The type of IMRT machine they want to use for my brother is tomotherapy.
Anyone have any experience with this?

No experience, but I know our hospital only recently bought one. After ten minutes reading about it and IMRT and IGRT my brain hurts! It sounds like it is an improvement in targeting the tumour and reducing collateral damage. I look forward to someone else's more knowledgeable response.

I never had it either, but Tomo, a form of IMRT, different program, uses CT guidance in real time, which is good for moveable tumors, and works slice by slice, around the patient. There was a study with IMRT vs Tomo posted here a while ago, I think I may have, and believe Tomo was better in certain aspects, outcome.

Tomo seemed popular in 2009 when I was going to have radiation, and now I hardly read about it, everything is IMRT/IGRT, but some center who have it, still use it. Maybe other future investments seem worthwhile...Proton therapy.

http://en.m.wikipedia.org/wiki/Tomotherapy

Here it is. It's more of a challenge from the makers of Tomo.

http://medicalphysicsweb.org/cws/article/research/33598

There are so many options! So once NCCC (the one we go to has tomotherapy).
Not sure what the other NCCC would use for radation. A hospital an hour away which is not a NCCC has proton therapy. How do
We know which one is best.

From what I read Proton Therapy really works well. For what specific cancer profiles I have not a clue. I would absolutely ask your current doctors if radiation recommendations are still open for discussion. The drive may be an issue but pales if it means better outcomes, especially in patients so young.

[quote=donfoo]From what I read Proton Therapy really works well. For what specific cancer profiles I have not a clue. I would absolutely ask your current doctors if radiation recommendations are still open for discussion. The drive may be an issue but pales if it means better outcomes, especially in patients so young.[/quote]

We aren't worried about the drive as the NCCC is 45 mins away also. I just wonder is a hospital with proton therapy better than a NCCC with tomotherapy.

Paul and others are better educated and experienced to go into the details of Proton Therapy. I know for a fact the facilities and equipment are very expensive and there are still very few of them built. My understanding is it has the ability to better focus and treat the cancerous tissues more precisely and able to do less damage to non cancerous tissue.

I mention it as your brother is so young and the more that can be done to reduce long term side effects is more important the younger the patient.

Talk to the RO about Proton and get their opinion if it might offer better outcomes for him. There are so many variables it is virtually to make any sort of generalized suggestion except for the doctors who have the full data and expertise.

Don

Don answered better than I. Discuss it with your radiation oncologist. I think there are some requirements to meet in order for the doctor to approve it, either at the proton center or your referring hospital, as well as for insurance, over the use of other therapy, like IMRT, and is a case by case decision. Mine was recommended by my RO, probably as a last resort, in the recurrence setting, so there were no other options having already done radiation 4x in the same location, two IMRT and two IORT, and the new recurrence was on the carotid artery, which has a dose limitation, including the spinal cord, even though resected the buds still needed to be radiated.

The Proton Center I went to is a private for profit entity only for Proton Therapy, but 5 major NYC hospitals just affiliated with them in September, 2013, for their use, and would have one of their RO's on premises once a week, so it was a hassle to get radiation one location, and chemo another location, 2 hrs away, which was supposed to be at my CCC, but chose to have chemo locally, which was easier, somewhat, and still had to pay someone to drive me everyday to a remote area in NJ for Proton, once a week chemo. Some are associated, in or nearby a major CCC. There are a total of 14 Proton Centers throughout the country now.

It's expensive, $7,151 a day, but Medicare covered it, and I have full Medicare coverage with a supplemental, If not, the 20% non coverage adds up, but what Medicare pays is probably half. They did have grants, but never needed to apply.

Tomorrow I see my Proton Radiologist for follow-up.

Hi everyone,
So I called the second NCCC in MI(Ann Arbor) to see what machine they use for radiation and they use an IMRT machine that starts with a V. I asked them if they have tomotherapy (the place we are treating has tomotherapy) and they don't. To tomotherapy seems like it's more targeted and it's more slice by slice radiation.

My brother is expected to start radiation at karmanos on 9/15/14 tomotherapy and chemo. I trust the doctors at karmanos but I always worry . What if there is something better out there? UM said "you have to look at other factors and not just the machine" well the karmanos radiation doctor that my brother has is the chief of his department.

UM said they can squeeze us tomorrow morning for a second opinion but they wouldn't be able to start treatment until 9-19-14.

At this point is it worth another opinion?

It's probably Varian.

One of the side effects many overlook is the second guessing that can occur. Did we go to the right place? Did we agree to the right treatment plan? Was there another place that could have done it better? ......

Some people manage doubt quite well, others find it difficult and get quite stressed. If you have doubts now and tend to chant coulda-woulda-shoulda, get more input now and be 100% sure you are proceeding on the best path knowing all you know and reviewing all available options.

There are no do-overs and a short delay is a very small price to pay to have peace of mind if you are not 100% sure. All providers will fully understand.

Good luck
Don

Not heard of tomotherapy...my brother 42 has umdergone surgeryand his entire lower jaw has been removed n they ve put skin from the thighs but the flap is not responding coz no blood circulation in tht area..coz he is obese n diabetic...nyone any idea of nythng like this...even radiation n chemo is being delayed coz of this....

If the mandibulectomy surgery failed the patient could end up having to go thru it again. The procedure has a relatively high failure rate but I doubt it is due to obesity. This is a serious problem! Until the doctors can fix his jaw then nothing else will be done. It might be a good plan to consider getting a second opinion at one of the country's top comprehensive cancer centers. It happened to me too and I am now living without half of my lower jaw.

Best wishes!