Stereotactic radiotherapy is used to treat tumors in the lung without having to make an opening in the skin. The treatment machine directs beams of high-dose radiation directly to the area in the lung that needs to be treated. The radiation beams are silent and invisible.
Radiotherapy can play a pivotal role in the treatment of lung cancer of all stages and can result in long-term curative outcomes for patients.
Listen in as Helen Chen, MD explains how Stereotactic radiotherapy is used to help treat lung cancer.
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Radiotherapy for Lung Cancer
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Learn more about Dr. Helen Chen
Helen Chen, MD
Dr. Helen Chen is an assistant clinical professor in the Department of Radiation Oncology.Learn more about Dr. Helen Chen
Transcription:
Radiotherapy for Lung Cancer
Melanie Cole (Host): Radiotherapy can play a pivotal role in the treatment of lung cancer of all stages and can result in long-term curative outcome for patients with early stage disease. My guest today is Dr. Helen Chen. She’s a board-certified Radiation Oncologist at City of Hope. Welcome to the show. Dr. Chen, what is radiotherapy?
Dr. Helen Chen (Guest): Radiotherapy -- or what we just simply call radiation -- our field is called Radiation Oncology. First, I want to just preface this with something real basic that I think cancer patients don’t always understand when they’re first diagnosed with cancer. When someone is diagnosed with cancer there’s basically three modalities of treatment that can cure their cancer, or prolong their life, or alleviate symptoms from that cancer. There’s surgery, cutting out tumors. There’s chemotherapy, or drugs, to treat the cancer everywhere in the body. And then there’s radiation which is what I do, which is more actually similar to surgery. It focuses on just a certain part of the body to treat the tumor or where the tumor was. So the patient would see for surgery, a surgical oncologist, for chemotherapy, it’s a medical oncologist, and for radiation, they would see a radiation oncologist. We each specialize in our own treatment modality. I’m a radiation oncologist and radiation is -- you can think of it as high-energy x-rays -- we’ve had x-rays, but it’s a high-energy beam that can penetrate the deeper tissues and with current technology, we’re able to specifically localize where the radiation is delivered. We can treat a volume of tissue anywhere in the body and know exactly what dose is given to any particular location in the body, even within millimeters. And the key thing for radiation is to treat the tumor or the area of the cancer, but avoid giving radiation to nearby healthy tissue. That’s where the technology, the expertise, experience all come into play. And something even more fundamental is that radiation kills cancer cells, so that’s actually why it works. The radiation damages the DNA of the cancer cells preferentially, compared to normal cells, and that’s the biologic basis of how radiation kills cancer.
Melanie: So what does that actually mean when someone hears radiotherapy? Now, we’re talking specifically in this case about lung cancer Dr. Chen, and that it can be used -- as you stated so beautifully -- that it can aim to control the cancer, or the symptoms, to be used to ease the symptoms, or even to possibly cure the cancer. So as it’s killing those cancer cells in there and you say that it doesn’t – we hope that it doesn’t affect the other cells around – how is it that precise? How does that work?
Dr. Chen: Oh okay. Radiation is precise in that anytime—it’s all in the preparation actually -- when somebody is going to get radiation, say they have a lung cancer – everybody has a different shape of tumor, different location, different size – and say we want to treat that tumor, we always do a planning scan prior to treatment. It’s actually a CT scan, but it’s a dedicated CT scanner in our radiation department. With that scan, we have the patient in the treatment position, the position that they’re going to be in for radiation, for example, with their arms up. We actually do a scan, but we’re actually able to perform what we call a four-dimensional CT scan where -- we already know there are three dimensions -- but there’s a fourth dimension of motion that when a patient is breathing, a lung tumor, as you can imagine, can move. Usually, it moves up and down with breathing so we can actually take that into account in our planning, the amount of motion from the tumor from the breathing.
So again, the first thing is the scan, to localize the tumor, account for the breathing and then it’s all behind the scenes work. We have a team of physicists, dosimetrists, myself, radiation oncologists. I localize, I actually outline on the CT scan the area that I want treated and with the physicist and the – what we call dosimetrist—we create a treatment plan where radiation beams come from multiple angles to basically treat a volume of tissue to treat the volume that we want treated, yet avoid areas of healthy tissue that we do not want treated. We are aided by sophisticated computer programs, planning software, obviously, a very state-of-the-art treatment machine, where we can actually angle the beam very precisely and block areas where we don't want to treat.
Melanie: People get nervous when they hear radiation, to begin with, Dr. Chen. Does radiotherapy, radiosurgery, or stereotactic body radiation therapy – do any of these -- which basically you said are all the same thing – do they affect long-term radiation? Do we get radiation from them?
Dr. Chen: Oh, okay, yes. Any kind of radiation treatment, you’re giving a very high dose of radiation to the tumor and I think the thing that people fear, and they should, is number 1, what is the radiation going to cause during treatment? What kind of side effects am I going to have? Number two, what long-term complications can occur from the radiation? I’ll address all of those during radiation if there are radiation doses to normal healthy tissues nearby the tumor, for example, the esophagus or certain areas, you can get side effects from radiation. The key is to minimize, again, radiation doses to normal tissues so you don’t get those side effects, but also if it’s impossible, like the tumor’s right next to the esophagus, and the esophagus gets a dose a person might feel, for example, heartburn when they’re swallowing during the latter course of radiation. So there’s ways to mitigate that, there’s medications to relieve discomfort temporarily until the radiation is finished and then those side effects go away. We can always also put a break in the radiation, but we prefer not to do that because radiation is more effective when it’s given continuously. Now, long-term side effects of radiation are, again, based on how much radiation dose is given to normal tissue, so that’s actually going back to the treatment planning stage. We know exactly how much radiation dose any part of the body can handle, so we limit that dose. There’s very strict guidelines on how much radiation dose can be delivered particularly to – for example, the spinal cord, the esophagus, heart, even how much lung can be treated safely. So those guidelines need to be followed. And then another fear people have is of developing cancer from radiation. Any kind of radiation – the radon from an airplane, or even a chest x-ray there’s some radiation dose. There's a finite chance of developing cancer from radiation, but it’s basically a statistical issue, a math issue. If the chance of developing cancer is very remote, very minuscule, whereas the chance of curing cancer is much higher, so when we weigh the risk versus benefits, so if you have a very high chance of curing cancer versus a very tiny risk of causing cancer, you’re going to give the radiation to cure the cancer. This leads into your question about side effects. One of the revolutionary advents in radiation for lung cancer is the advent of SBRT, stereotactic body radiation, or you can call it radiosurgery, there’s different names for it. So let me give you some background on that. Traditionally, for decades, even since I’ve trained 30 years ago, radiation for lung cancer has been given over six to seven weeks. The patient comes every day, Monday through Friday, for six to seven weeks and we give a small dose of radiation to the lung tumor and then that has potential to cure the lung cancer. But over the last 15 years there's been a new treatment course called SBRT, where instead of treatment over six or seven weeks, treatment for lung cancer can be performed in less than a week, typically, you know, three to five treatments only. So that’s very different. The patient can basically come for the planning scan, then a week later starts treatment and just come in once a day for say four days. The radiation requirement is less than an hour a day, just lay on a table, breathe normally, watch TV, meditate, relax, and during each treatment, a much higher dose of radiation is delivered to this tumor and the total radiation dose, even though it’s five treatments, is actually far greater biologically compared to the six-week treatment. And what we’ve found is that treatment with SBRT is comparable to surgery. The local control rate, meaning the chance of eradicating the tumor with SBRT is in the range of 97%.
What this means is the patients with this early stage lung cancer -- if they are not a candidate for surgery, or don’t want to undergo surgery, or maybe they’re elderly and can’t handle surgery -- can have this SBRT treatment and in less than a week just laying on the radiation table, have a comparable chance of curing their cancer. Let me explain though that SBRT is only for early stage lung cancer. If there’s an early stage lung cancer, instead of surgery, or six weeks of radiation, often times the patient can have SBRT treatment within a week. I’ve been amazed at this. I’ve treated many patients with the SBRT and I actually haven't seen side effects.
Melanie: Isn’t that amazing? What a fascinating advancement in technology. Dr. Chen, in the last few minutes, tell us what’s on the horizon, what’s exciting at City of Hope?
Dr. Chen: City of Hope in general, there are I’d say -- if we’re talking about lung cancer -- for advanced lung cancers, say lung cancers that have spread, or patients who have had chemotherapy, there are numerous clinical trials for new drugs. I think that’s where maybe patients will come to City of Hope having undergone standard chemotherapy and it’s not working any longer, in search of other drugs that may prolong their life so that’s a perfect scenario for them to enter a clinical trial. I’ve definitely seen them work. I’ve seen people -- I mean I just saw a patient in the hospital -- he was actually a friend of a friend – he looked like he wasn’t even going to live more than a few weeks and then they started a new clinical trial drug and just a couple months later he came to my office and gave me a Christmas present and looked perfectly normal. I think that’s where City of Hope is really making strides in not only treating these patients but actually creating these drugs that go from the lab to the clinical trial to the patient. Bench to patient is what’s very unique about City of Hope. In the radiation department, what I really am proud of is that we collaborate, so we have several, maybe half a dozen radiation oncologists like myself in the community. I’m in South Pasadena where we can basically offer City of Hope care closer to the patient. Right in their own community patients can drive just ten minutes and there should be parking and just walk the steps and be right in my clinic so it’s like a miniature City of Hope, so to speak, very convenient. Convenience, I think that’s key when you're talking about someone with cancer. You don’t want somebody spending all their time in the hospital or a clinic. You want to give them their treatment and then they’re out of here, living their life.
Melanie: That is absolutely great information, Dr. Chen. Thank you so much for being with us today. You’re listening to City of Hope Radio and for more information, you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole, thanks so much for listening.
Radiotherapy for Lung Cancer
Melanie Cole (Host): Radiotherapy can play a pivotal role in the treatment of lung cancer of all stages and can result in long-term curative outcome for patients with early stage disease. My guest today is Dr. Helen Chen. She’s a board-certified Radiation Oncologist at City of Hope. Welcome to the show. Dr. Chen, what is radiotherapy?
Dr. Helen Chen (Guest): Radiotherapy -- or what we just simply call radiation -- our field is called Radiation Oncology. First, I want to just preface this with something real basic that I think cancer patients don’t always understand when they’re first diagnosed with cancer. When someone is diagnosed with cancer there’s basically three modalities of treatment that can cure their cancer, or prolong their life, or alleviate symptoms from that cancer. There’s surgery, cutting out tumors. There’s chemotherapy, or drugs, to treat the cancer everywhere in the body. And then there’s radiation which is what I do, which is more actually similar to surgery. It focuses on just a certain part of the body to treat the tumor or where the tumor was. So the patient would see for surgery, a surgical oncologist, for chemotherapy, it’s a medical oncologist, and for radiation, they would see a radiation oncologist. We each specialize in our own treatment modality. I’m a radiation oncologist and radiation is -- you can think of it as high-energy x-rays -- we’ve had x-rays, but it’s a high-energy beam that can penetrate the deeper tissues and with current technology, we’re able to specifically localize where the radiation is delivered. We can treat a volume of tissue anywhere in the body and know exactly what dose is given to any particular location in the body, even within millimeters. And the key thing for radiation is to treat the tumor or the area of the cancer, but avoid giving radiation to nearby healthy tissue. That’s where the technology, the expertise, experience all come into play. And something even more fundamental is that radiation kills cancer cells, so that’s actually why it works. The radiation damages the DNA of the cancer cells preferentially, compared to normal cells, and that’s the biologic basis of how radiation kills cancer.
Melanie: So what does that actually mean when someone hears radiotherapy? Now, we’re talking specifically in this case about lung cancer Dr. Chen, and that it can be used -- as you stated so beautifully -- that it can aim to control the cancer, or the symptoms, to be used to ease the symptoms, or even to possibly cure the cancer. So as it’s killing those cancer cells in there and you say that it doesn’t – we hope that it doesn’t affect the other cells around – how is it that precise? How does that work?
Dr. Chen: Oh okay. Radiation is precise in that anytime—it’s all in the preparation actually -- when somebody is going to get radiation, say they have a lung cancer – everybody has a different shape of tumor, different location, different size – and say we want to treat that tumor, we always do a planning scan prior to treatment. It’s actually a CT scan, but it’s a dedicated CT scanner in our radiation department. With that scan, we have the patient in the treatment position, the position that they’re going to be in for radiation, for example, with their arms up. We actually do a scan, but we’re actually able to perform what we call a four-dimensional CT scan where -- we already know there are three dimensions -- but there’s a fourth dimension of motion that when a patient is breathing, a lung tumor, as you can imagine, can move. Usually, it moves up and down with breathing so we can actually take that into account in our planning, the amount of motion from the tumor from the breathing.
So again, the first thing is the scan, to localize the tumor, account for the breathing and then it’s all behind the scenes work. We have a team of physicists, dosimetrists, myself, radiation oncologists. I localize, I actually outline on the CT scan the area that I want treated and with the physicist and the – what we call dosimetrist—we create a treatment plan where radiation beams come from multiple angles to basically treat a volume of tissue to treat the volume that we want treated, yet avoid areas of healthy tissue that we do not want treated. We are aided by sophisticated computer programs, planning software, obviously, a very state-of-the-art treatment machine, where we can actually angle the beam very precisely and block areas where we don't want to treat.
Melanie: People get nervous when they hear radiation, to begin with, Dr. Chen. Does radiotherapy, radiosurgery, or stereotactic body radiation therapy – do any of these -- which basically you said are all the same thing – do they affect long-term radiation? Do we get radiation from them?
Dr. Chen: Oh, okay, yes. Any kind of radiation treatment, you’re giving a very high dose of radiation to the tumor and I think the thing that people fear, and they should, is number 1, what is the radiation going to cause during treatment? What kind of side effects am I going to have? Number two, what long-term complications can occur from the radiation? I’ll address all of those during radiation if there are radiation doses to normal healthy tissues nearby the tumor, for example, the esophagus or certain areas, you can get side effects from radiation. The key is to minimize, again, radiation doses to normal tissues so you don’t get those side effects, but also if it’s impossible, like the tumor’s right next to the esophagus, and the esophagus gets a dose a person might feel, for example, heartburn when they’re swallowing during the latter course of radiation. So there’s ways to mitigate that, there’s medications to relieve discomfort temporarily until the radiation is finished and then those side effects go away. We can always also put a break in the radiation, but we prefer not to do that because radiation is more effective when it’s given continuously. Now, long-term side effects of radiation are, again, based on how much radiation dose is given to normal tissue, so that’s actually going back to the treatment planning stage. We know exactly how much radiation dose any part of the body can handle, so we limit that dose. There’s very strict guidelines on how much radiation dose can be delivered particularly to – for example, the spinal cord, the esophagus, heart, even how much lung can be treated safely. So those guidelines need to be followed. And then another fear people have is of developing cancer from radiation. Any kind of radiation – the radon from an airplane, or even a chest x-ray there’s some radiation dose. There's a finite chance of developing cancer from radiation, but it’s basically a statistical issue, a math issue. If the chance of developing cancer is very remote, very minuscule, whereas the chance of curing cancer is much higher, so when we weigh the risk versus benefits, so if you have a very high chance of curing cancer versus a very tiny risk of causing cancer, you’re going to give the radiation to cure the cancer. This leads into your question about side effects. One of the revolutionary advents in radiation for lung cancer is the advent of SBRT, stereotactic body radiation, or you can call it radiosurgery, there’s different names for it. So let me give you some background on that. Traditionally, for decades, even since I’ve trained 30 years ago, radiation for lung cancer has been given over six to seven weeks. The patient comes every day, Monday through Friday, for six to seven weeks and we give a small dose of radiation to the lung tumor and then that has potential to cure the lung cancer. But over the last 15 years there's been a new treatment course called SBRT, where instead of treatment over six or seven weeks, treatment for lung cancer can be performed in less than a week, typically, you know, three to five treatments only. So that’s very different. The patient can basically come for the planning scan, then a week later starts treatment and just come in once a day for say four days. The radiation requirement is less than an hour a day, just lay on a table, breathe normally, watch TV, meditate, relax, and during each treatment, a much higher dose of radiation is delivered to this tumor and the total radiation dose, even though it’s five treatments, is actually far greater biologically compared to the six-week treatment. And what we’ve found is that treatment with SBRT is comparable to surgery. The local control rate, meaning the chance of eradicating the tumor with SBRT is in the range of 97%.
What this means is the patients with this early stage lung cancer -- if they are not a candidate for surgery, or don’t want to undergo surgery, or maybe they’re elderly and can’t handle surgery -- can have this SBRT treatment and in less than a week just laying on the radiation table, have a comparable chance of curing their cancer. Let me explain though that SBRT is only for early stage lung cancer. If there’s an early stage lung cancer, instead of surgery, or six weeks of radiation, often times the patient can have SBRT treatment within a week. I’ve been amazed at this. I’ve treated many patients with the SBRT and I actually haven't seen side effects.
Melanie: Isn’t that amazing? What a fascinating advancement in technology. Dr. Chen, in the last few minutes, tell us what’s on the horizon, what’s exciting at City of Hope?
Dr. Chen: City of Hope in general, there are I’d say -- if we’re talking about lung cancer -- for advanced lung cancers, say lung cancers that have spread, or patients who have had chemotherapy, there are numerous clinical trials for new drugs. I think that’s where maybe patients will come to City of Hope having undergone standard chemotherapy and it’s not working any longer, in search of other drugs that may prolong their life so that’s a perfect scenario for them to enter a clinical trial. I’ve definitely seen them work. I’ve seen people -- I mean I just saw a patient in the hospital -- he was actually a friend of a friend – he looked like he wasn’t even going to live more than a few weeks and then they started a new clinical trial drug and just a couple months later he came to my office and gave me a Christmas present and looked perfectly normal. I think that’s where City of Hope is really making strides in not only treating these patients but actually creating these drugs that go from the lab to the clinical trial to the patient. Bench to patient is what’s very unique about City of Hope. In the radiation department, what I really am proud of is that we collaborate, so we have several, maybe half a dozen radiation oncologists like myself in the community. I’m in South Pasadena where we can basically offer City of Hope care closer to the patient. Right in their own community patients can drive just ten minutes and there should be parking and just walk the steps and be right in my clinic so it’s like a miniature City of Hope, so to speak, very convenient. Convenience, I think that’s key when you're talking about someone with cancer. You don’t want somebody spending all their time in the hospital or a clinic. You want to give them their treatment and then they’re out of here, living their life.
Melanie: That is absolutely great information, Dr. Chen. Thank you so much for being with us today. You’re listening to City of Hope Radio and for more information, you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole, thanks so much for listening.