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#175308 12-16-2013 10:44 AM
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donfoo Offline OP
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For those geeks who are interested in the technology used for radiation therapy, this is some info on the machine that performed the treatment on me.

It is made by Varian and the system is called Trilogy. This system does not use a tube, rather you lay on a platform and the arm swings 360 degrees around you. One other thing of note is the system shoots the beam and is guided by a panel that has a large set of plates/fingers that constantly move in and out and provide the outline of the area being targeted.

Many people mention clicking. I believe this is tomo-therapy type systems that administer dosage in slices thus the clicks whereas Trilogy is 100% real time adjusting the dosage so there is no clicking or fixed slices.

Lastly, the "beam on" time is 60 seconds in each sweep around the body. It goes around counter then clockwise for a total of 120 seconds. I noted the time once and it was 5 minutes from the time I laid down to the time I popped off the platform.

Last edited by donfoo; 12-16-2013 10:44 AM.

Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
donfoo #175309 12-16-2013 01:55 PM
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Hello Don:

I too am using a Varian Trilogy. From conversations with my RT she says they can use the machine in two different modes.

1. Continuous arc - apparently what you are getting.

2. Point and shoot - as many stationary shots as dosimetrist determines necessary.

The method of operation is chosen by the RO. Apparently they have different opinions as to which is better. My RO prefers point and shoot, so I get 11 shots each treatment. Laying on the table looking up at 12:00, my shots start at 5:30 (below right shoulder), 5:00, 3:00, 1:30, 12:00, 10:30, 9:30,
8:30, 7:00, 6:30 and then back up to 12:00 with a table reposition for a super-clavicular shot where they radiate the lymph nodes below my adams apple. Each shot is about 15 seconds in duration.

After 25 treatments they terminated the super-clav, saying I'd received all the dosimetrist wanted.

New, the machines were about $2.4 million each. Mine is about 4 years old. It takes about 2 hours to warm up every day before use and the beam is high energy x-rays, capable of going through you as well as the concrete wall on the other side of the room. The wall next to the therapists has about a half inch of lead in it besides the concrete. There are parking spots outside the other wall, so I expect they put lead in that wall too.

I'm a bit of a techy too.

Tony

Last edited by n74tg; 12-16-2013 01:56 PM.

Tony, 69, non-smoker, aerobatics pilot, bridge player/teacher, avid dancer (ballroom, latin, swing, country)

09/13 SCC, HPV 16, tonsillectomy, T2N0.
11/13 start rads, no chemo
12/13 taste gone, dry mouth,
02/14 hair slowly returning
05/14 taste the same, dry sinuses, irrigation helps.
01/15 food taste about 60% returned, dry sinuses are worse in winter.
12/20 no more sinus problems, taste pretty good

donfoo #175323 12-16-2013 06:32 PM
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2.5" of concrete, 1" of steel and 0.5" of lead all reduce the radiation levels by about half. Very, very roughly.

My treatment started with the continuous arcs and then in the last several they switched to the targeted spot treatment. They called the latter "boost".


Oropharyngeal Cancer, SCC, HPV 16+, stage IV T1N2b age 45
Started in my tonsils and spread to my lymph nodes
Cisplatin x3 with concurrent daily radiation treatments started 10/22/13 finished 12/6/2013
donfoo #175324 12-16-2013 06:33 PM
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I had the Varian IMRT at one facility, most likely the same at two other locations, not sure of the models though, and looks the same as the Trilogy, but may have done "Rapid Arc" too, which dosage time is accelerated as mentioned, and they may do IGRT also, not sure. Mine, point and shoot, some continuous, took about 17 minutes for 17 zaps, done bilaterally, and left side received the most, 9, and longer time.

My last IMRT a year ago, was 6 zaps, and the techs had to come in and turn the whole table for the last two shots to be in a 3 o'clock position.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






donfoo #175333 12-16-2013 09:14 PM
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donfoo Offline OP
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[quote]Benefits of Trilogy

The Trilogy is the world's first image-guided radiation therapy system optimized for both conventional and stereotactic approaches to treating cancer. The versatile Trilogy system delivers IGRT as standard, and can be used to deliver 3D conformal radiotherapy, IMRT, stereotactic radiosurgery, fractionated stereotactic radiation therapy, and intensity-modulated radiosurgery for cancer and neurosurgical treatment.

The versatility of the Trilogy enables any area of the body to be treated using the latest and most effective treatments available. This includes advanced radiosurgery treatments. With full under couch access and multi-treatment modalities, the flexibility of the Trilogy helps clinicians offer treatments from a range of techniques suited to the needs of each patient.

In the case of IMRT, this includes:

Step and shoot
Sliding window
Small to large fields
Coplanar or non-coplanar fields
Radical or palliative plans[/quote]
As you can see Varian supports quite a variety of methods. It also needs the nuclear bomb shelter surrounding the thing.
From what I read about Tomotherapy is it is portable in that all the shielding is self contained, something like that.

Gulf - I've always wondered how common it is for treatment plans to alter the dosing of the fractions over the course of the plan. I suspected but never did validate that some of my side effects arrived at different times due to a change in what they zapped each day. Then again, it could just as easily be the simple accumulation of rads that take their toll in due time.

Last edited by donfoo; 12-16-2013 09:22 PM.

Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
donfoo #175586 12-17-2013 06:57 PM
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I did notice a variation in symptoms, too. The RO said the dose was constant, but maybe how it was directed altered the side effects.


Oropharyngeal Cancer, SCC, HPV 16+, stage IV T1N2b age 45
Started in my tonsils and spread to my lymph nodes
Cisplatin x3 with concurrent daily radiation treatments started 10/22/13 finished 12/6/2013
donfoo #175627 12-18-2013 11:43 AM
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donfoo Offline OP
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From the way the treatment plan is specified; i.e. 2yg by 35 fractions = 70gy, then that aligns with constant dosing throughout. As to altering the map over time, that seems less likely. Just from what I saw of the process of identifying the areas to be radiated and the contouring and creation of the actual plan that is fed to the accelerator, it seems like more work for the dosimetrist and the risk outweigh the benefits.
Of course, my guessing is about as good as counting grains of sand on the beach. :-)


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
donfoo #175633 12-18-2013 01:29 PM
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I had 35 doses from collar bone to chin (tumor and affected nodes). I then had 5 doses of "cone-down boost" to the tumor site. Ten days after the boost was, shall we say, interesting.


Dx March 2011 via FNA (49 yrs old)
SCC BoT
HPV+ exact strain unknown
Stage IVa T3N2cM0
Cisplatin x 3, IMRT x 40 (7267 cGy)
One node removed post-treatment (rad dmg)
Clean PET 10/28/11
Swallow therapy
donfoo #175642 12-18-2013 04:21 PM
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Interesting stuff for sure. I had Tomotherapy. From the little bit of reading I've done, it seems they are essentially the same sans the time on the table.

Here's an interesting article from 2008 on the subject.

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

The bottom line is if it works period. Both are equally effective from what I can discern.

Positive thoughts

"T"


57
Cardiac bypass 11/07
Cardiac stents 10/2012
Dx'd 11/30/2012 Tx N2b MO Stage IV HPV+
Palatine Tonsillectomy/Biopsies 12-21-12
Selective Neck Dissection/Lingual Tonsillectomy/biopsies TORS 2/7/13
Emergency Surgery/Bleeding 2/18/13
3/13/2013 30rads/6chemo
Finished Tx 4/24/13
NED Since
donfoo #175670 12-19-2013 10:00 AM
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donfoo Offline OP
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"T"
Great link. It highlights, at least at the time, neither one was clearly superior to the other. Five years on in the clinical medical business is not much time; yet I'd be curious if much has changed.

Don

Last edited by donfoo; 12-19-2013 10:01 AM.

Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
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