Calypso Presentation

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/17/2010 12:30 AM (GMT -6)   
I mentioned here before that we were having a guest speaker at this months UsTOO meeting here in Las Vegas tonight. And what a delightful presenter. Let me set it up with that first. The oncologist, Dr. Brian Lawenda, had practiced in the military but his credentials are impressive. He received his degree at Temple, did his residency at the Harvard Radiation Center, interned at Mass. General, and was well versed in IMRT, IGRT, and Proton Beam Therapy.

Tonight he spoke on IGRT and Proton therapy using the Calypso guidance seeds. I have several of them with me at home tonight. This isn't rocket science, er, maybe it is...

The Calypso system is basically seeds and an electro magnetic field. These tine seeds are not irradiated but rather preinstalled into the prostate to map it's location. The system tracks the location of the seeds and delivers IMRT radiation or PBT directly a the seed limiting the "overspray". It is based on the fact that the prostate moves around during and between therapies.

The cost of the seeds is about 1200.00 for three to be implanted. Most insurance will fight their use, but it is relatively inexpensive and a patient can elect to do it if they insurance won't. Then the normal process is followed.

It was a very impressive presentation but I attribute that to the RO. He was fantastic. He also is a specialist on integrative approaches to oncology like Mark Moyad is. He has agreed to return in November and present that aspect of prostate cancer treatment.

Tony

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 9/17/2010 7:14 AM (GMT -6)   
Sounds like a useful guidiance idea and maybe is a better concept (maybe?). Did you ask or anybody ask about possible 'synergistic' effect of radiation that could hit these planted seeds?
I don't know what is in these marker seeds and the argument may hold no water. But, in the past the arguments between Dattoli (Florida) and RCOG (Radio Therapy Clinics of Georgia-mulitple locations in Georgia-fyi). Was Dattoli says IMRT first then brachy seeds thereafter to prevent the 'synergistic effect' of radiations hitting those implanted seeds, this is vs. RCOG whom endorsed seeds first, then IMRT or EBRT radiations thereafter. I have not kept current on what RCOG is doing, maybe they changed their protocol or ignore the Dattoli argument.

I presume with todays knowledge the Calypso shouldn't have any concerns about synergistic effect, but I am not up on this stuff to know what is fact or fiction? Is this a concern in this? IS there any argument against its usefulness?
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35 normal, ct and bone scans appearing clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off for 1 yr., controlled so well, resumed, using intermittently, pleased with results

142
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Date Joined Jan 2010
Total Posts : 6945
   Posted 9/17/2010 8:19 AM (GMT -6)   
Zufus,
I did the Caylpso seeds in my post-DaVinci IGRT. The thread is in the sig below.
 
The "seeds" are actually tiny glass-encased transponders that are activated by the Calypso panel, which they position over you during treatment. Each one sends a unique signal (once done, you have an id card with the codes that they transmit that also is to give to the techs if you have to have an MRI in the future). They do not put off any treatment radiation.
 
Since mine were post- DaVinci, they were implanted in the mass of scar tissue that was expected to be the target. The objective in scar tissue was not to aim at them, but to use their relationship to the target area to refine/validate the daily position in the radiation plan.
 
You'll see, if you have the patience to go through the thread, that 2 times in the 39 sessions they did have to pause because things moved. I'm not sure that two sessions of nuking the wrong place would have made things worse, but I'm happy at least that was avoided.
 
It was a battle with the insurance company (they tried to write it off as experimental, even though the technology is installed in VA hospitals all over the country). We came to a compromise.
 
To add - the Rad. therapists looked at the mini-ct scan technology someone else mentioned, and they thought it was a comparable technology. They did say that the machine is dramatically more expensive, so may not show up in widespread use for a while.
My IGRT journey -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Post Edited (142) : 9/17/2010 8:25:15 AM (GMT-6)


John T
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Date Joined Nov 2008
Total Posts : 4223
   Posted 9/17/2010 9:57 AM (GMT -6)   
Tony,
Did he give any indication of the effectiveness of the Calypso system to just having gold markers? I know it's supposed to recaculate as the prostate is moving, but what are the true effects, does it reduce side affects by 5%, 10% ???
To answer Zufus's question: I did a lot of research before my implantation as to the "scatter effect" of implanting seeds before IMRT vs after. I came to the conclusion that there is no difference. The guys trained on the east coast prefer seeds after and the guys trained on the west coast perfer the seeds before as they give a clearer target to aim at even with the gold seeds. I think the before or after difference is much more a marketing differentiation, which both Dattoli and RCOG, are very good at.
Any system that delivers the radiation more accurrately is better, but I think you have to sift the marketing aspects out and look at the actual benefits. Sometimes a treatment is just more expensive, not more effective; just look at proton as an example.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


don826
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Date Joined May 2008
Total Posts : 1010
   Posted 9/17/2010 4:25 PM (GMT -6)   
My radiation was delivered by the Varian machine. I had three "fiduciaries" placed and mapped prior to the treatment. The fiduciaries are gold seeds placed such that the area to be treated is triangulated by the seed positions and this guides the beam and limits exposure of nearby tissue. The seeds are about the size of a grain of rice. I looked at the film when my seeds were mapped and they produced a very bright image on the screen. It would be hard to miss this during the treatment. In addition to the seeds I received two tattoos. One on each hip they are used to position the table prior to beginning the treatment session.

Don
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
PSA:
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/17/2010 11:42 PM (GMT -6)   
Bob there was very little concern for the synergistic effect. Because only three seeds are implanted the devices are not active in treatment. 142's experience mirrored what Dr. Lawenda stated.

John he compared the gold markers directly and stated that the Calypso beacons were active in tracking the equipment as the gold markers required human alignment. By this me meant that the electromagnetic field automated the alignment process versus human intervention. This is a bit different than what Don describes. The process is not entirely automatic in the gold marker process as Don said though he may know more about that than I do.

What was interesting is how the calypso beacons are used in SRT. Dr. Lawenda stated that this is a very complex process requiring physiologists and himself spending days mapping each patient.

it was a very cool presentation.

Tony

142
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Date Joined Jan 2010
Total Posts : 6945
   Posted 9/18/2010 9:19 AM (GMT -6)   
For the comparison with the gold markers - I did not understand that there was much of an initial alignment process difference between the two. Yes, I also had tatoos on each hip and one on my belly for initial alignment.
 
Then the calypso panel was brought over (and stayed during the session). It ran a short check, found the beacons, identified me from the signals, even pulled up information they took during the planning sessions to verify that they had the right person.
 
The initial positioning was still very manual, but I understood that the calypso was validation. Then, if anything moved during the session, it was detected by the calypso, things stopped, and the techs had to do whatever it was they needed to do to get things back in line. That was reassuring - had too many years with computers around for me to trust them to make decisions like that. 
 
Again, I only saw things actually stop twice. I understood that the changes were made by the techs from their control systems based on an indication that something moved, not by the calypso itself, but then I would love to have seen a full presentation of the equipment myself from the manufacturer's view. I think I have a cd presentation around here somewhere.
My IGRT journey -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/18/2010 9:23 AM (GMT -6)   
142,
Dr. Lawenda did touch on the tattoos. He said that they are still used for initial positioning but they are also a fall back if the beacons fail. Basically you resort back to IMRT.

Thank for you input here. It's always best to have personal experiences represent the facts.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 9/18/2010 11:16 AM (GMT -6)   
So it's not a continuous alignment and it only points out out of alignment situations that the tech has to adjust. For some reason I thought the beam tracked the calypso beacons and made constant adjustments as the prostate moved.
With the gold marker alone only an initial adjustment with a CT scan is made. There are no midcourse realignments.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/18/2010 11:21 AM (GMT -6)   
No Dr. Lawenda pointed out that the prostate can indeed move during therapy and that an adjustment can be made in the therapy session. He showed two examples.

1> Treatment itself can cause movement. This is usually only slight but enough to put the rectum in the line of sight.

2> A patient can have gas move into the rectum. They will stop the therapy and wait for it to pass or they will readjust after the positioning is stable.

I'm sure there are other reasons the targeting can change...

Tony

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6945
   Posted 9/18/2010 11:42 AM (GMT -6)   
Tony,
 
The points you mentioned are what I experienced. At least one "stop" was because I had some bowel issues later in the sessions. Wasn't really sure what happened the second time.
 
Also, as treatment progresses, I was told that the tissue starts to react, and can move (swelling, most likely).
 
I went back and did a quick run-through of all the booklets & DVD I have - they all make the point of constant monitoring and real-time information to the technician. There is no claim that the Calypso initiates any treatment changes. Just notification, and alarms if tolerances are off. 
If you have a bad tech who is sleeping on the job, it might not be as useful smhair
I didn't see any of mine yawning or checking sports scores, so we will expect good results.

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 9/18/2010 2:24 PM (GMT -6)   
During one session the machine did stop and the table adjusted. The technician said this was because the machine detected that the markers were not in the prescribed position. Prior to my treatment they showed me how this worked. The image came up and there were the three markers and out of phase was the treatment plan. I.E. another set of markers on the screen that indicated the machine beam delivery and tracking. The machine them brings the two images into sync resulting in one image. Thus the actual measurement for session is overlayed by the treatment plan. I guess I got a bit more into this than typical but it was really interesting.
 
I forgot about the tummy tattoo but I have that as well. And yes the seeds are not radioactive and are only for positioning feedback.
 
Don
 

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/18/2010 2:30 PM (GMT -6)   
After this weeks meeting I was left with about a dozen of the beacons. I'll hand them out to anyone at our meetings considering this treatment. They are indeed fascinating.

I love the technology and wish I had more knowledge about it when I was going through it. It would not have changed my primary treatment choice as that was predicated on getting that complete pathology.

But I would have gone that route for SRT.

Tony

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6945
   Posted 9/18/2010 3:22 PM (GMT -6)   
Tony,
 
It would be fun to have one of the beacons for "show and tell", but I will settle for the three I've already got. A little hard to show off, but I've got an id card! Sort of like knee replacements at the airport.
 
This (the implied improved potential result of using Calypso) was a key part of the proposal to use IGRT as the primary treatment, but I wasn't convinced for a lot of reasons, and went the DaVinci route as primary.
 
 
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