Selected Podcast
Innovative Treatments & Treatment Planning for Radiation Oncology
Dr. Steven Damore discusses the TrueBeam and other cancer therapies and treatments available through the MemorialCare Cancer Institute at Saddleback Memorial.
Featured Speaker:
Dr. Steven Damore, MD
Steven J. Damore, M.D. is a board certified cancer specialist in Radiation Oncology. A native to California, Dr. Damore completed his undergraduate studies at the University of California, Los Angles (UCLA) where he graduated Cum Laude and then went on to obtain his medical doctorate from the Washington University School of Medicine in St. Louis, Missouri. He completed his internship at San Francisco's St. Mary's Medical Center followed by residency training at the University of California, Irvine where he also served as Chief Resident. Transcription:
Innovative Treatments & Treatment Planning for Radiation Oncology
Deborah Howell (Host): Hello and welcome to the show. You are listening to weekly dose of wellness brought to you by Memorial Care Health System, I am Deborah Howell and today’s guest is Dr. Steven J. Damore, a board certified cancer specialist in radiation oncology affiliated with Saddleback Memorial. He is here today to talk to us about some innovative treatments and treatment planning for radiation oncology. Welcome Dr. Damore.
Dr. Steven J. Damore (Guest): Oh, my pleasure, thank you for having me.
Deborah: So let’s get right to it, what is radiation oncology and how is it used to fight cancer?
Dr. Damore: Radiation oncology is the use of radiation to treat cancer and depending on the type of cancer patient may have or the stage of the cancer, we use radiation in several different ways, sometimes this radiation is delivered through a machine called external beam radiation which focuses x-ray beams onto the tumor inside the patient. Sometimes, we inject radioactive material and sometimes we implant radioactive material inside the patient and all of those options are available at the new cancer center here at Saddleback.
Deborah: It sounds a little bit alarming, you know, injecting radioactive material into the human body, so want you to try to ease our fears by explaining that a little bit.
Dr. Damore: Well, generally speaking, all the different modalities that we use to deliver radiation are quite safe and quite effective and with current technology, the side effect profile has improved quite a bit and most patients go through whatever form of radiation they are going to receive fairly comfortably and do well.
Deborah: Great, how is radiation therapy planned for an individual patient.
Dr. Damore: Well, it is actually a fairly complex process. It usually begins with diagnostic imaging and then the patient usually undergoes additional imaging inside the radiation oncology department and for external beam treatment which is what most patients receive, the physician then uses a process called a stimulation where we set up the actual radiation beams, determine how the radiation beams would traverse through the patient to focus on the target which has been defined by the physician and then a series of calculations are done with our physicist to determine the amount of radiation that needs to be delivered from the machine to achieve the desired effect.
Deborah: Okay, I have been doing a little homework, now I understand that with the opening of the Memorial Care Cancer Institute at Saddleback Memorial, Saddleback Memorial will have a new treatment option or two available for patients including the TrueBeam. I am very interested to find out what makes the TrueBeam so special.
Dr. Damore: Yeah, we are all very excited about it, the TrueBeam is the technologically most advanced linear accelerator which is the machine that we use to deliver radiation that is available and it has got a lot of features in it, I mean a lot of innovations that improve our accuracy and our targeting capability, so that is one nice thing. It also delivers the treatments more quickly which allows for less patient motion during the treatment which also improves accuracy and also it makes it more comfortable for the patient. The patients can be monitored continuously during treatment, they can listen to music and so it should make for a better experience all the way around.
Deborah: So, what did you experience as a patient. You are lying there and what happens, what goes on?
Dr. Damore: Well, the patients usually experience very little actually during the treatment, it is more of a nonevent from their perspective than anything else. They don’t feel anything during the treatments and the machine moves around them and it delivers the radiation in a pattern that has been predetermined and is based on the computerized planning process that we talked about earlier and they are on the table for a few minutes and then they get off and go about the rest of their day and come back in most cases, then do it over again for several more sessions.
Deborah: Can they go right to work after treating session.
Dr. Damore: Oh, I would expect so. Yeah, that is our anticipation and for the majority of patients that certainly should be true.
Deborah: That is just incredible, how far we can, I mean, think about that. You are getting your cancer treatment and then you are popping off to your job, home or walking your dog.
Dr. Damore: Yeah, it has come a long way, the process is that we are going to implement with a TrueBeam, you know, really weren’t even invented, you know 10 years ago, 15 years ago and now they are becoming more and more common place in the technology that it is just amazing in terms of what it allows us to do as physicians than what it allows patients to do while they are going through their cancer treatment.
Deborah: So, I am assuming since getting into their car and driving away that they are not even under sedation of any kind when they are.
Dr. Damore: No, no, we rarely need to use sedation. We never need to use it for patients who are going through external beam therapy and so generally speaking, they should leave the department in the same condition that they arrived in prior to the treatment each day.
Deborah: So, of course I am sure every patient wants to be able to be the beneficiary of TrueBeam but what type of cancers does TrueBeam help treat specifically.
Dr. Damore: Well, the TrueBeam will be able to deliver all of the what we call general radiation therapy that we currently use, you know, other linear accelerators for but don’t really require higher levels of technology but in addition, it treats some patients that we are currently not treating right now for example delivering what is called stereotactic treatments which means highly precise, highly localized radiation treatments and a small number of treatments who have very large doses are delivered and we anticipate using that for example in the brain and in the lung and in the future probably in the prostate but patients who have cancers in virtually any area of the body will probably be able to be treated on this machine as well.
Deborah: Okay, but you are saying prostate cancer is not one of the candidates at this point.
Dr. Damore: For the patients with prostate cancer who come to the radiation oncology will be treated on the TrueBeam. For the initial phase of implementation of the TrueBeam, we will probably be treating those patients with small doses of radiation for a large number of treatments similar to what has been done here on our other machine for, you know, sometime. In the future as the data matures, they will probably be a push for some patients with very early stage prostate cancer to be treated with a smaller number of treatments, so instead of a nine-week course of treatment, they will have it treated in five treatments or so and those trials are currently underway right now.
Deborah: Okay, and I have to ask since it is the biggie, the number one form of cancer, breast cancer also a candidate.
Dr. Damore: Oh, for sure, yeah, we anticipate that patients who have breast cancer will also be getting treated on this machine.
Deborah: Yeah, it is wonderful news. Does the TrueBeam offer other benefits to patients like treatment times and increased comfort.
Dr. Damore: It does, so the treatment times are shorter and that always more comfortable for the patient. The other piece of technology that the TrueBeam offers is that we will have the ability to synchronize the delivery of the radiation beams with respiratory motion of the patient and so in patients who have tumors that are in movement in response to the respiratory cycle, the TrueBeam has some innovations that allow the beam to go on only when the tumor is in a specific position and that will allow a smaller portion of the patient’s lung to be treated, that is called respiratory gating and we plan on implementing that certainly for lung cancer patients as well as possibly some others.
Deborah: Now in the brain, I would assume that TrueBeam is really critical because you really want to damage as few cells around the cancer as possible.
Dr. Damore: Absolutely, yeah and by being extremely accurate with where the radiation is delivered and knowing that very minimal of the normal brain is to be treated in certain circumstances, it allows us to give much higher doses of radiation per treatment and so in some cases, we can deliver full course of treatment in one setting, sometimes it is up to five treatments but that is much shorter number of treatments than would be given for conventional radiation therapy.
Deborah: And five treatments over the course of what kind of time, a month or.
Dr. Damore: Usually, one to two weeks.
Deborah: Oh weeks.
Dr. Damore: Yeah, usually one to two weeks, so usually it is every day or every other day depending on the clinical circumstances.
Deborah: Incredible, this is got to be the best news ever for cancer patients.
Dr. Damore: Yeah, it is very exciting, you know, we are in a field where technology tends to drive innovation and it tends to make its way into practice fairly quickly and the TrueBeam certainly offers a lot of innovations that we are going to be able to make use from and that our patients will benefit from greatly.
Deborah: They certainly need some good news, don’t they when they get the news that they have cancer.
Dr. Damore: They absolutely do and being able to tell them that we have this technology available certainly makes the conversation little bit easier.
Deborah: Yeah, I have one final question because time has flown, how will the addition of the TrueBeam enhance the current services offered at Saddleback Memorial.
Dr. Damore: Well, we have always had excellent technology at Saddleback Memorial and this will add to, it will allow us to deliver some treatments for example those I spoke of in the brain and in the lung, mainly with the small numbers of treatment that we have not had before and I think that that will be, you know, the biggest difference and improvement in options we have for patients based on just the machine alone.
Deborah: Well, thank you so much Dr. Damore for the great news and it has been wonderful to have you on the program today and spreading the word about TrueBeam.
Dr. Damore: Oh, my pleasure, thank you very much.
Deborah: To listen to the podcast and for more info, please visit memorialcare.org. I am Deborah Howell, join us again next time as we explore another weekly dose of wellness brought to you by Memorial Care Health System. Have a fantastic day.
Innovative Treatments & Treatment Planning for Radiation Oncology
Deborah Howell (Host): Hello and welcome to the show. You are listening to weekly dose of wellness brought to you by Memorial Care Health System, I am Deborah Howell and today’s guest is Dr. Steven J. Damore, a board certified cancer specialist in radiation oncology affiliated with Saddleback Memorial. He is here today to talk to us about some innovative treatments and treatment planning for radiation oncology. Welcome Dr. Damore.
Dr. Steven J. Damore (Guest): Oh, my pleasure, thank you for having me.
Deborah: So let’s get right to it, what is radiation oncology and how is it used to fight cancer?
Dr. Damore: Radiation oncology is the use of radiation to treat cancer and depending on the type of cancer patient may have or the stage of the cancer, we use radiation in several different ways, sometimes this radiation is delivered through a machine called external beam radiation which focuses x-ray beams onto the tumor inside the patient. Sometimes, we inject radioactive material and sometimes we implant radioactive material inside the patient and all of those options are available at the new cancer center here at Saddleback.
Deborah: It sounds a little bit alarming, you know, injecting radioactive material into the human body, so want you to try to ease our fears by explaining that a little bit.
Dr. Damore: Well, generally speaking, all the different modalities that we use to deliver radiation are quite safe and quite effective and with current technology, the side effect profile has improved quite a bit and most patients go through whatever form of radiation they are going to receive fairly comfortably and do well.
Deborah: Great, how is radiation therapy planned for an individual patient.
Dr. Damore: Well, it is actually a fairly complex process. It usually begins with diagnostic imaging and then the patient usually undergoes additional imaging inside the radiation oncology department and for external beam treatment which is what most patients receive, the physician then uses a process called a stimulation where we set up the actual radiation beams, determine how the radiation beams would traverse through the patient to focus on the target which has been defined by the physician and then a series of calculations are done with our physicist to determine the amount of radiation that needs to be delivered from the machine to achieve the desired effect.
Deborah: Okay, I have been doing a little homework, now I understand that with the opening of the Memorial Care Cancer Institute at Saddleback Memorial, Saddleback Memorial will have a new treatment option or two available for patients including the TrueBeam. I am very interested to find out what makes the TrueBeam so special.
Dr. Damore: Yeah, we are all very excited about it, the TrueBeam is the technologically most advanced linear accelerator which is the machine that we use to deliver radiation that is available and it has got a lot of features in it, I mean a lot of innovations that improve our accuracy and our targeting capability, so that is one nice thing. It also delivers the treatments more quickly which allows for less patient motion during the treatment which also improves accuracy and also it makes it more comfortable for the patient. The patients can be monitored continuously during treatment, they can listen to music and so it should make for a better experience all the way around.
Deborah: So, what did you experience as a patient. You are lying there and what happens, what goes on?
Dr. Damore: Well, the patients usually experience very little actually during the treatment, it is more of a nonevent from their perspective than anything else. They don’t feel anything during the treatments and the machine moves around them and it delivers the radiation in a pattern that has been predetermined and is based on the computerized planning process that we talked about earlier and they are on the table for a few minutes and then they get off and go about the rest of their day and come back in most cases, then do it over again for several more sessions.
Deborah: Can they go right to work after treating session.
Dr. Damore: Oh, I would expect so. Yeah, that is our anticipation and for the majority of patients that certainly should be true.
Deborah: That is just incredible, how far we can, I mean, think about that. You are getting your cancer treatment and then you are popping off to your job, home or walking your dog.
Dr. Damore: Yeah, it has come a long way, the process is that we are going to implement with a TrueBeam, you know, really weren’t even invented, you know 10 years ago, 15 years ago and now they are becoming more and more common place in the technology that it is just amazing in terms of what it allows us to do as physicians than what it allows patients to do while they are going through their cancer treatment.
Deborah: So, I am assuming since getting into their car and driving away that they are not even under sedation of any kind when they are.
Dr. Damore: No, no, we rarely need to use sedation. We never need to use it for patients who are going through external beam therapy and so generally speaking, they should leave the department in the same condition that they arrived in prior to the treatment each day.
Deborah: So, of course I am sure every patient wants to be able to be the beneficiary of TrueBeam but what type of cancers does TrueBeam help treat specifically.
Dr. Damore: Well, the TrueBeam will be able to deliver all of the what we call general radiation therapy that we currently use, you know, other linear accelerators for but don’t really require higher levels of technology but in addition, it treats some patients that we are currently not treating right now for example delivering what is called stereotactic treatments which means highly precise, highly localized radiation treatments and a small number of treatments who have very large doses are delivered and we anticipate using that for example in the brain and in the lung and in the future probably in the prostate but patients who have cancers in virtually any area of the body will probably be able to be treated on this machine as well.
Deborah: Okay, but you are saying prostate cancer is not one of the candidates at this point.
Dr. Damore: For the patients with prostate cancer who come to the radiation oncology will be treated on the TrueBeam. For the initial phase of implementation of the TrueBeam, we will probably be treating those patients with small doses of radiation for a large number of treatments similar to what has been done here on our other machine for, you know, sometime. In the future as the data matures, they will probably be a push for some patients with very early stage prostate cancer to be treated with a smaller number of treatments, so instead of a nine-week course of treatment, they will have it treated in five treatments or so and those trials are currently underway right now.
Deborah: Okay, and I have to ask since it is the biggie, the number one form of cancer, breast cancer also a candidate.
Dr. Damore: Oh, for sure, yeah, we anticipate that patients who have breast cancer will also be getting treated on this machine.
Deborah: Yeah, it is wonderful news. Does the TrueBeam offer other benefits to patients like treatment times and increased comfort.
Dr. Damore: It does, so the treatment times are shorter and that always more comfortable for the patient. The other piece of technology that the TrueBeam offers is that we will have the ability to synchronize the delivery of the radiation beams with respiratory motion of the patient and so in patients who have tumors that are in movement in response to the respiratory cycle, the TrueBeam has some innovations that allow the beam to go on only when the tumor is in a specific position and that will allow a smaller portion of the patient’s lung to be treated, that is called respiratory gating and we plan on implementing that certainly for lung cancer patients as well as possibly some others.
Deborah: Now in the brain, I would assume that TrueBeam is really critical because you really want to damage as few cells around the cancer as possible.
Dr. Damore: Absolutely, yeah and by being extremely accurate with where the radiation is delivered and knowing that very minimal of the normal brain is to be treated in certain circumstances, it allows us to give much higher doses of radiation per treatment and so in some cases, we can deliver full course of treatment in one setting, sometimes it is up to five treatments but that is much shorter number of treatments than would be given for conventional radiation therapy.
Deborah: And five treatments over the course of what kind of time, a month or.
Dr. Damore: Usually, one to two weeks.
Deborah: Oh weeks.
Dr. Damore: Yeah, usually one to two weeks, so usually it is every day or every other day depending on the clinical circumstances.
Deborah: Incredible, this is got to be the best news ever for cancer patients.
Dr. Damore: Yeah, it is very exciting, you know, we are in a field where technology tends to drive innovation and it tends to make its way into practice fairly quickly and the TrueBeam certainly offers a lot of innovations that we are going to be able to make use from and that our patients will benefit from greatly.
Deborah: They certainly need some good news, don’t they when they get the news that they have cancer.
Dr. Damore: They absolutely do and being able to tell them that we have this technology available certainly makes the conversation little bit easier.
Deborah: Yeah, I have one final question because time has flown, how will the addition of the TrueBeam enhance the current services offered at Saddleback Memorial.
Dr. Damore: Well, we have always had excellent technology at Saddleback Memorial and this will add to, it will allow us to deliver some treatments for example those I spoke of in the brain and in the lung, mainly with the small numbers of treatment that we have not had before and I think that that will be, you know, the biggest difference and improvement in options we have for patients based on just the machine alone.
Deborah: Well, thank you so much Dr. Damore for the great news and it has been wonderful to have you on the program today and spreading the word about TrueBeam.
Dr. Damore: Oh, my pleasure, thank you very much.
Deborah: To listen to the podcast and for more info, please visit memorialcare.org. I am Deborah Howell, join us again next time as we explore another weekly dose of wellness brought to you by Memorial Care Health System. Have a fantastic day.