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True Beam Radiotherapy System

Builder23
Posts: 29
Joined: Jun 2013

Has anybody heard of or is familiar with the True Beam Radiotherapy System?  A Cancer center in my area is installing this $4.5 million dollar machine and stressing this as a new extremely safe and offers pin point accuracy for treating cancer.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

From a brief review, TrueBeam apparently claims an deliver EVERY current form of radiation treatment -- 3D conformal, IMRT, IGRT, SBRT, you name it.  I find that hard to believe and not sure it that's even desirable in one piece of equipment BUT who knows.  If it works, it would be great.  Then you could match the type of treatment desired for the specific cancer involved (not just PCa) and just go to one location to get it done.

 See: https://www.21co.com/radiation-therapy/technologies/varian-truebeam.

 

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3228
Joined: May 2012

Builder,

 

As SSW'ers article notes, TrueBeam is a Varian-multimodality machine.  Varian is a competing company with the folks who build CyberKnife.  CyberKnife and True Beam can both deliver SBRT radiation, and both are pretty close to identical regarding available SBRT bells and whistles. Cyberknife is SBRT only however, I believe.

TrueBeam adds the other modalities (IMRT/IGRT) in one machine, selling it to hospitals as a cost saving device (again, repeating SSW). TrueBeam can also feature the Calypso radio frequency/GPS tracking technique for beam guidance. I was offered Calypso-guided IGRT by the radiation oncologist I consulted with before decideing on surgery.

My hospital system and its cancer center installed TrueBeam several years ago. Several guys here have described the difference as 'Ford vs. Chevy.'  IF a patient needs SBRT radiation, they are a match.  No compelling reason to drive past one to get to the other.

 

Old Salt
Posts: 720
Joined: Aug 2014

As far as SBRT is concerned, all the papers that I have read present results from CyberKnife treatments. I am thinking about the many (!) papers from the King group, the Katz group and the Collins group. And there are papers from non-US investigators as well.

Although, the True Beam system is supposed to deliver an 'identical' treatment modality as the CyberKnife system, are there data (preferably in refereed journals) to support that hypothesis? Perhaps those data exist; I just haven't made an effort to search for them.

hopeful and opt...
Posts: 2218
Joined: Apr 2009

Dr. King did his original research using cyberknife while he was at Stanford. He now does SBRT using Novalis, a competitive machine. Apparently there is little difference found in patient success  between  Cyberknife and Novalis machines...as discussed above, a ford versus a chevy. I am not familiar with the True Beam system, but I would bet that the effectiveness of this machine providing SBRT is similar to the others.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3228
Joined: May 2012

Novalis IS Varian.  Varian is the manufacturer, Novalis a trade name.  Novalis states a manufacturer of Brainlab AG, of Munich, Germany, but Brainlab is in turn owned by Varian.  Same for TrueBeam: TrueBeam is a Varian product also (see SSW's link, above).

My cancer center, on one of the doctor's blogs, presented a lengthy article on why they went with Novalis vs. Cyberknife: For versatility and to save money.  His blog, if I can locate it, cites many articles establishing that Novalis is equivalent to CyberKnife. I will look for it.

This article from JNCI, Nov 2011, says many doctors prefer one or the other, but that many questions remain about certain aspects of SBRT generally.  Please read for yourself.  The article says also that there are not just two SBRT manufacturers, but many.

http://jnci.oxfordjournals.org/content/early/2011/10/17/jnci.djr447.full

https://www.varian.com/oncology/products/treatment-delivery/truebeam-radiotherapy-system

https://www.novalis-radiosurgery.com/patient-center/faqs/

max

 

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Swingshiftworker
Posts: 1013
Joined: Mar 2010

Like most of the rest of us here, I'm no expert (not a doctor, engineer, etc.) but while the techniques used in True Beam and CK may both be called SBRT, they are NOT necessarily the same.

When I had my CK treatment, I was told (and saw) that UCSF was using Accuray/CK's proprietary equipment AND software.  While the mechnical device (the bed and arm) may be similar, there may be some mechanical differences in the positioning of the arm/bed, but those differences probably aren't critical, unless there are some limitations in the True Beam design that limit the arm/bed placement and/or range of motion.

The more important difference, however, is probably in the proprietary software used to control the delivery of the radiation itself.  Just before I was treated, my RO said they they just had just installed the most recent software update from Accuray at that time.  My treatment had to be delayed because of it.  So, Accuray (and I assume other vendors) are constantly tweaking their software to make cancer identification and radiation delivery (using the CT/MRI scan overlays) better/more accurate.

So, it is very important to pay attention to this in assessing the studies that you mention, particularly for Katz's results since he's clearly an advocate/spokesman for Accuray and uses CK exclusively.

That said, there is NO way to determine if one method of SBRT delivery is better than another in an INDIVIDUAL case, because all cases are different; perhaps for groups of patients with similiar PCa characteristics over time but not individually. 

As far as I know, the only "long term" SBRT/PCa studies currently available are limited to CK because it has been around the longest and has been the most used method to date.  Not sure about Varian but, in my research awhile back, I hardly ever heard Varian mentioned in a study.

So, if you need SBRT now AND want/need to rely on the available "long term" research, you're probably limited to using CK.  Without comparable data, if you use True Beam/Varian or other methods, you'll just have to HOPE that they can achieve the same results as CK. 

Not exactly a "crap shoot" but it still will be an unknown.  We all differ in our risk tolerance.  So, this may matter to some but not others.  On the other hand, some may not be able to "choose" CK because Varian (or another SBRT approach) may be the only one available to them where they are receiving treatment.

There wasn't much data 5 years ago when I had my CK treatment, but I went ahead w/CK because I thought the pros outweighed the cons (vs surgery and BT, which were my only other options) and the "lack of data" didn't concern me, but I recall that there were a few men here who said that there still wasn't enough data for them to to take the chance on CK back then and opted wait (until there was more data) or to go with another treatment method then instead.

To each is own . . .

 

 

 

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

This is an interesting discussion regarding RT guns. I am not an expert on the matter so I have abstained from commenting. In any case, one should note that the data on outcomes used as reference for choosing the "best" or the ideal, must be "differentiated" in terms of treatment Gy (Grays) and "volume" administered in each fraction. SK has proven to be reliable and delivered "great" results in hypofractionate therapies (delivering high "volumes" in one shoot). In any case initial SK machines would revolve around the patient shooting once from each direction. Newer machines are prepared for delivery the hyperfractionated rays at one time from several directions (SBRT). The machine, therefore, is different. Some look like a CT (circular) with high-energy delivery capabilities (Tomotherapy).

In the link provided by Max one can read about the use of SBRT (CK) to debulk tumours leaving the patient in a chronic status for later treatment (spot radiation). It also suggests about SK used in "zipping" types of therapies substituting the conventional IMRT machines.

Best,

VG

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
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Joined: May 2012

Let me say that like VG, I claim no "expertise" with radiation.  I merely passed along what I was told when consulting with a radiation oncologist with whom I had a consultation.  Because I have been reading a lot of posts regarding CK since I begain here, when I see articles comparing Varian and CK, they catch my attention. Since a pulmonologist has been following a small nodule on my right lung for two years (very likely benign), I realized that I may someday need precision radiation myself.  Hence the interest, and an attempt to "stay current."  The linked articles I submitted are a three-second Google search for anyone interested in the subject.

CK and Varian machines no doubt have minor, proprietary differences.  What I have read at independent sites suggest that they are both too new for either to claim "Best."   As my first linked article notes, arguing about "best" is a marketing activity, not a medical one. 

Fortunately SBRT is saving lots of men's lives with minimal inconvenience and minimal immediate side-effects.  Allways a good thing, regardless of "brand."  I'm thankful they are available and increasing in use.

 

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hopeful and opt...
Posts: 2218
Joined: Apr 2009

 

Back in Aurgust 2012 I asked some questions  to compare the Novalis and Accuray delivery machines at the cyberknife.com discussion site. Here is the post and answers for your information.

 http://cyberknife.com/Forum.aspx?g=posts&t=5088#jumptobottom

 

Also asked at this site

http://csn.cancer.org/node/243703

 

.......................................

Here is the cyberknife discussion site for prostate cancer

http://cyberknife.com/Forum.aspx?g=topics&f=2586

 

......................................

 

Here is a "Stereotactic body radiotherapy for localized prostate cancer: pooled analysis from a multi-institutional consortium of prospective phase II trials." From these various institutions, cyberknife and novalis cases., are used to contribute to the total SBRTs. So Novalis and cyberknife cases are combined. Additionally there are different Gy's by the various docs. Most of the docs administer SBRT in 5 days, but at least one Fuller administers SBRT in 4 days.

http://www.ncbi.nlm.nih.gov/pubmed/24060175

 

.............................

 

Here are various studies about SBRT found at Pubmed.gov

http://www.ncbi.nlm.nih.gov/pubmed/?term=sbrt+prostate+cancer

 

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

Sorry for my mistake in my post above; mine SK reference should be CK (CyberKnife).

Hopeful (Ira)'s list of links is great for those investigating details on the treatment. A note to above Max's comment "precision radiation", I would think that all modern machines manage to deliver radition with precision. CK is not the only one in such respect but it can provide higher volume of grays in one goal (with the same level of precision), therefore good in spot radiation of particular cases.

Proton RT is the only system that manages to deliver high grays to a predefined spot with no prejudice to the tissues in the same ray's direction beyond the spot location. Photon machines deliver rays that will cross the whole boddy affecting the tissues in its path. The delivery direction in hypofractionate must be well study for not affecting organs positioned before and after the "spot", which may lead choosing a treatment based in low grays deliveried in a number of fractions.

Best

VG

 

 

roryo's picture
roryo
Posts: 2
Joined: Apr 2019

I'll let everyone know how my planned True Beam treatments go.  I have to 2 radiologist consultations in the next 2 weeks, one with Torrance Memorial CA as they are suposed to have the latest model and one City of Hope Torrance, who too has True beam (dont know how old).

I was diagnozed last year when PSA climbed in just 4 months from 4>12>26>39 in a matter of about 120 days.  The biopsy confirmed gleason 9...not a 10 but might as well have been.  Surgery was performed Nov 2 2018, jan 2019 psa was .04...holding my breath until Feb did not prove to be promisng, it went to .12, then around .29 and just this week it went to .50.   The good news is,the radiology report from a axiom pet scan concluded it was  "mild" and they are condident it can be killed with True Beam...

I have a Road full of Hope!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3228
Joined: May 2012

I hope it goes well for you, roryo.

City of Hope is among the best cancer networks in the world, true leaders in research.  They developed the breakthrough drug Rituxan, which dramatically improved the treatment of non-Hodgkin's lymphomas.  You can be confident that everything they do is world-class and up-to-date.

max

mstoriop
Posts: 34
Joined: Dec 2016

Best of luck Roryo hopefully your follow up procedures will lead to a great recovery.  I wanted to dig out some old notes before adding any information to the original question of True beam versus Cyberknife etc.  I don't have much to add to the comments above they cover pretty much what I more or less learned along the way.  In my due diligence which included consultations with both surgeons and radiologists, and after I decided to go with Cyberknife, I was very fortunate to have two different hospitals in very close proximity that could deliver Cyberknife SBRT.  I did not choose one hospital for a few reasons, none haviong to do with my thoughts regarding their abilities as they are very highly regarded.  I did however have a great discussion with the Radiologist.  I found out that their Cyberknife system was installed around 2004 and he personally was on staff since 2007.  He was not forceful at all but suggested that if I wanted cyberknife at his facility to decide quickly as their system was soon to be deactivated and replaced by True Beam in a completely newly constructed wing at the hospital.  This led to a really good discussion as to whys and comparisons.  In summary, and straight from the Doc's mouth was that the new system was an economic decision as it could deliver several different modalities with the same equipment.  He had no reservations about the True Beam except he honestly had no direct experience with it and obviously had great comfort with Cyberknife as he was close to 10 years with it.  As with all above I am no expert in any way just ended up with Cyberknife as my choice.  I do believe though that after my decision on this path was made, and I only had the True Beam to choose from, knowing it seems to be at the least a fairly comparable technology to Cyberknife, I would have chosen it.  Best Regards.  Mike      

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