Novalis

Novalis shaped beam radiosurgery integrates state-of-art imaging and targeting software with a high energy shaped beam delivery system to obliterate tumors within the brain and elsewhere in the body, without damaging the normal surrounding tissues. The idea behind Novalis is conceptually straightforward: By combining many precisely shaped beams, each directed toward the tumor, but from a different direction, it is possible to achieve a tumor-killing dose where the beams intersect, while keeping the dose from each individual beam below that which would cause any normal tissue complications. Novalis offers physicians the ability to treat the broadest range of indications with applications that include cranial, head and neck, and spinal treatments. The result is that both patients and physicians benefit from Novalis.

The Novalis technology is designed specifically to deliver a variety of complex radiation therapy treatments, including radiosurgery, radiotherapy, and IMRT (Intensity Modulated Radiation Therapy), a variation of the sophisticated treatment delivery system Novalis employs to deliver radiosurgery, predominately to the brain and head and neck areas. Each treatment technique varies somewhat but all have at their core extremely precise and accurate three-dimensional radiation dose delivery. With radiosurgery, imaging, treatment planning and treatment will all take place on the same day. A frame is placed on the patient’s head on the morning of the treatment, by the neurosurgeon, using local anesthetic. The patient is then given a CT scan for imaging and data acquisition. The CT scan data is reviewed so that the targets and objects at risk are identified.

During the review the patient rests in a designated area and is monitored by our staff. The review can take anywhere from one to four hours depending on the type of lesion being treated. Once the treatment plan is verified, the patient is brought to the Novalis unit, and the treatment performed in the stereotactic frame. A typical treatment can range from 30 to 90 minutes. Once the treatment has been completed the frame is removed and the patient is then placed under observation for an hour, then discharged.

Radiotherapy uses all the precise and sophisticated treatment planning and stereotactic treatment, but is done over an extended period of time similar to standard radiotherapy. Treatment will be delivered over a week for a period of five to six weeks. The patient will wear a relocatable frame with a mask which is used to immobilize, scan, and treat the patient over the course of the treatment. A typical treatment usually lasts 20 to 40 minutes.

Intensity modulated radiation therapy (IMRT) is a variation of the sophisticated treatment delivery system Novalis employs to deliver radiosurgery. A micro-multi-leaf collimator (a device that can control the shape and the intensity of the radiation beam produced by the linear accelerator) is used to "modulate" or control the radiation dose delivery. Using computer-controlled and activated motion of the collimator leafs, a very precise three-dimensional dose can be administered to the target lesion, with minimal dosage delivered to sensitive areas. Patients will be treated with the releasable mask/frame as discussed above and treated on a daily basis with stereotactic radiotherapy. A typical treatment usually lasts 20 to 45 minutes.

Indications

• Brain tumor; Meningioma, Pituitary adenomas, Tumor of skull base
• Metastatic brain tumor, recurrent tumor
• Head and neck tumor
• Vascular lesion, AVM
• Epilepsy
• Tumors of the spine, prostate, lung
• Hepatocellular carcinoma, cholangiocarcinoma, liver Metastasis

We can treat benign, slow-growing tumors in places normally too difficult to reach surgically as well as aggressive small and static cancers that in some cases have spread to multiple locations in the brain that would be inaccessible surgically. We can also treat vascular lesions affecting the brain, such as arterial venous malformations.

Stereotactic radiosurgery is also used sometimes alone or in conjunction with other modalities to avoid the risk of a large, open standard surgery. It’s also used for functional disorders, ones that involve movement such as Parkinson’s Disease or chorea, and in rare instances can be used for treatment of patients who suffer from excruciating pain that medication cannot resolve. In addition to the vascular abnormalities and movement disorders mentioned above, Novalis has applications for the spine and, in the near future, tumors in other organs, primarily prostate, lung and liver.

Advantages

The great advantage of Novalis is that it permits us to accurately direct the radiation beam at the neoplasm (tumor-cancer) and spare the surrounding normal brain tissue. Thus any patient with a limited number of lesions in the brain is a candidate for the Novalis program.

The Novalis program for radiation therapy may not be the best form of therapy for patients with multiple brain lesions, lesions that have been given the maximum amount of radiation or in situations where the malignancy is known to involve a majority of the brain. Age and size do not exclude patients, but the patients' general health must be good enough to permit them to live long enough to benefit from the therapy.