Amanda Wilde (Host): Radiation is a critical tool for many different cancer treatments, and the Holy Cross Cancer Center offers the most advanced technology and radiation therapy services. We'll discuss those innovations and the impact of the Holy Cross Cancer Center with Dr. Sheela Modin. Dr. Modin is Holy Cross Cancer Center's Medical Director of Radiation Oncology Services.

This is Your Best Life podcast from Holy Cross Health. I'm Amanda Wilde. Thank you for joining us. And welcome, Dr. Modin.

Dr. Sheela Modin: Thank you, Amanda.

Host: What was the impetus for moving the Radiation Treatment Center to its location?

Dr. Sheela Modin: Well, you know, our previous center had been there for about 25 years. It was pretty small. It was in the basement of a medical complex and parking was sometimes difficult. And in fact, some patients had trouble finding the clinic within the complex. So, that certainly was some motivation.

 We wanted to upgrade our equipment to the latest technology. And we needed additional space for patients and staff and equipment. But in actual fact, when we thought about radiation treatment going forward in the future, we envisaged the radiation department being part of a larger cancer center so that we could offer our patients state-of-the-art in the community. And so, that really was the real impetus and motivation for moving.

Host: Can you go a little more deeply into what the advantages are now for patients in the center?

Dr. Sheela Modin: The cancer center was specifically designed with the patient experience in mind. The center is light filled, airy, soothing, all the things that we feel give the patients a feeling of hope and healing. We have state-of-the-art technology. We have two linear accelerators, advanced CT scanning capability, and sophisticated planning systems. which integrate to the EMR. In fact, we encourage our patients to join myChart, so that they can actually get details of their radiation treatment via our planning systems and the machine software. And this is done daily. So, it's really great for patients to feel like they have a sense of control and understand what's going on with their treatment.

Host: Because patients and doctors are really partners in this.

Dr. Sheela Modin: Oh, absolutely.

Host: What types of cancers are you treating as a radiation oncologist?

Dr. Sheela Modin: Well, approximately 60% of cancer patients will require radiation treatment at some part of their cancer treatment. And if I could just do a macro view, a sort of 10,000-foot view of radiation, just to let your listeners have an idea of what radiation treatment is, it's essentially high-energy x-ray beams and it's directed to a cancer. So, patients cannot see it. You cannot feel it. There's no pain with the actual treatment. Patients lie on a table. It looks like a CT scanner with a rotating arm, and that's where the beam comes from. Radiation treatment is directed to a specific area of the body. So, it differs from chemotherapy where it goes everywhere in the body, this is just directed to a limited area most times.

Host: So, it's targeted. And did you say no pain?

Dr. Sheela Modin: There's no pain with the actual treatment, because it's like an x-ray.

Host: And are there side effects?

Dr. Sheela Modin: There absolutely can be side effects. You know, it really just depends on where the radiation is directed. So, both the side effects during treatment and after treatment are really going to be confined to just where the patient gets treated. So if a patient gets treated to, for example, the breast, then you could have skin irritation, you can have some skin redness, you can have fatigue, which is actually common to all radiation treatment. But if you get treated, for example, to the stomach, you can have nausea, you can have some effect on the bowels, but you wouldn't expect to have redness of the skin. So, it really just depends on where you get treated, what kind of symptoms that you can have. But they're all manageable, and most people do really quite well. This is outpatient treatment. So, we have very few inpatients that come in, and those are mostly emergency patients. But otherwise, it's outpatient treatment. So, many people work full time when they have radiation treatment or have an altered work schedule, but can still work.

Host: You have the cutting-edge equipment at the center. Can you describe the benefits and the differentiators and innovations of the technology at the center and then how that will impact patients?

Dr. Sheela Modin: We have the state-of-the-art technology, but I think the best way to describe the machines and describe the benefits of the machines as it relates to patients, and just to kind of walk you through a patient going through from consult to treatment, each room has a computer on a swivel so that the patients can see any relevant images or test results along with their physician. So, the next step in the process is having a planning CAT scan. This simulates a treatment and this is what we use to start the planning process. Our new CT scanner has one of the largest bores available, which helps with patient discomfort and also can accommodate larger patients. It also has artifact-reducing technology so that implanted hardware like a hip replacement, which typically gives a lot of distortion, can be minimized so we can actually ensure accurate treatment. Our CT is able to do very accurate and fast scans, which of course is absolutely important for patients. And it also allows us to do 4D scans, where we can actually follow a tumor with respect to breathing. So, we can actually see the tumor move when someone is breathing, and it's very important for breast, for lung tumors, for abdominal tumors, because it helps us be much more conformal in our treatment.

In the past, we used to give patients tattoos and I think many people will remember this, but it was used to essentially put patients in the right position, and we'd use these tattoos to help us with that. But now, we use something very novel, which is surface guidance. So, we have a series of cameras in the CT room, which are actually also in the treatment room, but they're actually looking at the surface of the patient, and we use those cameras to actually align patients. We don't need tattoos anymore, and we have very, very accurate setups. And this all comes from having this advanced CT scanning ability. So once the patient has their CT scan, then they come in for treatment. And we have two linear accelerators. So, those are the two machines that deliver radiation treatment. One is the TrueBeam and the other is called the Edge.

We're actually very fortunate to have the EDGE and HyperArc, as very few community centers have that in this area. Now, they both have robotic tables in which patients are moved so that patients are in the exact position every day for treatment. Both have surface guidance to also ensure accurate delivery. And both deliver treatment quickly and precisely. The Edge uses something called HyperArc technology, and we use that for the treatment of multiple brain lesions. About 20-40% of cancer patients will develop brain metastases sometime during their course, and about half of them will actually have more than one brain lesion. And the HyperArc allows for planning and delivering state-of-the-art radiosurgery to highly complex cases efficiently. We can treat, we can be very aggressive with these brain lesions. And by targeting them, by giving precise treatment, we can minimize side effects for patients, but at the same time address each lesion separately. This HyperArc capability allows for faster treatment. And because it allows for faster treatment and very precise treatment, patients get through treatment faster, there's less issue about patient motion. And because it's so precise, we reduce the side effects that patients can have from this.

The other treatment machine that we have that very few other places have is something called the high-dose rate unit, which is used for implants. We have a separate room for this kind of treatment. It's right next to our CT scanner so that patients do not have to be moved much after they have their implants placed. They have a separate, comfortable, quiet place to rest while they wait for their treatment. And again, this is something that not very many places have, and one of the advantages that we have here is that our physicians here have extensive experience with brachytherapy as a whole. And the other technology that we have, but patients don't actually see that, is our highly sophisticated planning systems that allow us to plan very precise treatment.

Host: So, more and more precision and accuracy. It's also much less invasive. You can treat more complex cases and the treatment is faster. What do you see in terms of results?

Dr. Sheela Modin: There's been a sea change in the way we think about metastatic disease. In the past, when someone would have metastatic disease, it would be basically considered a palliative treatment. We didn't actually think we could talk about control or cure, but now we can. In patients who have limited metastases, we are able to target those lesions very precisely, even if there are multiple lesions that we're targeting. But because it's very precise and very high doses can then be given, we are seeing better control. In patients who have, for example, lung tumors that cannot be addressed surgically or the patient chooses not to have surgery, we can treat those lesions and we have excellent control rates at this point, rivaling that of surgery, and these are patients who would not have had any option before.

Host: That is a remarkable breakthrough in cancer treatment. And it sounds like the services are really patient-centered. What are other services available to patients at the center?

Dr. Sheela Modin: So, we actually have medical oncologists and oncologic surgeons at the center, and we're looking to add even more cancer specialists. We have nurse navigators who guide and help a patient through their treatment journey. We have a nutritionist that patients can see. We also have oncology social worker and the social worker helps patients with their emotional and sometimes practical needs to make their cancer journey a little easier and less stressful. Our goal here is to provide wraparound services to our patients in keeping with this vision of hope and healing, that was what motivated us to move in the first place and for this cancer center to come about.

Host: Thank you so much for your work, Dr. Modin. You have so many support services as well as cutting edge technology for patients. I just wish you the greatest success with the center. And it sounds like you'll be able to serve more people because of faster treatment and achieve higher success rates. So, just looking forward to the success of the center.

Dr. Sheela Modin: Thank you so much, Amanda.

Host: That was Dr. Sheela Modin, Holy Cross Cancer Center's Medical Director of Radiation Oncology Services. For more information, visit holycrosshealth.org. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. Thanks for listening. This is Your Best Life Podcast presented by Holy Cross Health.