Frequently Asked Questions
- What does “stereotactic radiosurgery” mean?
- What types of SRS are available?
- What type of treatment is available at the Trilogy Center?
- What enables the Trilogy System to be so precise?
- How safe is it?
- What happens before and during treatment?
- How long will the treatment take?
- What are the credentials of the people performing the radiosurgery?
- Will my insurance cover it?
- What are some of the side effects?
- What if I accidentally move my body during the surgery?
- What is the recovery time?
- Can pediatric cancers be treated with Trilogy?
Q. What does “stereotactic radiosurgery” mean?
A. Stereotactic radiosurgery is a method of delivering a high dose of radiation to precisely defined regions of the body. The Trilogy System, which VCU experts have combined with ExacTrac positioning technology, provides the most advanced form of stereotactic radiosurgery available anywhere.
Although its name suggests otherwise, “radiosurgery” does not require scalpels. It is non-invasive, does not involve cutting, bleeding or general anesthesia and is usually performed as an outpatient procedure. Radiation does not remove the tumor or lesion; instead it damages the DNA of the tumor cells. The cells then lose their ability to reproduce and die over time. The growth of the cancer is stopped.
Q. What types of SRS are available?
A. The two most common forms of stereotactic radiosurgery are Gamma Knife® and linear accelerator-based systems. Linear accelerator-based radiosurgery is the most common today. It utilizes a highly collimated beam of radiation redirected in a number of arcs to distribute the dose within a targeted area.
The Gamma Knife® utilizes 201 fixed radioactive cobalt-60 sources to produce multiple small radiation beams which converge on a single, focused radiation target volume.
Q. What type of treatment is available at the Trilogy Center?
A. The Trilogy Center has installed a unique combination of technologies to offer unprecedented precision in directing radiation to tumors and protecting surrounding healthy tissue. This allows us to treat a wide range of abnormalities.
The system is built upon the Trilogy Stereotactic System, enabling our physicians to provide the most sophisticated form of SRS – image-guided radiotherapy (IGRT). The installation of Trilogy at VCU Medical Center marks the beginning of a new generation of cancer care.
Q. What enables the Trilogy™ System to be so precise?
A. The Trilogy System incorporates sophisticated technologies for shaping the radiation beam so that the dose of radiation is limited to the tumor or region of the abnormality. By changing the beam shape over time while delivering the radiation, our doctors achieve very fine control over how, and where, the radiation is administered.
Our system incorporates a number of technologies for positioning patients accurately, including:
- A special X-ray imager that is used to check the patient's position prior to treatment and to monitor the position of the targeted area during treatment.
- An optical guidance system with infrared cameras that continuously monitor the patient's position to provide therapists with real-time feedback about any changes in a patient's position.
A. Trilogy System treatments at the VCU Medical Center are safe for two reasons:
- Trilogy combined with ExacTrac X-ray provides the world’s most accurate treatment of tumors and other abnormalities. Our unprecedented accuracy means that we can protect more healthy tissue and significantly reduce the chance of injury to important structures nearby.
- Trilogy treatments are a form SRS, and we have been treating patients with SRS with great success for more than 13 years.
Because all forms of radiation treatments work over time, they may be inappropriate if symptoms are severe or life-threatening. Relief of acute symptoms may drive the first treatment choice to surgery or medication. For instance, if current symptoms when diagnosed are so severe that quality of life is affected, the appropriate choice for the first treatment may be surgery to relieve those symptoms. The secondary treatment could then be radiosurgery.
In other cases where cells are extremely fast growing (with or without severe symptoms), such as in brain metastases, radiosurgery can quickly control the brain tumors to allow time to treat the primary cancer site. Medication can be given for the side effects of edema and radiation therapy may be used over a period of time to help eliminate the stray cancer cells from the brain.
Q. What happens before and during treatment?
A. To begin, follow the instructions of your physician and nurse the night before, and show up at your appointment time. It’s that simple.
On the day of treatment, our team takes great care in preparing for the treatment delivery, including taking additional diagnostic scans. Treatment planning for SRS is very sophisticated. We incorporate previously acquired diagnostic images such as PET scans, CT scans and MRIs to accurately identify:
- The lesion/target
- Adjacent areas at risk for disease
- Areas that may be a high risk for complications
In general, patients arrive in the morning for CT simulation, which usually includes a special CT scan with various removable “fiducials” used for localization. You may receive sedation to immobilize the targeted treatment area. After the simulation, you will rest comfortably in the outpatient surgery recovery area. At the same time, the neurosurgeon or radiation oncologist and other members of your team will review the scan and run through some quality assurance procedures.
See also "What To Expect."
Q. How long will the treatment take?
A. Trilogy detailed planning and treatment takes from 4 - 8 hours, including surgery and post-surgery resting time.
The actual treatment may only take 15 - 30 minutes, but setting up and then leaving the treatment room means that a typical treatment time is 45 – 60 minutes. Before the treatment, usually on the same day, the planning CT scan also takes 15 - 30 minutes. Treatment planning by the radiosurgery team done after the CT scan and before the treatment takes from 30 – 60 minutes or more. During this time, the patient is allowed to wait in a specialized hospital area. As a result of the various processes involved in scanning, treatment planning and treatment delivery, patients generally spend most of one day in the VCU Medical Center for a radiosurgery procedure.
Q. What are the credentials of the people performing the radiosurgery?
A. The team that treats the patients generally includes attending physicians in radiation oncology and neurosurgery as well as physicists (Board-certified by the American Board of Radiology), dosimetrists (Board-certified by the American Association of Medical Dosimetrists), and therapists (Board-certified by the American Registry of Therapeutic Technologists).
Q. Will my insurance cover it?
A. Yes, most insurance companies will pay for this type of therapy, but pre-approval may be necessary.
Q. What are some of the side effects?
A. While the likelihood of experiencing anything more than a mild ache is small, your doctor will discuss all of the potential side effects of your treatment, which will vary depending on the location of the tumor and the function of the area in which it resides.
Complications due to radiosurgery are rare, but can include seizures, brain or normal tissue injury, and neurologic or other effects of such injury.
Q. What if I accidentally move my body during the surgery?
A. The treatment facility is very sophisticated. Working with the team’s expertise, robotics, and technology devices, we monitor the entire procedure in real time. We have the ability to verify your position and we can identify any motion and respond accordingly. Our system can even account for your breathing rate and the movement that breathing causes.
A. Patients usually return home at the end of the day and no recovery time is required. In general, your follow-up appointment will be within four to six weeks to monitor the lesion’s response to the radiation, and this might include having a CT or MRI.
Q. Can pediatric cancers be treated with Trilogy?
A. Yes. The system's precision makes it particulatly suitable for treating children and young adults.
