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Radiation Oncology

Trilogy System Adds to Convenient Treatment Options

The University of Virginia Health System has just installed a Varian Trilogy® radiation therapy system complete with RapidArc™, state-of-the-art treatment planning software that enables precisely targeted treatment to be delivered in two minutes or less. Patients have easy access to the Trilogy at UVA’s newly renovated Moser Radiation Therapy Center, which provides free parking right outside the front door.
With the addition of Trilogy, UVA is one of the few medical centers to have three leading-edge radiation therapy systems – Trilogy, TomoTherapy and the Gamma Knife Perfexion – to provide comprehensive radiation therapy tailored to each patient’s condition.
“You know patients are going to get the best treatment option for their condition,” says Dee Eadie, R.N., UVA Cancer Center administrator.

RapidArc and Trilogy: Short, Precise Treatment Sessions

UVA is one of the first 10 hospitals – and the first in Virginia – to use RapidArc radiotherapy technology, says radiation physicist Stanley Benedict, Ph.D. The RapidArc’s ability to deliver a precise, 3-D shaped radiation dose in less than two minutes benefits patients, says radiation oncologist Paul Read, M.D., because research has demonstrated that the chances of the patient or tumor shifting increases as the length of the treatment session increases. Several members of UVA’s team of 10 physicists and four board-certified dosimetrists, Benedict says, have played a key role in refining RapidArc for clinical use.
Radiotherapy through RapidArc is one of the extensive treatment options available to patients through the Trilogy system. Trilogy can deliver the full range of radiation therapies, including image-guided radiation therapy, intensity-modulated radiation therapy, 3-D conformal radiotherapy, stereotactic radiosurgery, fractionated stereotactic radiation therapy and intensity-modulated radiosurgery. UVA also uses a stereotactic system from BrainLab.
Trilogy’s benefits include 2-D and 3-D kV image guidance as well as mV and cone-beam CT for pinpoint setups for treatment sessions. The Trilogy is also able to perform respiratory gating, which times treatment to a portion of the patient’s breathing cycle to more precisely target the tumor.
“We have three different treatment systems that we use to tailor treatments to the patient’s specific cancer. We are moving to an era of personalized medicine,” says James Larner, M.D., Chair of UVA’s Department of Radiation Oncology.
Treatment can be delivered through non-coplanar fields, Read says, allowing radiation to come from any angle and in any shape – not just slices – to better target the tumor and spare healthy tissue. For certain patients, Trilogy’s ability to perform stereotactic radiosurgery can shorten treatment from a series of sessions over six to seven weeks to as little as a single day, Larner says.
The Trilogy’s imaging capabilities enable adaptive radiation therapy, allowing the treatment team to make real-time adjustments to the patient’s treatment plan to adjust for elements such as a shrinking tumor or a patient’s weight loss, Larner says.
By next summer, UVA will install a second, identical Trilogy at the Moser Radiation Therapy Center, increasing reliability for patients by ensuring scheduled treatments will occur if one of the twinned systems needs maintenance. “The only difference between the two systems will be the paintings on the wall,” Benedict says.

Full Complement of Radiation Therapies

The new Trilogy joins TomoTherapy and the Gamma Knife Perfexion, ensuring patients at UVA will receive state-of-the-art treatment that’s ideal for their specific condition. “We can plan cases in two or three different ways and make a comparison to find out which is the best way to treat a patient,” Larner says. In 2004, UVA was the first hospital in Virginia to install a TomoTherapy system. TomoTherapy uses 3-D CT imaging to confirm the location of the tumor, making radiation treatment more accurate and sparing more healthy tissue. TomoTherapy then delivers intensity-modulated radiotherapy in a 360-degree helical pattern, focusing more radiation on the tumor and less on surrounding tissue.
Last year, UVA was one of the first hospitals in the world to receive the Gamma Knife Perfexion, the first redesign of the Gamma Knife in about 30 years. The minimally invasive instrument uses 192 beams of highly focused Cobalt 60 radiation to target brain tumors and vascular malformations in the brain and cervical spine. Benefits of the Perfexion include reduced treatment time, better dose delivery and planning, which greatly reduces the amount of background radiation reaching parts of the body outside the treatment area, along with improved patient comfort.
To refer a patient for radiation therapy, call UVA Physician Direct at 800.552.3723.