Novalis vs CK

[KathleenMary]

Hi all,
  I have been reading about Novalis and would like  feedback on Novalis vs CK, is Novalis better, worse than CK?  I have another thread going but I continue to look and ran across Novalis and I think I read a comment that was not real great on Novalis somewhere on one of these threads and just thought I would see if I could get some feedback.  Will be seeing neurosurgeon at the University of Colorado Hospital in Denver area, for second opinion next week and  they have the Novalis and not CK....so another issue  to think about.Is the Novalis the latest technology or CK?  Thanks for your input.  KathleenMary

[Joseph]

Interesting... this is new technology... many here may not have even heard of this. Like myself I have not heard of this but quickly googled it and found out all kinds of information. I am currently debating whether to go with GK or CK and have been leaning towards CK, but this is another option I was unaware of so thanks for the heads up. I will study this in more detail...

           

[iluuvpups]

I had never heard of Novalis until your post.  I too googled it and read some.  It certainly seems to be another option.  I'll be curious to see what both of you decide.  Keep us posted on what you learn!  --Carol Ann

[ppearl214]

Novalis machine has been around for a good number of years... usually treating AN's over a time period of 25-30 days.  They tout on their website of having a margin of error of +/-2mm when targeting the tumor. I know of some that have had successful AN treatments with Novalis and some not (as with any treatment option, the chance is there of the outcome not being what was hoped).

CK was developed approx 15+ years ago at Stanford Univ by John Adler.  CK touts a margin of error of +/-.85mm (at last check) when targeting the tumor.  I know of many (incl myself) that were successfully treated with CK and some that have run into issues (ie: enhanced hearing loss, etc).

I believe both are "comfortable" in treatment (I believe Novalis treatment of AN also uses a "mask"..... someone pls correct me if I'm wrong) and can be done in single-dose or "fractionated" over a number of days. CK treatments on AN's tend to run (on average) 3-5 days, depending on situation although I do know of one in AZ that also had a single day dosage since her hearing was very low in her AN ear and hearing retention was at a minimal.

Those are basic, laymen info I can share. I know there have been posts here done in the past (in this "Radiation/Radiosurgery forum) that you may want to do a "search" option for both treatment options to see the many discussions here in the past. I believe "Mark" has shared terrific knowledge in the past about these 2 radio-treat options and would look for his posts for simple comparisons.

Not sure if this helps but wishing you well during this time. We're all here to help as best as we can!

Phyl

[iluuvpups]

Thanks for your informative post, Phyl!  I wonder how both of those options compare to gamma knife?  Do you know what the margin of error is on that?  Thanks.  -Carol Ann

[ppearl214]

Thanks for your informative post, Phyl!  I wonder how both of those options compare to gamma knife?  Do you know what the margin of error is on that?  Thanks.  -Carol Ann

Hi Carol Ann... glad to help if I can.  Both, CK and GK, are touting the approx same total margin of error of 0.85mm (there is some wiggle room on that... I have heard recently that the CK number may actually be just slightly better, but overall, the 2 run about the same, give or take....).  GK has been around since the 1960's and is also a very viable AN radio-treatment choice.  Although CK has not been around as long as GK, both are being shown to be very viable AN treatment options.  Many of us (including myself) are anxiously awaiting updated data out of Stanford (Dr Steven Chang) re: CK.... trying some back door tricks to see if I can get some insight into the data. I do have confirmed that Beth Isreal Boston is now publishing a paper (could possibly be in peer review right now but double checking that as well) as they are now touting 100% hearing retention in all AN's treated with CK at their facility (I am part of that study and do confirm that they did save 100% of my serviceable hearing... I'm still at 94% hearing recognition).  So, from a CK standpoint, much data is forthcoming and looking forward to sharing.

Univ of Pitt has some extensive data/studies that have been published over time for their work with GK.  Many times, here on the forums, the Univ of Pitt studies have been posted (too many discussion threads for me to count) and would suggest doing a "search" option for those data studies as well.

To me... IMO..... the data now coming out, across the board for radio-treatments of AN, seems to be extremely positive. Now, on the flip side, I know of some that unfortunately do not fall in the "success" rate numbers but, overall, the success rates of many of the radio-treatments are well over 90% successful and tickled to see that the medical community is recognizing this and thus, helping to provide add'l options for AN'ers (for those that have smaller AN's -- typically less than 3cm) for those that have options (vs. no choice but to have surgery).

Bottom line, it's a personal choice (for those that have choices) and great to see the data now starting to really take notice to the efficacy of radio treatments on AN's.

Sorry, I had a 2nd cup of coffee.

Phyl

[sunfish]

Phyl's answer sounds right on track with what I've read, too.  I had CK about 5 months ago.  I like the feeling that there's over 90% chance the brain sucker is dead!

My coworker's brother is a radiation oncologist - he says Novalis is quite good too.

[ppearl214]

I like the feeling that there's over 90% chance the brain sucker is dead!

....and sending healing hugglez to keep that brain sucka' on its death path! xo

[Tumbleweed]

Regarding the different types of radiation treatments, there is more to consider, of course, than just the accuracy of each procedure (although accuracy is of paramount important). I compared CK and GK in a previous thread, here: http://anausa.org/forum/index.php?topic=6670.0 (look partway down the page for my post).

Here, for your convenience, is an excerpt copied from my post:
CK delivers a more homogeneous dose to the tumor compared with GK. CK delivers only 15% higher dose to the center of the tumor than at the periphery, whereas GK delivers fully double (100% greater) dose at the center compared to at the periphery. CK advocates believe that GK's higher dose at the center of the tumor increases the chance of damage to nearby healthy tissue. Also, GK delivers one large dose to the tumor because one treatment is all you can do with GK (this is because a ring is fitted to your head for the treatment and, once it's removed, there's no way to get it exactly in the same place for a second treatment). With CK, on the other hand, a thermoplastic mask is custom-fitted to your head and the tumor's location (in relation to the mask and your bony structures) is plotted into the computer; on followup visits for treatment, they put the mask on your head again and you're ready for the next dose. This flexibility allows CK to apply smaller doses to the tumor than GK with each treatment; together, the smaller doses add up to the same total biologically equivalent dose as you would get with GK's one and only treatment, but (theoretically, at least) the hearing nerve and other healthy tissue has time to recover in between treatments (whereas the tumor supposedly doesn't recover as quickly). Presumably due to the fractionating of dosage, studies show CK yields slightly better results at preserving hearing compared with results for GK. Furthermore, GK's ring is screwed into the head (the screws stop at the skull) to keep it stationary (so that the radiation stays focused on the tumor), a mildly invasive procedure. CK is totally non-invasive: a series of overhead X-rays tracks the patient's head movements and tells the computer-controlled CyberKnife machine which way to move to track any small movements the patient may make so that the radiation stays centered on the tumor. GK advocates say that's all well and good, but GK has about 40 years of track record, whereas CK has been around a lot less time and is not as proven of a treatment as GK. (CK was approved by the FDA in 1999, although Stanford University Medical Center has been using it since 1994 in clinical trials because their Dr. Adler invented CK.)

Best wishes,
TW

[iluuvpups]

Thanks to everyone for their responses!  I've learned a lot on here.  I hadn't previously thought to investigate some of the other options, but I will now. 

[ppearl214]

TW, what is the source of this data? It's a terrific exerpt and I'd like to be able to note the source if I use this info.  Can you pls confirm? Thanks! Phyl

Regarding the different types of radiation treatments, there is more to consider, of course, than just the accuracy of each procedure (although accuracy is of paramount important). I compared CK and GK in a previous thread, here: http://anausa.org/forum/index.php?topic=6670.0 (look partway down the page for my post).

Here, for your convenience, is an excerpt copied from my post:
CK delivers a more homogeneous dose to the tumor compared with GK. CK delivers only 15% higher dose to the center of the tumor than at the periphery, whereas GK delivers fully double (100% greater) dose at the center compared to at the periphery. CK advocates believe that GK's higher dose at the center of the tumor increases the chance of damage to nearby healthy tissue. Also, GK delivers one large dose to the tumor because one treatment is all you can do with GK (this is because a ring is fitted to your head for the treatment and, once it's removed, there's no way to get it exactly in the same place for a second treatment). With CK, on the other hand, a thermoplastic mask is custom-fitted to your head and the tumor's location (in relation to the mask and your bony structures) is plotted into the computer; on followup visits for treatment, they put the mask on your head again and you're ready for the next dose. This flexibility allows CK to apply smaller doses to the tumor than GK with each treatment; together, the smaller doses add up to the same total biologically equivalent dose as you would get with GK's one and only treatment, but (theoretically, at least) the hearing nerve and other healthy tissue has time to recover in between treatments (whereas the tumor supposedly doesn't recover as quickly). Presumably due to the fractionating of dosage, studies show CK yields slightly better results at preserving hearing compared with results for GK. Furthermore, GK's ring is screwed into the head (the screws stop at the skull) to keep it stationary (so that the radiation stays focused on the tumor), a mildly invasive procedure. CK is totally non-invasive: a series of overhead X-rays tracks the patient's head movements and tells the computer-controlled CyberKnife machine which way to move to track any small movements the patient may make so that the radiation stays centered on the tumor. GK advocates say that's all well and good, but GK has about 40 years of track record, whereas CK has been around a lot less time and is not as proven of a treatment as GK. (CK was approved by the FDA in 1999, although Stanford University Medical Center has been using it since 1994 in clinical trials because their Dr. Adler invented CK.)

Best wishes,
TW

[Tumbleweed]

Phyl, this info isn't from one source only; it's what I've learned from several different sources. For example, I believe it was either Dr. Chang or Dr. Iris Gibbs (the doctors who treated me at Stanford) who told me about the homogeneity of CK's radiation delivery vis-a-vis that from GK; it was in response to a question I asked them during my pre-treatment consultation about how much radiation would my cranial nerves be subjected to during treatment. Some of the research I'd done on the Internet, prior to choosing my treatment, discussed the mildly invasive aspect of GK (which is fairly common knowledge to all who have frequented this forum for awhile) and how X-rays are used to track a CK-patient's head movements. It was definitely  Dr. Chang, I remember, who told me about the biologically equivalent dose that CK delivers; I remember asking him why the individual doses added up to more than what one would get from GK, and he replied that you can't do simple addition with fractionated radiotherapy to arrive at the biologically equivalent dose. (That conversation occurred two days before I was treated, during my pre-treatment consultation, during which I asked him a laundry list of questions.)

When I wrote that particular post, the information was very fresh in my mind and I was able to just sum it up in one place. I'm positive it's 100% accurate.

Best wishes,
TW

[ppearl214]

Hey TW and thanks. That is what I needed!   Stanford CK team was the source as shared to you!   Thanks again! Phyl

Phyl, this info isn't from one source only; it's what I've learned from several different sources. For example, I believe it was either Dr. Chang or Dr. Iris Gibbs (the doctors who treated me at Stanford) who told me about the homogeneity of CK's radiation delivery vis-a-vis that from GK; it was in response to a question I asked them during my pre-treatment consultation about how much radiation would my cranial nerves be subjected to during treatment. Some of the research I'd done on the Internet, prior to choosing my treatment, discussed the mildly invasive aspect of GK (which is fairly common knowledge to all who have frequented this forum for awhile) and how X-rays are used to track a CK-patient's head movements. It was definitely  Dr. Chang, I remember, who told me about the biologically equivalent dose that CK delivers; I remember asking him why the individual doses added up to more than what one would get from GK, and he replied that you can't do simple addition with fractionated radiotherapy to arrive at the biologically equivalent dose. (That conversation occurred two days before I was treated, during my pre-treatment consultation, during which I asked him a laundry list of questions.)

When I wrote that particular post, the information was very fresh in my mind and I was able to just sum it up in one place. I'm positive it's 100% accurate.

Best wishes,
TW