Tomotherapy - is the most advanced concept in radiation therapy.

It employs a 360-degree revolutionary treatment system to deliver tens of thousands of radiation beamlets. The beamlets are focused precisely to your unique target area, to kill the prostate cancer cells while minimizing radiation exposure to healthy tissue. It is a form of external radiation which passes through you from the outside. It is also a form of intensity modulated radiation therapy (IMRT), as well as image guided radiation therapy (IGRT), but more precise to the moment (within seconds). Each day prior to treatment, the Tomo unit develops its own CAT scan and we can guide treatment based on what your prostate looks like that minute, not last week or last month. This makes it easier to target only your prostate and minimize radiation to surrounding critical structures, such as the bladder and rectum.

Uses of Tomotherapy: Retreatment: When cancer recurs in a part of the body that has previously been treated with radiation, retreating the area can lead to scarring and ulceration. Because of tomotherapys precision, retreatment is now safer and more effective for people who have reached their maximum tolerance for conventional radiation. In these cases, the initial CT scan to map the recurrent cancer is particularly important, since it can sometimes be difficult to distinguish between active recurring cancer and scar tissue from previous treatment. Total Metastases Irradiation (TMetI): When multiple metastases are present, tomotherapy can target visible tumors in multiple areas of the body with high doses of radiation, while limiting damage to healthy tissue. In this case, doctors typically use tomotherapy in coordination with chemotherapy, which helps treat smaller metastatic sites, called micrometastases, that may not be visible or treatable with targeted radiation.

Brain tumors: Tomotherapy allows doctors to treat metastatic brain tumors cancer that has spread to the brain from other parts of the body with a two-step process. First, they treat the whole brain with a moderately low dose of radiation not strong enough to damage the brain, but enough to eliminate scattered cancer cells that cannot be seen on scans. Then, doctors use tomotherapy to treat all visible brain tumors with extra radiation, while avoiding damage to healthy brain cells. Head and neck cancer: Tomotherapy makes it possible for doctors to treat the lymph nodes in the tongue, throat, and larynx while avoiding the salivary glands. Damage to the those glands can result in permanent dry mouth, a condition known as xerostomia.

Advantages of Tomotherapy 1. Advanced Radiation Treatment Delivered by a Fully Integrated System The TomoTherapy system is designed to perform treatment planning, quality assurance, patient set-up and treatment delivery from an all-in-one centralized system. Because all patient and treatment information is stored in a single location, the risk of data transfer error is minimized. This level of integration allows doctors to scan and treat patients with a single piece of equipment, with more time to focus on the safety of the treatment. 2. Image-Guided Treatment Delivery For radiotherapy to be effective, the anatomic position of the tumor and surrounding healthy tissue must be accurately defined. TomoTherapy takes radiation therapy a notch higher with its integrated 3D computed tomography (CT) system. This feature allows doctors to perform a quick CT scan before each treatment starts to verify that the patient is aligned accurately with the treatment plan and ensure that the prescribed radiation is focused on the tumor. This minimizes dose to surrounding healthy tissue, resulting in fewer and less severe side effects. 3. Adaptive Intensity Modulated Radiotherapy with Unparalleled Treatment Precision By using daily CT imaging, doctors are able to track any changes in the shape and position of tumors. This enables the delivery of adaptive radiation therapy, where tumor response to treatment can be monitored on a daily basis and treatment plans adjusted and customized to accommodate these changes at any time during the course of treatment. TomoTherapy radiation treatment is delivered using cutting-edge beam modulating technology. TomoTherapy radiation beams are further subdivided into smaller and narrower beamlets, with each beamlet delivering a different dose of radiation from all angles around a patient (spiral or

helical treatment delivery). The different doses go to different parts of the tumor with less damage to the surrounding healthy tissue. 4. Simplified, Flexible, and Painless Treatment Process The TomoTherapy system customizes treatment delivery specifically for each patient. It is capable of treating small, large and multiple tumors in multiple areas of the body, even during the same treatment course. It is non-invasive and as painless as having a CT scan or an X-ray examination. The unique design of the TomoTherapy unit results in superior treatment plans and improved clinical outcomes, with a greater potential for fewer and less severe side effects. Treatment Process: Planning. Before beginning a TomoTherapy treatment, the doctor uses 3D images from a combination of scanning technologies (such as CT and MRI) and special software to establish the precise contours for each treatment volume (tumor) and any regions at risk (sensitive organs or structures). The doctor then decides how much radiation the tumor should receive, as well as acceptable levels for surrounding structures. The TomoTherapy treatment system calculates the appropriate pattern, position and intensity of the radiation beam to be delivered, to match the doctors prescription as closely as possible. Patient positioning. As both a treatment delivery machine and a CT scanner, the TomoTherapy system allows doctors to take a CT scan just before each treatment. With the scan, they can verify the position of the tumor and, if necessary, adjust the patients position to help make sure radiation is directed right where it should be. Precise treatment delivery. The TomoTherapy treatment system delivers radiation therapy with a spiral delivery pattern (TomoHelical) or discrete-angle approach (TomoDirect). Photon radiation is produced by a linear accelerator (or linac for short), which travels around the patient and moves in unison with a device called a multi-leaf collimator, or MLC, that shapes the beam. Meanwhile, the couch is also movingguiding the patient slowly through the center of the ring.

References: http://www.tomotherapy.com/ http://www.makatimed.net.ph/main.php?id=811 http://www.accuray.com/solutions/treatment-delivery/tomotherapy-treatment-delivery http://www.cancercompass.com/cancer-guide/conventional-treatment/tomotherapy.html