TrueBeam radiotherapy in Turkey

TrueBeam is a C-arm linear accelerator: the radiation source sits on an arm that rotates around a single point, the couch places the tumour at that point, and a multileaf collimator of thin metal leaves shapes the beam as the arm moves. It produces photon beams at several energies, including a high-output mode for stereotactic treatments, and electron beams for superficial targets. Cone-beam scans and planar images taken on the machine before each session line the plan up with the tumour that day, and a breathing-gated mode delivers the beam only in the phase of the breath where the tumour sits where it was planned.

The same unit therefore covers most of what a radiotherapy department does: conformal and intensity-modulated arc therapy for prostate, breast, head and neck, lung, gynaecological and rectal cancers; stereotactic body radiotherapy for small lung, liver, spine, prostate and adrenal targets in a few sessions; and frameless stereotactic radiosurgery of brain metastases and benign brain lesions when fitted with a fine collimator and precise mask. Its geometry allows beams from outside the horizontal plane, which helps some brain and head and neck plans. What it cannot do is treat a target longer than its field without joining fields, which is where a helical machine has the advantage.

• Conventional courses

  Daily arc-based intensity-modulated radiotherapy for the common cancers; the bulk of what any department does, and a TrueBeam does it as well as any other current accelerator.

• Stereotactic body radiotherapy

  A few high-dose sessions for small, well-defined targets in lung, liver, spine, prostate and adrenal; needs breathing management, tight immobilisation and a physics team used to it.

• Brain radiosurgery

  Single or few-session treatment of brain metastases and some benign lesions with a mask instead of a frame; an alternative to Gamma Knife and CyberKnife whose choice depends on the case and the team.

• Where another machine is chosen

  Whole-spine and whole-marrow irradiation and very long targets, where a helical unit avoids field junctions; and any case where the indication itself has not been settled.

The general questions about a course of radiotherapy abroad are covered on the radiation therapy page. For the helical alternative see TomoTherapy; for dedicated radiosurgery systems see CyberKnife and Gamma Knife; for the wider picture see oncology in Turkey.

• Side effects belong to the site and the dose, not the machine. Fatigue is near universal; skin reaction, mouth and throat soreness, swallowing difficulty, nausea, diarrhoea, bladder irritation and hair loss depend on what is treated. TrueBeam does not remove them; the plan reduces them.
• Stereotactic treatments concentrate risk as well as dose. A very high dose in a few sessions is unforgiving of a target drawn too generously or a patient who moves; rib fracture, airway or bowel injury and radiation necrosis in the brain are the specific hazards, and they are the reasons the plan is verified on the machine first.
• Late effects. Fibrosis, dry mouth, bowel and bladder changes, fertility loss, heart and lung changes and a small long-term risk of a second cancer follow from dose to normal tissue on any machine and appear months to years later.
• Geometric miss and machine error. Rare, but real; daily imaging, a mask that fits, a physics quality-assurance programme and an oncologist who reviews the images are the defence. Ask about all four.
• Interruptions. A course that stops for illness, travel or money loses effect; plan the stay for the whole course plus margin.
• Emergencies far from home. Chemoradiation can cause dangerous drops in blood counts, infection and dehydration; the hospital treating you must be the one you can reach at night.
• Follow-up in two countries. Late effects and recurrence are found by follow-up scans; if the handover is not arranged before you travel, the treatment is unfinished.

• Choose the department, not the unit. Ask for the radiation oncologists, the medical physicists and the tumour board; a machine without a strong physics team is a liability.
• Ask what the department does routinely. Stereotactic body radiotherapy and radiosurgery are programmes, not settings; ask how many of your treatment the team does a year.
• Insist on a written plan before you fly. Intent, target, dose, sessions, technique, concurrent chemotherapy and who is responsible.
• Budget for the whole stay. Accommodation near the hospital for the full course, a companion, and a margin for delays.
• Fix the handover in advance. Treatment summary, plan images and scan schedule to your oncologist at home, in a format they have agreed to accept.
• Keep your own copies. Histology, staging, plan and treatment summary; you will need them for years.

• European Society for Radiotherapy and Oncology, patient information on radiotherapy techniques including intensity-modulated, image-guided and stereotactic radiotherapy.
• National Cancer Institute, radiation therapy to treat cancer: types, side effects and what to expect.
• American Society for Radiation Oncology, patient guidance on external beam radiotherapy and stereotactic body radiotherapy.
• Varian, TrueBeam platform technical description and indications for use.
• Republic of Türkiye Ministry of Health, register of facilities authorised for international health tourism and radiation oncology licensing.