NOVALIS® Shaped Beam Surgery

NOVALIS® Shaped Beam Surgery – Patient FAQs

Novalis Brainlab and Novalis TX are state of the art technologies that are offered at our Palomar Hospital and Sharp Memorial Hospital treatment centers. Both planning and treatment delivery systems offer image guidance to ensure maximal targeting of dose with minimal dose to adjacent structures. Novalis systems are used to treat a wide variety of cancers including brain tumors, spinal tumors, and prostate cancer.

Treating tumors no longer means having to put life on hold. Choosing Novalis® Shaped Beam Surgery makes your treatment a simple non-invasive outpatient procedure. So you can simply get on with life.
Finding out you have a serious medical condition, such as a tumor of the brain, spine, lung or prostate, brings about many challenges, concerns, questions and emotions. Learning as much as possible about your condition and the available treatment options is critical to selecting the best course of treatment for you.
This website contains important information on Novalis, a non-surgical outpatient treatment for cranial and extracranial tumors. It is our mission to help you select the most appropriate treatment for your diagnosis, while maintaining your quality of life. Novalis…because it’s your life.

Peace of mind can be obtained by learning more about your illness and how treatment can be pro¬vided. The following information will assist you in learning about Novalis Shaped Beam Surgery, usually performed as an outpatient procedure for the treatment of tumors in the brain, body and for Arterioveneous Malformations (AVM).

Novalis delivers precise doses of high-energy radiation to the tumor. It continuously shapes the treatment beam to match the size and shape of the tumor from all angles, ensuring that the tumor receives the fully prescribed dose of radiation while at the same time protecting the surrounding normal tissue.

This type of treatment is virtually painless and does not typically require anesthesia. Moreover, as compared to conventional surgery, there is no scar¬ring or disfigurement and little risk of infection.

What is radiotherapy?
Radiation therapy, or radiotherapy, is the use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to destroy cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Fractionated radiotherapy is administered in a series of treatment sessions over a specified period of time.

What is radiosurgery?
Radiosurgery is a radiation therapy procedure that uses a special system to precisely deliver a large radiation dose to a tumor in a single session. The goal of this non-invasive procedure is to destroy the target without surgery or harming nearby healthy tissue. It is used to treat brain tumors and other brain disorders. It is also being studied in the treatment of other types of cancer, such as lung and spinal indications. It is also called radiation surgery, stereotactic external-beam radiation, stereotactic radiation therapy, stereotactic radiosurgery, and stereotaxic radiosurgery.

What is Novalis Shaped Beam Surgery?
Novalis is an advanced treatment device for patients undergoing stereotactic radiosurgery or fractionated stereotactic radiotherapy for a variety of medical conditions, including different types of cancer. With Novalis, the treatment beams are shaped to match the exact contour of the tumor or lesion so that even irregularly shaped tumors or lesions can receive doses of radiation consistent with what has been prescribed, effectively destroying the tumor. Sophisticated software calculates the ideal access points to the tumor or lesion and defines the treatment plan.

During treatment, Novalis moves around the patient’s body so that the radiation penetrates the entire tumor or lesion from different angles quickly. While the tumor or lesion receives the full dose of radiation, the surrounding healthy tissue only receives a small percentage of the radiation, which reduces potential damage to delicate structures such as the brainstem or spinal cord. Novalis was first implemented almost a decade ago for the treatment of brain tumors or lesions, where pinpoint precision is required to focus radiation treatment on tumors or lesions close to critical structures. Now, experts are taking advantage of the precision of Novalis to increase the range of a patient’s available treatment options and treat other areas of the body, such as the lung, liver, prostate and spine.

Why is fast treatment important?
There are two reasons why short treatment times can be important: treatment accuracy and patient comfort. The length of treatments with some devices can be extreme, lasting an hour or more, during which the patient must lie as still as possible. Prolonged treatment times can make the entire process even more stressful, and some physicians recommend practicing meditation during the procedure or even prescribe a sedative. Reducing the treatment time also minimizes the time where the patient may make small movements that can affect the overall accuracy of the treatment.

Novalis is optimized for the fastest treatment delivery, improving both patient comfort and treatment accuracy. A Novalis treatment or fraction typically lasts only 15-20 minutes. Novalis continuously tracks any micro patient movement and allows for automatic adjustment, ultimately increasing the level of accuracy, from the start to the end of the treatment.

What is the advantage of shaped beam radiosurgery?
Traditionally, circular beams are used for radiosurgery. The resulting dose of such an approach is a spherical dose volume. As most lesions are very irregular in shape, several of those spherical dose volumes have to be composed together to cover the complex tumor shape. Other systems try to move the circular beam to “paint” the dose into the tumor volume over a time. Both approaches are time consuming and do not ideally tailor the dose to the exact shape of the tumor. This can result in lower than desired irradiation to parts of the tumor and higher than desired irradiation to healthy tissue. Novalis Shaped Beam Surgery has set a new standard by shaping each treatment beam to contour the exact shape of the tumor and avoiding normal tissue with highly accurate and homogeneous doses.

Why is it important to have a flexible radiosurgery system?
Each tumor is different. They vary greatly by patient in location, size, shape, and proximity to vital organs, making each case completely unique. To compose the ideal treatment plan for each particular tumor and patient it is important for the physician to be able to choose from a wide range of different treatment modalities.

Only Novalis offers the widest spectrum of modalities in the industry, from circular arc for very small spherical lesions and functional radiosurgery, to conformal beam, dynamic arc and intensity modulated radiosurgery (IMRS), Novalis allows the best mix of all these modalities to perfectly sculpt the dose to the exact shape of the lesion and protect vital risk organs at the same time. In comparison, other systems offer a limited treatment approach and rely simply on circular beams, which often gives uneven coverage over the tumor and has an increased chance of negatively affecting nearby healthy tissue.

Why is it important whether a system is ‘proven’?
For any treatment, the experience of the practicing physician makes an important difference. When a type of treatment is extensively researched and proven in well-known medical journals, your physician is able to draw on the experience and knowledge of leading physicians from around the world. As a result, words like “advanced,” “robotic” and “precise” are only meaningful if they are sufficiently clinically proven, and that your physician has the experience and research available to give you the best treatment possible.
Numerous publications, covering the treatment of thousands of patients, have proven the effectiveness of Novalis. Over the past several years, over 20,000 patients have been treated with Novalis Shaped Beam Surgery. Novalis continues to remain on the cutting edge of technology, with treatment protocols and processes constantly being refined. BrainLAB actively supports the sharing of knowledge: leading doctors from around the world can share successful treatment protocols via the Novalis Knowledge network and at regular Novalis Circle conferences. With Novalis, 'No compromises' means providing proven cutting edge treatments.

What effect is the radiation likely to have on my disease?
With radiosurgery and radiotherapy, high-energy radiation beams aim to destroy tumor cells by damaging the cells and causing them to die. Visible results, as seen on a follow-up scan, might include shrinkage of the tumor or the cessation of further tumor growth. Because cell destruction and the absorption of the cells within your system is a lengthy process, it can take up to six months before the effect of the treatment is visible on a follow-up image.

Will there be any side effects?
The procedure itself is not painful. Side effects that you might experience immediately following treatment include headache and dizziness. Your doctor will discuss specific side effects with you, which may occur depending on your overall treatment plan

What is the difference between stereotactic radiosurgery and fractionated stereotactic radiotherapy?
Radiation treatment of a tumor can either be applied in a single session with a high dose of radiation, also known as stereotactic radiosurgery, or in a series of treatments over a period of time, known as fractionated stereotactic radiotherapy. Fractionated radiotherapy involves similar total doses of radiation as radiosurgery, but the radiation is delivered in smaller amounts. Fractionated stereotactic radiotherapy allows the healthy tissue to recover from the impact of the radiation before the next treatment session.

Novalis Shaped Beam Surgery includes both stereotactic radiosurgery and fractionated stereotactic radiotherapy. Unlike some systems, Novalis can provide a very high number of fractions, which, studies have shown, are necessary for the best treatment of some tumors, protecting more healthy tissue. This is particularly true for tumors near auditory nerves, and the ability to spread the treatment over enough fractions can provide better treatment outcomes and preserve the patient’s hearing.

Your doctors will recommend the technique most appropriate for you, depending on the size and location of your tumor. For fractionated treatments, a face mask is worn. Each face mask is formed to contour to the exact shape of the patient's head and will be used for each treatment fraction.

What is the history of Novalis?
In 1951, the use of focused high-energy radiation for the treatment of brain disorders was introduced by Lars Leksell, a physician at the Karolinska Hospital in Stockholm, Sweden. Clinical applications began in 1967 with the introduction of cobalt radiation sources. Since inception, the technology’s precision and possibilities, and the number of clinical conditions that can be treated, have greatly increased. The Novalis system was introduced in 1997. Novalis Shaped Beam Surgery builds upon the possibilities and precision of these early systems. With Novalis Shaped Beam Surgery, doctors use computerized and highly sophisticated software to develop a customized treatment plan that is specially adapted to your individual needs.

What types of conditions can be treated with Novalis?
Depending on your particular case, Novalis Shaped Beam Surgery may be the right treatment option for you. Novalis can be used to treat non-cancerous and cancerous conditions such as:

• Arteriovenous malformations (AVM)
• Cavernous angiomas
• Trigeminal neuralgia
• Intractable seizures
• Parkinson’s disease
• Brain metastases / Gliomas
• Acoustic neuromas
• Pediatric brain tumors
• Recurrent brain tumors
• Pituitary adenomas
• Meningiomas of the skull base
• Craniopharyngiomas
• Spine, prostate, liver and lung malignancies

What are the benefits of treatment with Novalis?
There are several reasons why you might want to request treatment with Novalis:

• Extremely precise—radiation damage to normal tissue is minimized
• Ensures tumor or lesion receives an even distribution of the prescribed radiation dose by shaping the beam to accurately match the outline of the tumor or lesion
• Optimized to deliver radiosurgery in the shortest possible time, averaging 15 minutes, preventing errors due to minor movements during long treatments
• One of the most technologically advanced procedures available today
• Non-invasive, with only minor incisions for cranial halo procedures
• Painless—treatment is usually performed on an out-patient basis

What should I expect at my treatment session?
You don’t need to bring special clothing or equipment to the hospital for treatment with Novalis. You might want to dress comfortably and bring a book or something else to keep you busy during the waiting periods. You may also bring a friend or a relative with you and he / she may stay with you during the day. However, during the actual treatment procedure, your companion will have to leave the treatment room. Please make sure to arrange for transportation home as you might feel tired after the treatment; driving is not recommended. Novalis allows a complete treatment session to take place in a single-day, although your doctor will decide if your treatment should be administered in a single dose.

For more information, please visit the Novalis website.