GK, CK,....What About Novalis radiation? Is it another treatment option or not?

[justafactoflife]

Hi,

I'm in the Midwest and I am seriously considering my options for either GK, CK, or Novalis radiation.  Any input on Novalis from anyone?  Did you have your AN treated by Novalis rather than GK, CK?  Is it something new and state of the art?  I was told there is a difference in the type of radiation treatments and Novalis is not the best.  What is the difference between GK, CK, and Novalis systems?  Which is the best?

[centimeter]

Hi
  I think for re-Tx, GK is employed more than the others and generally, radiation follows surgery and surgery follows radiation if regrowth or a complete Tx failure occurs.
  All forms of radiation are quite accurate with more than likely a market share desired by the creators of the different types. Some might argue slightly less accuracy with GK due to head frame shift but with the plastic face mask utilized in CK and FSR and anywhere from 5 to 21 sittings, a head frame shift would be offset by repeated re-positioning of the pt. on successive days of CK, FSR, etc. GK is a 1 day sitting.
  GK has the longest track record being in use for AN since 1969. The others are far fewer years. GK is the only type which has a constant cobalt source of radioactivity. The others use linear accelerators.
  Good luck to you!

[SKConner]

Hi newbie, from another newbie... I'm also from the midwest, Ft. Wayne, IN.
   I weighed all the options also like all the others. Was scheduled for surgery, which was canceled at the last minute due to a op. room glitch. Gave me a chance to raise the radiation option again. Was greatly encouraged by that possibility. I talked to a GK doc., in Indy  - upon a reference from someone who had very successful results there (St. Vincent's).  In exploring further, looked into the Cyber-knife procedure also in depth. The two technologies accomplish the same result - accurate delivery of radiation to a precise point of attack on the tumor. The CK is technologically about 2 to 3 generations of development newer than the GK, but the difference between the two I was told does not discount the quality of the GK approach.
  I have started just today my first treatment with the Cyber-knife group through Parkview Hospital Oncology here in Fort Wayne. I am extremely pleased with the science, the accuracy, - the entire experience so far. Dr. Marc Apple came highly recommended and if you are any where close to FW I would support that recommendation from my own experience. The entire CyberKnife team - is very professional and helpful. I cannot base any further recommendaton on my results because I don't have them yet, but at this point I am very confident and encouraged. The procedure was painless....the webmask held my head firmly in place... I returned to my office for awhile, before going home. I will have five treatments this week, each about 40 to 45 minutes in length.
   As I said before, I would not discount the other approach, or other medical facilities - I understand I.U. Med., which I believe is GK supported, is a great resource as well as St. Vincent's in Indy.
   For the CK approach, I don't think you can beat this group in Fort Wayne.

As the others have said, do your research, there is alot of information out there, and the credibility of both treatment options I found strong and worthy of consideration.

-God speed...
   -Steve

[Larry]

I had surgery almost 4 years ago and now have re-growth. I am in wait and watch as my growth is around 9mm. It doesn't seem to be causing any additional complications so I am not going to touch it yet. If and when I need to it will be GK. There are numerous posts on this message board - just do some searches and then send people personal messages to get their views on your approach.

From my understanding, there doesn't seem a lot in it between GK or CK. Not very good reports on the other so I wouldn't go near it.

the essentials to consider are:

one off hit versus many.
the level of GY's beamed at the tumour (major issue and jury is out on the ideal level)
the experience of the computer programmers (if their settings are off a fraction - well, we won't go there)
how many has the doc done before (experience is key - no need for you to be a guinea pig)
are you happy to have screws put in your head (gk)

Laz

[Mark]

While I don't disagree with the general theme of Centimeter's post I do think there are a couple of points that warrant some clarification

All forms of radiation are quite accurate with more than likely a market share desired by the creators of the different types. I would disagree with this statement as there are numerous studies which show a range from 1 mm at the best to around 3-4 mm at the worst. Also critical to this discussion is the machines ability to treat irregular shaped tumors evenly (hot spot vs. cold spot) and there are variations between machines in that regard

Some might argue slightly less accuracy with GK due to head frame shift but with the plastic face mask utilized in CK and FSR and anywhere from 5 to 21 sittings, a head frame shift would be offset by repeated re-positioning of the pt. on successive days of CK, FSR, etc. GK is a 1 day sitting. partially agree with this statement. Actually GK has long been regarded as the gold standard in accuracy among radiosurgical machines even with the frame error factor. CK is the first machine that has matched and exceeded GK accuracy in studies. It is true that machines that do FSR sacrifice some degree of accuracy through the process of repositioning the mask for each treatment, hence the lower doses over more days. CK is different because it actively targets the tumor during treatment and can maintain accuracy over multiple stages ( usually around 3 for an AN, but have heard 5 on occassion). All other systems are basically programmed and fire to a spot so positioning whether through a frame or mask is critical

GK has the longest track record being in use for AN since 1969. The others are far fewer years. GK is the only type which has a constant cobalt source of radioactivity. The others use linear accelerators.  Very true that GK has been around since 1969 and has a longer track record than other machines. However, I would maintain that means little since the biological principles of radiation on the tumor are well documented and fundamentally apply to all machines. the source of the radiation is irrelevant to effectiveness on killing the tumor. Only difference between the two is cobalt creates a disposal problem which LINAC doesn't.

As I mentioned previously, both GK and CK are equally effective and even the docs over on the CPSG board will acknowledge that point. Primary differences is whether the Headframe is a problem for the patient with GK or if someone wants FSR which GK can't do but CK can with accuracy as good as 1 shot GK.

Mark

[tony]

I do agree with all of you - I can only think GK is done slightly differently here
our mask is not plastic but METAL and it does not sit on your head
It is screwed on - 4 screws that were so tight they drew blood
It couldnt move - or if it did .....it would be because
...your skull would have fractured...
...what price accuracy ?......
Best Regards
Tony

[Mark]

Hi Tony,

GK is done the same way here in the states utilizing the metal head frame, the mask as a head restraint is utilized only by the the other linac systems. As noted by others the Mask and FSR with machines other than CK do sacrifice some accuracy. There are those who have posted that they have had GK and didn't mind the head frame being applied, however since CK now gives equivalent accuracy I've struggled to understand why anyone goes through it when there is no longer an incremental gain in accuracy as a result. Obviously a personal choice, but I'm with you that I certainly would prefer not to have it.

mark

[Larry]

Mark,

I would [prefer not to have the GK as plugging scews into an already beaten up head is not my idea of a good time. Unfortunatley CK is not available in Sydney so don't have a choice.

Laz

[Kilroy1976]

Hehheh, back on the headframe again... It really isn't that bad... What on earth do you folks do when you have to go to the dentist?

Unfortunately I can't add much about the Novalis machine. Everything I've read indicates that it is roughly equivalent to any other machine if the headframe is used, but you probably don't want to treat an AN with it using the mask.

[Larry]

Dentist, dentist, yuko - gassed / put out/ lotsa valium 

Actually, from all accounts, the headframe doesn't sound too bad - especially compared to the level of headaches one gets.


Laz

[ppearl214]

I did some research into Novalis during my research into radio-surgery treatment options.  As the radio-oncologist handling the Novalis/FSR told me, he claimed he could lower the treatments from 30 days to 5 day/dose.  My concern was accuracy if he made that claim.  Rather made me nervous (just for me), so I did further research into CK and GK.  Both are exceptional viable options for AN treatments.  For me, it was a personal choice of 1-day dose vs 3-5 day dose and yes, the use of the headframe.

As Kilroy notes, there has been a great deal of discussion here about the headframes.  Although I chose CK, I never ruled out GK based on the headframe.  For me, in my final decision process, the metal headframe for one day is only a brief discomfort if in the long run, the GK works.  So many here that have had GK note that it really is just a minor, temp issue and many tolerate it fine.  My NS did her internship in GK and clearly laid out the facts about the accuracy and headframe of GK (btw, she is based in a hospital that has Novalis and she even noted "ew!" for their Novalis!!!!).

Regardless if GK or CK, for radio-surgery options, both are top notch.  It's just a personal decision.

Just my opinion... only worth 2 cents.
Phyl