When you have cancer and need radiation, with conventional therapy, it is delivered in relatively small doses over the course of several weeks, with patients receiving daily treatments during that time.
With SBRT, ( Stereotactic Body Radiation Therapy), physicians are able to deliver a greater combined dose of radiation over the course of far fewer treatments. SBRT has shown dramatically better outcomes than conventional radiation therapy.
Listen in as Dr. Dan Cornell explains Stereotactic Body Radiation Therapy and the benefits for patients with shorter course radiation therapy.
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SBRT (Stereotactic Body Radiation Therapy) for Shorter Course Radiation Therapy
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Learn more about Dan Cornell, MD
Dan Cornell, MD
Dan Cornell, MD earned his medical degree from the University of Maryland Medical School in Baltimore and held a transitional internship at Montefiore University Hospital in Pittsburgh. He completed a residency in radiation oncology at Georgetown University Hospital in the District of Columbia.Learn more about Dan Cornell, MD
Transcription:
SBRT (Stereotactic Body Radiation Therapy) for Shorter Course Radiation Therapy
Melanie Cole (Host): With conventional therapy, radiation is delivered in relatively small doses over the course of several weeks, with patients receiving daily treatments during that time. With SBRT, or Stereotactic Body Radiation Treatment, physicians are able to deliver a greater combined dose of radiation over the course of far fewer treatments. It has shown dramatically better outcomes than conventional radiation therapy. My guest today is Dr. Dan Cornell. He's a radiation oncologist with the John R. Marsh Cancer Center. Welcome to the show, Dr. Cornell. First, let’s tell the listeners: what is Stereotactic Body Radiation therapy.
Dr. Dan Cornell (Guest): Well, Stereotactic Body Radiation Therapy is a completely new way of administering radiation therapy. In the past, what we would typically do is give radiation therapy to a tumor over a number of fractions, typically, say, 30 treatments, with the idea for exposing tumor and normal tissue to radiation therapy. The tumor would be more sensitive to the radiation therapy than the normal tissue, so it would gradually subside and shrink down. But, Stereotactic Radio surgery is different, or Stereotactic Body Radiation, as we call it. And the way it's different is it's a very high dose of radiation therapy focused on a very tiny area. If you can imagine like a laser beam except, unlike light, it's radiation such as x-rays are not attenuated by body tissues or blocked. So, we can focus on an area, say a small lung tumor, and give it enough dose to knock it out completely. So, we're using radiation like we would like a bloodless scalpel, rather than in the old days where we'd use radiation therapy as a number of fractions delivered over an extended period of time, like six weeks. Now, we can do treatments in about three treatments and get dramatically good results.
Melanie: So, who can benefit from Stereotactic Body Radiation Therapy? What type of cancers do you use it to treat?
Dr. Cornell: Well, the main beneficiary of this treatment would be patients that have small lung tumors and, obviously, most lung tumors are surgical patients, meaning that they would have the tumor resected, but, as you are aware, there are patients out there that have very poor lung function, for instance, somebody who has smoked for many years, and as a result of that, they might have enough lung disease, or what we call COPD, basically breathing problems, that they're not a candidate for surgery, meaning surgery would be too much for them. But, they have a small tumor that's been advancing in size and people are kind of scratching their heads saying "Well, what do we do? This person has a small tumor and it's curable, but we can't operate on them because they're not a candidate for surgery because of their lung function, or bad lungs, and so now we have a treatment that can administer a very high dose of radiation, knock the tumor out without having to cut the patient open. So, that's our prime candidate for the treatment. Now, certainly, you can use it in other areas, such as a brain for small brain tumors, and things like that. But, I think the real value of Stereotactic Body Radiation Therapy is going to be for treatment of lung tumors.
Melanie: And, what about metastases? Is it used if you find that something has spread to another organ?
Dr. Cornell: Yes, it can be. Obviously, when you're talking about metastatic disease, there are two categories. One would be widespread metastases where you've basically got disease everywhere. And then, there's another category, what we call “oligometastases” which is a fancy medical term to describe one or two metastases. For instance, if you had a sarcoma, or soft tissue tumor of the leg, and then, that tumor spreads to the lung. Well, technically, that's Stage IV disease, but with sarcomas, and some other tumors, you can have what's known as “oligometastasis”, which means one or two areas of metastatic disease which happens to be the only sites of metastatic disease. So, these patients, like Morris the cat, they might have nine lives, meaning that they are a candidate for treatment; either surgery to remove the lung lesion, or Stereotactic Body Radiation Therapy to treat that lesion and they have a second chance of cure, even though technically, they were considered Stage IV disease when they were diagnosed.
Melanie: Dr. Cornell, people hear these higher dose, lower amount of time required, but they worry about that dose of radiation. What do you tell them?
Dr. Cornell: Well, I tell them it's like anything else. It's very focused to a very small area, so that, yes, everything in that small area that we're treating is basically annihilated, meaning normal cells, tumor cells; there's really nothing that sort of survives in that small zone. But, it's like anything else, if you're treating a small area, you have much less side effects than if you're treating a relatively large area. It would be kind of like going to the beach and if you happen to very sensitive to the sun and you cover up completely but your little toe is out in the sun and it gets a heck of an exposure and you develop a terrible sunburn of your little toe, well, that's not the same thing as having that same exposure to your entire body and you have an entire body sunburn. So, yes, it's the same sunburn, but because the amount of your body that's exposed to it is very tiny, then the overall effects are manageable.
Melanie: What an excellent explanation that was, Dr. Cornell. Is Stereotactic Body Radiation Therapy--are there certain peoples who are not candidates?
Dr. Cornell: Yes, we have some patients that are less than ideal candidates and to give you an example it would be if the tumor was located very close to a critical structure such as like the spinal cord, or we have some patients that we have to be careful if the tumor is located too close to what we call the bronchial tree, which is the major airways that are going into the lung, but we can get around that by instead of giving three treatments, we make the daily done slightly smaller and we give them five treatments. So, we're able to sort of "thread the needle", so to speak, and get away with treating these tumors that are very close to critical structures by slightly modifying the dose regimen.
Melanie: Is there a difference in quality of life as someone is going through these treatments?
Dr. Cornell: Yes. I mean, I enjoy doing these treatments because we're able to take somebody who has a potentially fatally tumor if it's left untreated and we have a way of approaching that tumor, even in a patient who is very ill, somebody who has very poor lung function, or who is quite frail. You know, we could have somebody who is 90 years old who would never be a surgical candidate because of their advanced age, and they're in great health, but they're looking at a potentially fatal disease, so we can catch a small tumor in the lung, do the treatments, and months later when we do follow up CT scans or PET scans, we see the tumor is gone and it's very gratifying. Especially knowing that the treatment that we're doing has virtually no side effects as opposed to the old days where the radiation therapy fields were larger, less precise, and would go over a period of six or so many weeks, and a lot of times, there would be a lot of side effects. They would have difficulty with swallowing or something called “esophagitis”, as we call it. So, these types of treatments, because it's so focused in such a small area, that patients have virtually no side effects and it's very gratifying to see the end result of the tumor going away.
Melanie: Dr. Cornell, where do you see the future of radiation therapy going?
Dr. Cornell: Well, I see the future being perhaps treating more metastatic disease. In other words, we have scans now that are more sensitive than they've ever been. When I started my career, you know, CAT scans were the "cat's meow" and then, obviously, we went to MRI scans, but now we have PET scans that actually show active tumor versus no area of tumor, and so, these tumors light up on PET scans so we can see them. But, I foresee in the future that we'll have scans that we'll be using some type of antibodies that are linked to the tumor that we can actually identify small areas of tumor that are undetectable by even PET scans today, where we could have a patient that has, say, a small tumor, I don't know, say, we have a colorectal tumor, but when we do a scan on them, we can see that there's two tiny lesions in the liver that would about the size of a BB that would never show up on CAT scan, they would never show up on PET scan, but because of this new scan technology, we can locate a tumor that's very tiny, know that pretty much that's the only two areas of metastatic disease and treat those with Stereotactic Body Radiation, and the patient doesn't have to be cut open, they don't have to go through any big procedure, but that would be a way of actually curing patients that in the past might not have been considered curable.
Melanie: That's absolutely fascinating, Dr. Cornell. And in the last few minutes, please give your best advice to people that are looking at these different forms of radiation therapy, wondering what they should do, and why they should come to Meritus Health for their care.
Dr. Cornell: Well, I think these types of treatment are available at pretty much every center. You know, I'd like to think it's rocket science. It is sort of whiz-bang, and I can appreciate the technology that goes into treating these lesions, but the nice thing about it is we have very powerful computers that allow us to do these precise treatments that we didn't have in the past. They allow for things like respiratory motion. In other words, if you've got a lung tumor, it doesn't just sit there like a fixed object, it moves up and down with breathing. And so, because of the computer technologies we have, we can track that and do things that we could never do in the past. So, I guess, you know, think of back in WWII, we had the bombing campaign, you opened up the bomb bays, drop all the bombs, and hope that you hit the target. Now, we've got smart bombs that can go down the chimney stack of a home. So, it's because of this computer advancement and technology advancement that allows us to have precision that we could only dream of in the past.
Melanie: Thank you so much for being with us today. It's really great information. You're listening to Your Health Matters with Meritus Health, and for more information, you can go to www.meritushealth.com/mmg. That's www.meritushealth.com/mmg. This is Melanie Cole. Thanks so much for being with us.
SBRT (Stereotactic Body Radiation Therapy) for Shorter Course Radiation Therapy
Melanie Cole (Host): With conventional therapy, radiation is delivered in relatively small doses over the course of several weeks, with patients receiving daily treatments during that time. With SBRT, or Stereotactic Body Radiation Treatment, physicians are able to deliver a greater combined dose of radiation over the course of far fewer treatments. It has shown dramatically better outcomes than conventional radiation therapy. My guest today is Dr. Dan Cornell. He's a radiation oncologist with the John R. Marsh Cancer Center. Welcome to the show, Dr. Cornell. First, let’s tell the listeners: what is Stereotactic Body Radiation therapy.
Dr. Dan Cornell (Guest): Well, Stereotactic Body Radiation Therapy is a completely new way of administering radiation therapy. In the past, what we would typically do is give radiation therapy to a tumor over a number of fractions, typically, say, 30 treatments, with the idea for exposing tumor and normal tissue to radiation therapy. The tumor would be more sensitive to the radiation therapy than the normal tissue, so it would gradually subside and shrink down. But, Stereotactic Radio surgery is different, or Stereotactic Body Radiation, as we call it. And the way it's different is it's a very high dose of radiation therapy focused on a very tiny area. If you can imagine like a laser beam except, unlike light, it's radiation such as x-rays are not attenuated by body tissues or blocked. So, we can focus on an area, say a small lung tumor, and give it enough dose to knock it out completely. So, we're using radiation like we would like a bloodless scalpel, rather than in the old days where we'd use radiation therapy as a number of fractions delivered over an extended period of time, like six weeks. Now, we can do treatments in about three treatments and get dramatically good results.
Melanie: So, who can benefit from Stereotactic Body Radiation Therapy? What type of cancers do you use it to treat?
Dr. Cornell: Well, the main beneficiary of this treatment would be patients that have small lung tumors and, obviously, most lung tumors are surgical patients, meaning that they would have the tumor resected, but, as you are aware, there are patients out there that have very poor lung function, for instance, somebody who has smoked for many years, and as a result of that, they might have enough lung disease, or what we call COPD, basically breathing problems, that they're not a candidate for surgery, meaning surgery would be too much for them. But, they have a small tumor that's been advancing in size and people are kind of scratching their heads saying "Well, what do we do? This person has a small tumor and it's curable, but we can't operate on them because they're not a candidate for surgery because of their lung function, or bad lungs, and so now we have a treatment that can administer a very high dose of radiation, knock the tumor out without having to cut the patient open. So, that's our prime candidate for the treatment. Now, certainly, you can use it in other areas, such as a brain for small brain tumors, and things like that. But, I think the real value of Stereotactic Body Radiation Therapy is going to be for treatment of lung tumors.
Melanie: And, what about metastases? Is it used if you find that something has spread to another organ?
Dr. Cornell: Yes, it can be. Obviously, when you're talking about metastatic disease, there are two categories. One would be widespread metastases where you've basically got disease everywhere. And then, there's another category, what we call “oligometastases” which is a fancy medical term to describe one or two metastases. For instance, if you had a sarcoma, or soft tissue tumor of the leg, and then, that tumor spreads to the lung. Well, technically, that's Stage IV disease, but with sarcomas, and some other tumors, you can have what's known as “oligometastasis”, which means one or two areas of metastatic disease which happens to be the only sites of metastatic disease. So, these patients, like Morris the cat, they might have nine lives, meaning that they are a candidate for treatment; either surgery to remove the lung lesion, or Stereotactic Body Radiation Therapy to treat that lesion and they have a second chance of cure, even though technically, they were considered Stage IV disease when they were diagnosed.
Melanie: Dr. Cornell, people hear these higher dose, lower amount of time required, but they worry about that dose of radiation. What do you tell them?
Dr. Cornell: Well, I tell them it's like anything else. It's very focused to a very small area, so that, yes, everything in that small area that we're treating is basically annihilated, meaning normal cells, tumor cells; there's really nothing that sort of survives in that small zone. But, it's like anything else, if you're treating a small area, you have much less side effects than if you're treating a relatively large area. It would be kind of like going to the beach and if you happen to very sensitive to the sun and you cover up completely but your little toe is out in the sun and it gets a heck of an exposure and you develop a terrible sunburn of your little toe, well, that's not the same thing as having that same exposure to your entire body and you have an entire body sunburn. So, yes, it's the same sunburn, but because the amount of your body that's exposed to it is very tiny, then the overall effects are manageable.
Melanie: What an excellent explanation that was, Dr. Cornell. Is Stereotactic Body Radiation Therapy--are there certain peoples who are not candidates?
Dr. Cornell: Yes, we have some patients that are less than ideal candidates and to give you an example it would be if the tumor was located very close to a critical structure such as like the spinal cord, or we have some patients that we have to be careful if the tumor is located too close to what we call the bronchial tree, which is the major airways that are going into the lung, but we can get around that by instead of giving three treatments, we make the daily done slightly smaller and we give them five treatments. So, we're able to sort of "thread the needle", so to speak, and get away with treating these tumors that are very close to critical structures by slightly modifying the dose regimen.
Melanie: Is there a difference in quality of life as someone is going through these treatments?
Dr. Cornell: Yes. I mean, I enjoy doing these treatments because we're able to take somebody who has a potentially fatally tumor if it's left untreated and we have a way of approaching that tumor, even in a patient who is very ill, somebody who has very poor lung function, or who is quite frail. You know, we could have somebody who is 90 years old who would never be a surgical candidate because of their advanced age, and they're in great health, but they're looking at a potentially fatal disease, so we can catch a small tumor in the lung, do the treatments, and months later when we do follow up CT scans or PET scans, we see the tumor is gone and it's very gratifying. Especially knowing that the treatment that we're doing has virtually no side effects as opposed to the old days where the radiation therapy fields were larger, less precise, and would go over a period of six or so many weeks, and a lot of times, there would be a lot of side effects. They would have difficulty with swallowing or something called “esophagitis”, as we call it. So, these types of treatments, because it's so focused in such a small area, that patients have virtually no side effects and it's very gratifying to see the end result of the tumor going away.
Melanie: Dr. Cornell, where do you see the future of radiation therapy going?
Dr. Cornell: Well, I see the future being perhaps treating more metastatic disease. In other words, we have scans now that are more sensitive than they've ever been. When I started my career, you know, CAT scans were the "cat's meow" and then, obviously, we went to MRI scans, but now we have PET scans that actually show active tumor versus no area of tumor, and so, these tumors light up on PET scans so we can see them. But, I foresee in the future that we'll have scans that we'll be using some type of antibodies that are linked to the tumor that we can actually identify small areas of tumor that are undetectable by even PET scans today, where we could have a patient that has, say, a small tumor, I don't know, say, we have a colorectal tumor, but when we do a scan on them, we can see that there's two tiny lesions in the liver that would about the size of a BB that would never show up on CAT scan, they would never show up on PET scan, but because of this new scan technology, we can locate a tumor that's very tiny, know that pretty much that's the only two areas of metastatic disease and treat those with Stereotactic Body Radiation, and the patient doesn't have to be cut open, they don't have to go through any big procedure, but that would be a way of actually curing patients that in the past might not have been considered curable.
Melanie: That's absolutely fascinating, Dr. Cornell. And in the last few minutes, please give your best advice to people that are looking at these different forms of radiation therapy, wondering what they should do, and why they should come to Meritus Health for their care.
Dr. Cornell: Well, I think these types of treatment are available at pretty much every center. You know, I'd like to think it's rocket science. It is sort of whiz-bang, and I can appreciate the technology that goes into treating these lesions, but the nice thing about it is we have very powerful computers that allow us to do these precise treatments that we didn't have in the past. They allow for things like respiratory motion. In other words, if you've got a lung tumor, it doesn't just sit there like a fixed object, it moves up and down with breathing. And so, because of the computer technologies we have, we can track that and do things that we could never do in the past. So, I guess, you know, think of back in WWII, we had the bombing campaign, you opened up the bomb bays, drop all the bombs, and hope that you hit the target. Now, we've got smart bombs that can go down the chimney stack of a home. So, it's because of this computer advancement and technology advancement that allows us to have precision that we could only dream of in the past.
Melanie: Thank you so much for being with us today. It's really great information. You're listening to Your Health Matters with Meritus Health, and for more information, you can go to www.meritushealth.com/mmg. That's www.meritushealth.com/mmg. This is Melanie Cole. Thanks so much for being with us.