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Deborah Howell (Host): Radiation. The word means different things to different people, but to a Radiation Oncologist, it means a way to provide therapy for his or her patients. I'm Deborah Howell and today we'll find out more about Radiation Oncology with an expert in this exciting field. Dr. David Bergman is a Radiation Oncologist with McLaren in Michigan. Welcome Dr. Bergman.

David Bergman, MD (Guest): Good to be here. Thank you for having me.

Host: Nice of you to join us. Let's jump right in. What is radiation therapy and how does it work to treat cancer?

Dr. Bergman: Radiation therapy is one of our many options to treat cancers along with surgeries or various types of chemotherapy or other systemic therapies. It's a focal treatment and we use x-rays or sometimes other ways of delivering the radiation in order to target various parts of the body and stop abnormal cells from growing.

Host: And I've always wondered. What's the difference between external beam or internal radiation therapy?

Dr. Bergman: So, the vast majority of our radiation treatments for cancer care are external beam radiation therapy, and what that means is we're using a machine to create, again, most of the time x-rays to deliver the radiation from the outside. It's basically the same as laying still for a regular CAT scan or x-ray.

The machine moves around you, does all the work and delivers the radiation treatment where we want it to go. And you know, the differences between side effects and tolerability are based on all the different parts of the body that we're treating. There are other ways of delivering radiation treatments such as internal radiation therapy.

Another term for that is called brachytherapy. And that can be delivered for certain types of cancers as well. Most commonly gynecologic cancers, prostate cancers, sometimes lung cancers can be treated with that as well. And typically they use a method to deliver a radioactive source into the area that is being targeted to deliver the radiation from the inside.

Host: Thank you for that excellent explanation. So why is radiation therapy sometimes used in combination with other cancer treatments?

Dr. Bergman: So, the ways that we determine the best options for a certain patient's cancer is to get the, get all the information first. We have to diagnose with biopsy, various modes of imaging to stage the cancers appropriately. And based on all that information, we determine what's the best option, you know, is it surgery followed by radiation and or chemotherapy?

Is it chemo, radiation together? Is it radiation alone? Is it, you know, to the point where we only have the option to do chemotherapy alone. So, all that information plays into the recommendation of treatment. And based on again, you could have an early stage cancer that can be treated with surgery or radiation alone.

Maybe at a later stage, more locally advanced, they would need a combination surgery followed by radiation or chemotherapy or chemo, radiation therapy alone. Just for example, lung cancer treatments, early stage, you have the option for surgery, patients have the option for radiation treatment alone as well, but for locally advanced where there's a larger disease or more extensive involvement of the lymph nodes or in that region of the body, then typically standard of care is a combination of chemotherapy and radiation treatments.

Host: Got it. Now here's the biggie, what most patients want to know. What are the side effects of radiation therapy and how long do they last?

Dr. Bergman: So, that's a great question. And it all depends on what part of the body we're treating. I think, like I mentioned before, radiation is a very localized treatment. One of the big differences between radiation and chemotherapies or other systemic treatments is that we're really focused on certain parts of the body.

If you have treatment in the pelvis, you're going to have local side effects there, you know, bladder, bowel irritation. If you're treating an abdomen, similar types of irritation to the bowels or stomach or that type of area, in the lungs, you can get a mild cough. Maybe some difficulty swallowing, if we're treating near the middle of the chest. Certain types of radiation treatments are delivered near the skin surface, such as breast cancers or head and neck cancers. And you can expect some skin reactions. And those are some of the various side effects you can expect from radiation therapy. And it all depends again, on the amount of radiation treatment that we need to deliver to how intense they'll be and how long they'll last.

Typically radiation treatment side effects don't start right away. Usually the first week or two of radiation treatment you feel about the same as you do prior to starting, and then they slowly get more noticeable through the several weeks of treatment that we deliver. And then typically pretty soon after radiation treatments are done, the side effects are returning to normal. I would say on average, a couple of weeks after finishing.

Host: And how long has the normal course of radiation?

Dr. Bergman: That all depends again, on the type of cancer, the stage, and some other pieces of information as well. In general, our standard radiation courses are about five to eight weeks. And really does depend on just the type, the extent of the disease and the goals of treatment.

Host: Got it. Now, are there certain types of cancers that respond best to radiation therapy?

Dr. Bergman: There are. Yes. There are definitely certain cancers that are what we would call radio sensitive or radio resistant are the general terms that we use. Most cancers are pretty well responsive to radiation therapy. There are certain ones that respond less well. Certain types of liver cancer, kidney cancers, certain other types that don't respond very well to radiation therapy.

But other types are very sensitive. Typically lymphomas or other types of blood cell cancers are very sensitive to radiation treatment, but for the most part, they are also treated primarily with chemotherapy. So there's vastly different response to treatment, but most tumors respond pretty well to radiation treatment.

Host: We've been speaking with Dr. David Bergman, a Radiation Oncologist with McLaren. Thank you so much for being with us today, Dr. Bergman.

Dr. Bergman: Thank you for having me. I appreciate the time.

Host: And to learn more about Dr. Bergman, radiation therapy and other cancer treatments at McLaren Bay Region, please visit mclaren.org/baycancer. I'm Deborah Howell. Thanks for listening and have yourself a terrific day.