TomoTherapy, Varian TrueBeam, and HDR Brachtherapy

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 5/19/2011 11:20 PM (GMT -6)   
Tonights theme in our UsTOO group was radiation therapies. Dr. Anita Pomerantz from the Nevada Cancer Institute presented and then toured our group. I was able to arrange Anita because she is wonderful and a cool lady (and her husband David is the RO that irradiated my prostate bed...). I took these pictures and wanted to share them with this group. Kinda cool stuff. The technologies were:

1> TomoTherapy ~ this device combines CT scanning with a 3D linear Accelerator.

2> Varian TrueBeam IGRT ~ This is an IMRT device with a "camera".

3> HDR Brachtherapy ~ This device cooks quickly and the radiation delivery rods are then removed.

www.facebook.com/media/set/?set=a.1885415228873.108300.1646165444&l=01fb70a191

It was a great presentation and the group loved the tour and the presentation...

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3746
   Posted 5/20/2011 8:29 AM (GMT -6)   
Tony, thanks for the great information. It is good to see that you and others are being exposed to information on HDR. It was part of my treatment choice and my research included meeting with the rad-oncs at the country's premier seed operation here in Atlanta.

My oncologist was glad I chose HDR saying that "seeds are last century....HDR is 21st century". Sort of like moving from open surgery to robotic assisted.

My choice of HDR was based on three main factors; it is much more conformal to the tumor, the radiation source does not stay in the body and thus can not move around with the natural changes in the body over time, and it delivers a very high quick kill dose that compliments the lower slower kill dose of the IMRT.

I again refer everyone to www.cetmc.com and the work of Dr. Jeffrey Demanes at UCLA, who is regarded as the pioneer of HDR. He is a featured speaker at the PCRI 2011 Prostate Cancer Conference in Las Angeles this September.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/20/2011 11:04 AM (GMT -6)   
JNF if you are going to this years PCRI event I will be there as well. Let's make sure we hook up...

Tony

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/20/2011 11:26 AM (GMT -6)   
Good post, Tony
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 5/21/2011 12:31 PM (GMT -6)   

Hi Tony,

How long has the HDR been around? I do not recall coming across this in my initial research in 2008.

On the subject of treatments I just got a Mayo Clinic bulletin and they are using laser ablation at the Florida location for PCa primary and salvage treatment after surgery. Article did not address salvage for failed RT but seems to me it could work if the disease is still local.

Thanks for posting the ifomation.

Don


JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3746
   Posted 5/21/2011 6:27 PM (GMT -6)   
Demanes started using HDR in 1981.   For 10 years he used both HDR and permanent seed brachytherapy.   Based on his comparative results of the two procedures he has only used HDR since 1991.   HDR is also used for many different cancers.  
 
It isn't well known because over the last 15 years more attention was given to permanent seed brachytherapy.   In some areas rad-oncs have been using HDR and it is growing.   I am in Atlanta and one hospital uses HDR and my rad-onc practice has two people that do HDR.   Together they are performing 8-10 procedures per week.   My rad-onc is the junior and he and my urologist have done well over 1,000 procedures.   I understand that the hospital also does about a dozen procedures per week.
 
In Atlanta we also have the nation's preeminent permanent seed brachytherapy clinic headed by the doctor that pioneered the delivery of seed brachytherapy combined with IMRT concurently.   Thus we have a lot of radiology options.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3742
   Posted 5/22/2011 9:17 PM (GMT -6)   
If these treatments are so wonderful, why are there so few doctors performing them?? In Denver, the latest linacs are everywhere but getting any form of brachytherapy performed is almost impossible..You would think it would be the other way around if HDR was so superior...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/22/2011 10:33 PM (GMT -6)   
Fairwind,
While each of these devices can be utilized as a primary treatment for prostate cancer, one must not lose focus of the other uses in prostate cancer. The tour focussed of primary care, salvage and adjuvant care, and also on palliative care. While HDR is mostly designed for primary care it is not well documented on it's efficacy. However that stated, permanent seed implant has less side effects and supposed better long term performance with later techniques. That stated the center I was at had the latest new equipment and has instituted a HDR program for prostate cancer. The other two forms are well known and have been around a while. The Varian TrueBeam RapidARC system is latest technology applying IMRT through image guided technology. The TomoTherapy has been around a while.

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4226
   Posted 5/22/2011 10:43 PM (GMT -6)   
Fairwind,
I think the answer to your qustion is that the external radiation machines are used to treat all types of cancer and PC is probably a small percentage of thier use. Brachy both high and low dose is pretty much limited to PC and there are fewer doctors that practice it.
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3746
   Posted 5/23/2011 8:16 AM (GMT -6)   
Demanes, Martinez, Liu and a few other doctors have all published 7,10, and 15 year experience studies on HDR brachytherapy. Demanes also has a paper on the PCRI website. Recently he published a study on HDR monotherapy for low risk PCa showin a 96% disease free rate at 8 years.

HDR is used in many other cancers including breast, gynecologic, head and neck, esophageal, lung, bile duct and soft tumor sarcoma. Demanes reported a year ago over 21,000 HDR procedures with about 40% prostate and about 30% gynecologic. My rad onc practice used HDR for lung, head and neck, breast, and gynecologic but the bulk is prostate.

HDR is getting more popular, but is still relatively limited compared to permanent seeds. The HDR requires more equipment including CT scan to confirm the placement of the catheters and the afterloader. Not everyone wants to invest the additional money.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011
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