A Patient s Guide to the Calypso System for Breast Cancer Treatment

A Patient s Guide to the Calypso System for Breast Cancer Treatment

Contents Introduction How Radiation Works To Treat Cancer Radiation Treatment for Breast Cancer Special Concerns for Treating the Left Breast Protecting the Heart: The Breath Hold Technique Ensuring Breath Hold Consistency: Calypso Position Tracking The Treatment Experience Frequently Asked Questions Introduction Radiotherapy is often used to treat breast cancer, sometimes in conjunction with surgery and chemotherapy. Using radiotherapy can help to damage any cancer cells that may remain in the surgical area. With modern advances in radiotherapy, your medical team is able to aim the radiation very accurately and precisely to treat the targeted area while minimizing the exposure to nearby healthy tissue. When treating the left breast, your medical team takes special care to protect the heart. One tool they have to help is the Varian Calypso system, which uses GPS for the Body technology and Surface Beacon Transponders for temporary external placement on the skin, to monitor respiratory motion and other patient motion in real time during radiation therapy. Similar to how a GPS tracking system in a car locates where the car is at all times, Calypso provides continuous, real-time location and patient motion information during treatment. This enables clinicians to more accurately manage the delivery of radiation to the tumor.

How Radiation Works To Treat Cancer Radiotherapy uses high-energy radiation beams to destroy cancer cells while minimizing exposure to healthy tissue. Radiation damages the DNA in cancer cells, which interrupts their ability to reproduce, causing them to die and the tumor to shrink. Most normal cells have the ability to repair themselves and can more easily recover from the radiation. If normal cells near the tumor area are exposed to the radiation, it can lead to some serious side effects. Side effects vary from patient to patient. They can be minor or severe, depending on the size and location of the tumor and your general medical condition. Some common side effects of radiation treatments to the breast are fatigue, mild to moderate swelling of the radiated arm, and irritation or damage to the skin near the treatment site. Radiation Treatment for Breast Cancer For breast cancer, many patients are treated with surgery, chemotherapy, or radiotherapy alone. Many others are treated with a combination of surgery (either mastectomy or lumpectomy) and chemotherapy or radiotherapy or both. Whether you have a lumpectomy or a mastectomy as part of your treatment, external beam radiation is the most common treatment post-surgery. Following a lumpectomy, the whole breast is usually treated with radiation to damage remaining cancer cells that are too small to detect. To cover the entire breast, radiation beams are delivered from different angles. Standard whole breast radiation usually requires 25 treatments, given daily Monday through Friday for five or six weeks. In some cases, radiation therapy may be delivered in a shortened course that targets a high dose of radiation to the area of the breast where the cancer is most likely to recur. This is called Accelerated Partial Breast Irradiation (APBI for short). APBI may be delivered using internal or external sources of radiation. Individual treatment schedules may vary.* * Varian Medical Systems cannot and does not make any claims for combination treatment.

Special Concerns for Treating the Left Breast When treating cancer of the left breast, your medical team takes care to protect the heart from unnecessary exposure to radiation. In some patients, the heart is very close to the chest wall and the left breast. As a result, some areas of the heart could become exposed to radiation during whole breast treatment. Radiation can, in some cases, cause scarring and narrowing of a coronary artery that feeds the heart muscle. For this reason, your medical team takes specific precautions when treating left breast cancer with whole breast radiation. Protecting the Heart: The Breath Hold Technique In many patients, the heart may be spared from most or virtually all radiation exposure by a simple technique called Deep Inspiration Breath Hold (DIBH). Your radiotherapy team will determine if you are a candidate for this technique. DIBH can be effective at moving the heart out of the path of the radiotherapy beams. Taking in a deep breath and holding it compresses the heart slightly and pushes it downward a fraction of an inch within the chest. At the same time, the chest wall is pushed out and away from the heart. During breath hold, when the heart is out of the way, the radiation beam is turned on for a few seconds only. When you exhale and breath normally, the radiation beam is turned off. Radiation is delivered only during the breath hold periods. Ensuring Breath Hold Consistency: Calypso Position Tracking The key to the DIBH technique is consistency. Are you able to repeat the breath hold in the same way every time when the beam is turned on? Are you able to hold the breath for 40 seconds without letting any air leak out? To ensure that your breath hold is stable and repeatable, your medical team will coach you and give you ample time to practice before treatments begin. In addition, your medical team may use the Calypso system to monitor your breath hold position continuously during each treatment session. You don t need to be anxious about whether you are doing the technique correctly. Calypso lets the radiation therapist see when your breath hold has reached and stabilized within the planned zone for delivery of the radiation dose.

Optical System with 3 Infrared Cameras Array How the Calypso system works The Calypso system accurately and precisely tracks the position of targeted tissue in real time by using radiofrequency waves. The Calypso system has five parts that work together: The Beacon Transponder is a tiny L-shaped device that communicates patient position and motion information to the medical team. This information allows position and movement to be tracked as you breathe in and out and hold your breath. The beacon is taped lightly to your chest, in the exact same location for every treatment session. Surface Beacon Electromagnetic Transponder Console The electromagnetic array is a flat sensor panel that looks like a tray. The array is positioned above the patient during the treatment. Its job is to stimulate the beacon to transmit its location, collect the radio signals from the beacon, and relay the information to the tracking station. The optical tracking system consists of three infrared cameras mounted in the ceiling of the radiation therapy suite. They monitor the position of the array. The console contains the system components that generate and detect the signals used for patient alignment and continuous monitoring of the tumor position. Tracking Station The tracking station is a computer display that shows the position of the beacon as it moves with your breathing. The radiation therapist sees when your breath hold is stable and within the treatment zone. In this way, the therapist knows exactly when to turn the radiation beam on and off.

The Treatment Experience Whole breast radiation treatment with Calypso monitoring typically involves a number of steps. Your medical team will tailor your treatment according to your particular situation. They will guide you through all the various steps and answer all your questions along the way. Step 1: Simulation Deep Inspiration Breath Hold is not appropriate or necessary for every patient receiving radiation treatment to the left breast. To determine if the breath hold technique is right for you, your team will take a series of CT images while you breathe normally and while you hold your breath and compare these images. They will also take into consideration your medical condition and your comfort. They will use these images to plan your treatment. Step 2: Verification Your radiotherapy team will run a simulated treatment to verify their plan for you. They will also apply the skin markings that will enable them to position you in the same way for every treatment session. If you are a candidate for Deep Inspiration Breath Hold, they will coach you at this time until you are comfortable with the technique. Step 3: Treatment Delivery Your cancer treatment will be delivered on a machine called a linear accelerator, or linac for short. This machine produces the X-rays used to treat cancer. Your treatment plan will consist of a series of treatment sessions, as prescribed by your doctor. Typically, you will come to the radiation oncology department for treatment five days a week for five or six weeks. Each treatment takes approximately 20 minutes. Step 4: Follow Up Care After your last treatment appointment, you will be scheduled for a series of follow up visits with your radiation oncologist. Follow up care may include a physical examination, blood screening, additional imaging, and other tests. These visits offer a good opportunity to ask your doctor any questions.

FAQs Q: Do I wear the Calypso Beacon Transponder all the time? A: The Calypso beacon is attached to your chest by piece of tape at the beginning of each radiotherapy treatment, and it is removed at the end of the treatment. Between treatments it remains in the radiation oncology department. Q: Will the beacon cause any discomfort? A: The beacon is very small. It is taped lightly to your chest. Most likely you will not notice it. Q: Does the Calypso system expose me to any additional ionizing radiation? A: One of the advantages of the Calypso system is that it does not add any radiation exposure. Calypso uses radio waves which are everywhere around us all the time. Q: How long do I have to hold my breath during the treatment? A: Radiation will be delivered from two or more angles. For each beam angle, you will be guided to hold your breath while the beam is on. Typically, you will not have to hold your breath any longer than 40 seconds at a time. Q: What happens if I can t hold my breath for the required time? A: Your radiotherapy team will assess your ability to hold your breath before treatments begin. However, if, at any time, you have difficulty holding your breath, your team will likely stop treatment and consult your doctor.

Fighting cancer is challenging. And the treatment journey is unique for every person. Radiotherapy is a common form of treatment for cancer today. Your physician is the best person to decide on the suitability of radiotherapy for your treatment. If your physician prescribes radiotherapy for you, understanding the science behind radiation treatments and what to expect during treatment can make a big difference in your attitude, your decisions, and your life. Ask questions of your medical team. Radiotherapy is administered by a team of highly qualified healthcare professionals, who collectively have many years of experience in treating cancer. They want to answer all your questions. Safety Information Radiotherapy and radiotherapy of the left breast using the Calypso system are not appropriate for all breast cancer patients or all types of breast cancers. Serious side effects can occur, including skin irritation, mild to moderate breast swelling, fatigue, breast or chest wall tenderness, swelling to the arm nearest to treatment, reduced blood count, fibrosis and scarring and narrowing of a coronary artery. Talk to your doctor to determine whether radiotherapy and radiotherapy of the left breast using the Calypso system are right for you.

For more patient information, visit: www.varian.com/us/patient Varian Medical Systems, Inc. 3100 Hansen Way Palo Alto, CA 94304-1038 Telephone: 650.424.5700 Toll free: 800.544.4636 Gulf Coast Cancer Center 29653 Anchor Cross Blvd. Daphne, AL 36526 Telephone: 251.626.1755 This brochure is intended as a general guide to radiotherapy of the left breast using the Calypso system. This brochure does not replace a full discussion with your doctor and healthcare team about the Calypso system and other treatment options. It is important to know that radiotherapy is not appropriate for all types of cancer. Actual treatment times may vary. Typical radiotherapy treatments are delivered once a day for a series of weeks. 2013 Varian Medical Systems, Inc. All rights reserved. Varian, Varian Medical Systems, Calypso, Beacon Transponders are registered trademarks of Varian Medical Systems.