As we approach one year of having the Trilogy technology at Providence Hospital the response has been overwhelming. The patient need for this therapy has exceeded our expectations.
The hospital has hosted and trained over six groups of physicians from both national and international medical centers. The Trilogy Program at Providence Hospital is a leading referral center for the region and a prominent teaching institution. The purpose of our discussion is to inform referring physicians about the unique characteristics of Trilogy and the application of Trilogy technology appropriate to patients.
Question: What is Trilogy?
Answer: Trilogy is a state of the art stereotactic radiation delivery device. By using the micro-multi leaf collimator one can shape the beam to the exact tumor dimensions. This allows the therapist and physician the ability to maximize tumor dose while minimizing the dose to other structures. The term for this is intensity modulated radiation therapy or IMRT.
Question: Can Trilogy do other types of treatments?
Answer: Yes, by using round collimators or the micro-multi leaf collimator, physicians and therapists can form a beam to treat various lesions within the brain. This is referred to as stereotactic radiosurgery. Candidates for stereotactic radiosurgery include some tumors up to three centimeters in size, inoperable lesions, recurrent brain tumors and some vascular malformations. Contraindications to standard surgery, patient preference, advanced age and co-morbid conditions are all indicators for Trilogy stereotactic radiosurgery versus conventional surgery. Additionally Trilogy stereotactic radiosurgery can be used as an adjunct to conventional surgery in the treatment of some arteriovenous malformations. Trilogy can also be used with detachable coil or intravascular technology to maximize patient benefits by allowing physicians options of different modes of treatment.
Question: Can Trilogy also be used for other lesions within the brain?
Answer: Yes, Trilogy can be used for specific lesions such as trigeminal neuralgia. This represents a non-invasive treatment for trigeminal neuralgia, which may be used in patients that otherwise cannot undergo more invasive treatments. In addition, it can be used for refractory trigeminal neuralgia. There are some studies using Trilogy radiosurgery for movement disorders, such as Parkinson’s and dyskinesias. Currently Trilogy is not being used in Mobile for these types of lesions.
Question: What is IGRT?
Answer: Image guided radiotherapy is another capability of Trilogy stereotactic radiation therapy. By using image guided technology the therapist and physician optimizes treatment delivery dose to the tumor while minimizing dose to surrounding tissues. Image guided techniques may be used in all parts of the body and take into account body movement, such as, the respiratory cycle, any shift within the body itself, and movement of the table or gantry. By constantly monitoring the patient's position the beam can be turned on or off until the tumor is placed precisely at the right position. For example, in a lung tumor the beam will be turned on at the end expiratory phase of respiration. During the remaining respiratory cycle the beam is turned off. The respiratory cycle is monitored by the chest wall movement, which increases the accuracy and dose delivery. Coupled with shaped beam therapy and precise localization, treatment tolerances can be down to the one millimeter range. This has superior results as far as kill ratio and complication ratios within a given patient.
Question: What does all this mean?
Answer: In simple terms, by allowing radiotherapy to be concentrated at the target and no where else, the kill effectiveness of tumor goes up dramatically while the radiation to other or normal tissue is minimized. Minimizing radiation to other tissues reduces complication rates. This allows more precise localization and treatment deliveries to the affected area. Lesions, which were not amenable to conventional beam radiotherapy, may now be treated with Trilogy stereotactic technology. This also includes lesions which have previously been radiated with conventional beam radiation therapy.
Question: How can we contact the physicians using this technology?
Answer: For brain and spine lesions you may contact Dr. Ronderos at 251-633-5155 or toll free at 866-647-7711. In addition, you may contact Dr. Gilbert and Dr. Pittruzzello at 251-633-1890.
