Anyone have any opinions about tomotherapy?
It looks pretty interesting. I'm thinking of trying to use this if I am diagnosed. I would think it might be good but I dunno about whether or not it might be too accurate and miss stuff they don't know is there. I would think that it might be ver good at reducing side effects however.
Thanks.

Forgot to mention here is a link http://www.cancercenter.com/pharyngeal-cancer/tomotherapy.cfm
I am thinking about going to this place for treatment as I live in Oklahoma and it's probably about 2 hours away. Anyone know if they would be very good, and what is a good way to research cancer treatment centers?
Thanks again!

Before you waste your money and possibly your life read this: http://www.quackwatch.org/02ConsumerProtection/FTCActions/ctca.html

Try a google search on NCCN or NCI for legitimate comprehensive cancer centers.

That blew my mind lol, thank you. I am still curious about tomotherapy however and wondering if anyone has had experience with it or knows someone who has.

TomoTherapy is a registered trademark for a instrument which combines IMRT and CT to better target the area to be radiated, and to reduce damage to surrounding tissues. It is used particularly for cancers in areas where important organs/tissues lie close to the tumor, e.g. prostate, brain, head/neck. Most of the top HNC centers have or are getting TomoTherapy -- Johns Hopkins, Sloan-Kettering, etc. It is considered the next development up from IMRT.

We are going up Tuesday to consult with rad onc at Hopkins (Dr. Lee) and to find out more about TomoTherapy which is on-line there, and will post more when we return.

Btw, the JH web site has a page on TomoTherapy.

Barry Cooper

I've spoken to the Chief of R&D at Tomo a few times so if you need ANYTHING, just let me know...their installations are currently concentrated in the West Coast regions, but there are several nationwide.

In California, they are only in the Southern half.

- City of Hope
- Long Beach Memorial
- Hoag (Newport)
and a couple in San Diego

You might look into Stanford's new Cyber Knife as well.

good luck!!

I have posted this here before when IMRT hit the mainstream, and this "further development" of IMRT is interesting. But the truth of it all is that for the first time radiation oncologists have to know anatomy as well as a surgeon. Mapping the shape, intensity, and duration of many, many beams around vital structures, salivary glands, neurovascular bundles, and more - like known routes of metastasis is not as easy as radiation oncology used to be 5 years ago. More than ever, it is the knowledge and skill of the practitioner that makes the new technology useful or not. There is going to be a learning curve, and IMRT is still in one in many ways in the H&N world, and this extension of IMRT is no different. Just because Hoag, or LB has the equipment, I wouldn't necessarily correlate that to also having the experienced staff that has seen the volumes of patients and eventually their long term results that you would get at MDACC or MSKCC.... the fact is they just don't have the patient volume, and the "best of the best" are frequently attracted to the major centers for obvious reasons. It is always part science and part art. Medicine in not exact, and an improved piece of technology does not an improved outcome yield without the physician knowledge and experience component.

Barry,
treatment planning for IMRT is usually always done with a 3D CT. Sometimes they will also use fusion with a CT and a PET scan. I seriously doubt that what you described is a "further development", but rather some marketing spin on the tried and true.

When got my treatment 2 years ago, most regional treatment centers were just getting the LINAC upgrades. My RO is the top IMRT doc in the US according to the Castle Top US Docs book. She had a lot tricks up her sleeve (like limiting the dose through the thyroid and irradiating many lymph areas and the left tonsil as well) which she used based on vast amounts of experience and huge patient volume. She's also a clinical professor of radation oncology.

One of the things you want to ask in choosing a treatment center is their mortality ratio.

Although IMRT has been around for over 10 years now it was initially developed for prostate cancer. So the H&N application didn't start until some years later.

The cyberknife is used mainly for inoperable brain tumors. They have one at UCSF as well.

Update on the Tomotherapy device. I checked out their site. It seems like a more efficient way to do planning/treatment and probably more idiot proof, especially in local, regional treatment centers where there is no centralized medical team. Other than efficiency and idiotproofness, I don't see a lot of difference between Tomotherapy and the IMRT that Siemens or Varian offers. Many of the treatment planning photos amd dose curve histograms were very similar.

But in a world where the boomers are just starting to show up with cancer now (like myself) and they are running people through radiation treatment centers like cattle (and it's only going to get worse as the younger boomers enter the profile) this device makes sense.

One other item, from a regulatory perspective, if the device was offering new "indications for use" other than what already exists then they would have to file a PMA (Pre-Market Approval) which would take years to get the device on the market.

The device is listed under Section 510(k) [PMN - Pre-Market Notification] of the Food, Drug, and Cosmetic Act (K042739)which means it is "substantially equivalent" to existing devices. This is typically a three month or less process - It took them 29 days to recieve FDA clearance to market. Their regulatory guy must be good.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=16446

The major difference with tomo is that a CT scan is taken each day just before the radiation treatment starts and compared (by the system's computer) with the original simulation scan -- the computer then adjusts the IMRT radiation delivery to account for any changes in the location of the tumor(s) due to, say, weight loss, edema, or just normal day-to-day variation. Dr. Lee (our radiation oncologst at Hopkins) says that the device also allows the beams to be directed from more directions and he says it improves such things as sparing of the parotid gland (my notes have him saying that using regular IMRT he finds xerostomia reduced 50% over older EBR technologies and with Tomo, 66%. He uses amiphostine whenever possible, for further improvement). Since I have some rather significant upper end hearing loss, he wants to give me the Tomo as it will also allow him to avoid radiating my inner ears. (I will not be getting cisplatin for same reason).

Anyway, in again Monday for the simulation and meeting with the radiation nurse and more of the staff. A marathon session yesterday (7 am to 4 pm) so feeling both exhausted and somewhat encouraged. The Hopkins staff definitely are cognizant of patient's concerns re treatment and after-effects.

Lots of work being done there on HPV-related HNC (what they think I have) -- they took blood and tissue for testing. Survival rates for non-smoking patients appear to be better than the usual published results -- more like 2/3 after 5 years (their in-house data). They said it will help that I am (other than the cancer!) very healthy -- Dr. Forastiere said I was a perfect weight now BUT -- I should try to pack on some pounds before I start the chemoradiation as I will probably drop quite a bit of weight during the marathon.

A friend who heard about this sent me a huge cheescake -- should be good for about 10 pounds of bulking up!

Barry Cooper

DX 6/21/05, SCC, right tonsil and 1 cm base of tongue, T3N2bM0, Stage IV, tonsillectomy w/ negative margins except at b.o.t., no further treatment -- yet.