiation machine at OSF Saint Francis Medical Center.

It is a decision that Walkerhurst said saved her life.

"In this day and age, you see all kinds of machines, but I was delighted with Trilogy, and I am certainly singing the praises of (the doctors), they seem to be on the cutting edge. ... They are really familiar with the important new developments in cancer treatment," she said.

St. Francis was the first hospital in Illinois and is one of about 15 sites nationally to have this high-tech equipment.

"Traditionally there have been a lot of shortcomings in the way we have been able to deliver radiation therapy," said Dr. James McGee, director of cancer services for OSF Healthcare System. "This allows us to put the radiation in the right area."

More than half of all cancer treatments now use some form of radiation therapy.

The Trilogy System can deliver conventional forms of radiation therapy as well as focused radiation from multiple angles. That ability is used to treat hard-to-locate discrete lesions quickly and with unprecedented precision. It allows doctors to choose the most appropriate dose of radiation for treating cancer.

The idea behind Trilogy is delivering higher doses of radiation to smaller areas over a shorter period of time.

"I was trying to figure out why Trilogy was special, and to me it looked like there were three machines going around and they do different things," Walkerhurst said.

That is exactly why doctors like the system.

At the core of Trilogy is a high-powered linear accelerator, a machine that rotates around the patient to deliver radiation treatments from nearly any angle. More importantly, the radiation beam can be shaped to match the three-dimensional contours of the tumor. An imaging device on Trilogy provides fast, accurate, real time tumor tracking and automated patient positioning.

It takes at least three computers and as many as six to operate the system. Patients don't see or feel anything, but they will hear the buzzing sound of the machine, similar to a high-pitched cricket.

"We feel we have taken a large step forward by buying Trilogy," McGee said. "We'll be able to do a better job of protecting healthy tissue while delivering more powerful doses (of radiation) to the tumor. In the final analysis, this means improving cancer treatment outcomes for our patients."

The system arrived last summer, and doctors have been increasing its usage ever since.

Trilogy is put together so its rotational access is very tight. The machine weighs 18,000 pounds, and as it rotates, it wobbles less than one-fourth of a millimeter, further ensuring "a direct hit." The machine also is calibrated daily to ensure accuracy.

Doctors work with computers to help determine the pattern of varying intensity beams.

"You can make these . . . beams of radiation . . . that are ideal for the patient," McGee said. "In the past we wouldn't be able to get as much radiation dose, and if we did there would have been severe bowel and bladder problems."

Ensuring that the radiation is delivered to the correct place is most important. Technicians take pictures at the start of radiation, and align them with new pictures taken each day.

That is particularly important when the location is moveable, such as with the prostate. One patient's prostate had moved two centimeters from its original location, which would have meant radiation wasn't directly hitting the necessary spot.

"If the treatment were two centimeters off, it would have missed the (cancerous) part of the prostate, and the dose to the rectum would have increased, so you have a double negative," McGee said.

For long-term treatment plans, doctors implant tiny markers to identify where the cancer is located.

"The markers are easy to put in and allow us to get into the right locations," McGee said.

George Eiermann, 74, is among the patients using Trilogy to treat his prostate cancer.

"I was told that day (of diagnosis) that surgery was not an option. ... I read some things on the Internet. ... I decided that this Trilogy was a fairly new technology, and I determined it would do as good a job," said Eiermann, of Germantown Hills.

He had 9 1/2 weeks of treatment, finishing a couple of weeks ago.

Side effects were minimal, Eiermann said.

"The last couple weeks, when I was outside working ... I found that my stamina was not as good. I had no problems with feeling bad, burning, and all that kind of thing," said Eiermann, who is now waiting to see his doctor to see if it worked.

Walkerhurst, who lives in the Macomb area, needed only three treatments, which lasted about an hour each, and had no side effects.

She will continue to be monitored, but as of now, things look good.

"They think I am home-free. This system has been in place for such a short time they don't have that long of a history with results, but they did think they could promise five years at least, and at my age that is a large chunk," Walkerhurst said.

"With these doses of radiation, the chances the cancer will come back are much less then they would have been," McGee said.

Dayna R. Brown can be reached at 686-3194 or dbrown@pjstar.com.

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[RandyW]

The Trilogy™ System: For Image-Guided Radiation Therapy And Stereotactic Applications

Read about the

• Trilogy™ Accelerator

• Trilogy™ Stereotactic System

Varian Medical Systems has introduced the world’s first image-guided radiation therapy system optimized for both conventional and stereotactic approaches to treating cancer. The versatile Trilogy™ system can be used to deliver 3D conformal radiotherapy, IMRT, stereotactic radiosurgery, fractionated stereotactic radiation therapy, and intensity-modulated radiosurgery for cancer and neurosurgical treatment.

Trilogy is the first practical, clinically-viable system for delivering all forms of external-beam radiation therapy. It will enable doctors to choose and use the most appropriate treatment modality for treating cancer in the body or the head and neck, and to deliver the full spectrum of treatments, all on one machine in a single room.”

Trilogy represents a cost-effective means of expanding the patient case mix and treatment modality repertoire within a radiation oncology department. At the core of the Trilogy system is Varian’s 23EX Clinac® linear accelerator, which has been enhanced for stereotactic applications that involve delivering higher doses of radiation to smaller areas over a shorter period of time.

The Trilogy system is capable of delivering stereotactic radiosurgery by increasing its maximum dose delivery rate from 600 to 1000 monitor units (MU) per minute and by fine-tuning the Clinac isocenter, or focal point, to a 1-millimeter diameter sphere. Additionally, the treatment couch is moveable by remote control, which is necessary for speeding up treatment for the patient and maximizing the number of beam angles that can be used to optimize treatment.

With Trilogy, doctors have the option to treat some small lesions using stereotactic radiosurgery, which is delivered in a single treatment, or stereotactic radiotherapy, which is delivered over a period of a few days. The Trilogy system can also be used for conventional and conformal radiation therapy, which are delivered in daily small doses over a period of weeks.

The benefit of stereotactic approaches are generally realized with smaller lesions. As better diagnostic tools result in earlier detection, when the tumor is still quite small, stereotactic treatments are likely to play a larger role in radiation oncology.

The Trilogy system incorporates Varian’s Dynamic Targeting™ Image-Guided Radiation Therapy (IGRT) accessories for improved treatment precision, whether using conventional, conformal, or stereotactic approaches to radiation therapy. These currently include Varian’s new PortalVision™ aS1000, an electronic portal imaging device that produces high-resolution images for patient positioning, treatment verification, and quality assurance.

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