Transcription:
What You Need to Know About Radiation Therapy

Gabby Cinnamon: I'm your host, Gabby Cinnamon. And today, I'm joined by Amanda Kaczkowski, a radiation therapist at the cancer Institute to discuss radiation therapy. Thank you for joining me today, Amanda.

Amanda Kaczkowski: No problem.

Gabby Cinnamon: So before we get into the podcast, can you tell me about yourself and your role at Riverside as a radiation therapist?

Amanda Kaczkowski: So, as you said, my name is Amanda. I have been a radiation therapist with Riverside at the cancer center for four years now. I work as part of the oncology team to treat patients with cancer. As a radiation therapist, I deliver radiation therapy treatments to patients as part of their plan to help shrink or remove cancer cells.

Gabby Cinnamon: Awesome. So I feel like sometimes people use different cancer treatments interchangeably. But for those of us who don't know, can you explain what radiation therapy is?

Amanda Kaczkowski: Yeah. So radiation therapy is a type of treatment that uses high doses of ionizing radiation, which are just beams of intense energy to destroy cancer cells.

Gabby Cinnamon: Are there different types? Or is there only one type?

Amanda Kaczkowski: Yeah. So there are two broad types of radiation therapy. The first one being internal, which is where you use a radiation source to place inside the body. And then more commonly is external, which is what we use at the cancer center here at Riverside.

External can be broken down into a few different types, one being electron, which doesn't penetrate as deep. So we use it for more superficial things such as skin cancers. We also use photons, which are the same that you use in x-rays, but we just use a higher energy of them to be more therapeutic. Photons are kind of what we use for our everyday treatments. They can also be used for what we call special procedures, which this is just a larger dose that we use to treat a small precise area and they are typically in less treatments.

The special procedures that we can do at Riverside are stereotactic radiosurgery, which is just treating a small, precise area of the brain. And this is typically done in about one to three treatments. And we can also do stereotactic body radiation therapy, which is a large dose to a small area of the body, such as the lung. These are typically done within about five treatments.

Gabby Cinnamon: Oh, wow. So obviously, there's a lot of science that goes in behind it that, you know, sometimes we don't realize.

Amanda Kaczkowski: Yes.

Gabby Cinnamon: There's a lot, I'm sure. So you kind of touched on how radiation therapy is delivered, but can you kind of go in a little bit more into that?

Amanda Kaczkowski: Sure. Yeah. The external radiation therapy that we use at Riverside is delivered by a machine called a linear accelerator. Here at Riverside, we have a state-of-the-art clinic called the TrueBeam, which allows us to treat a variety of cases such as the special procedures I mentioned before.

Gabby Cinnamon: Oh, wow. So what should a patient expect during radiation therapy, especially, you know, if someone's listening to this podcast, maybe they've been recently diagnosed and radiation therapy has been recommended by their oncologist for their treatment plan. What should they expect?

Amanda Kaczkowski: So what to expect is kind of a big process. It's, you know, usually long treatments. So usually, first they will get a consult with our doctor. Once they go through their consult, their first day with us as radiation therapist is going to be their what we call a simulation day. The simulation is basically just a CT scan, except we lay them in the same position that there'll be an everyday for their treatments. The positioning is super important for us because it needs to be reproducible every day to maintain the accuracy during their treatment. We have different immobilization devices that we use to help them hold the position while being as comfortable as possible.

Each patient is unique and we have to use different devices and their setups are all different. Just like their setups, each patient's needs are also very different. So the simulation days, the first day, we really get to know the patient and what they need to feel comfortable. If the patient wants music to distract them, if they want us to talk them through everything the whole time, or maybe they don't want us to talk to them at all. This is kind of where we get a feel for that.

So after we do the CT scan, then doctor comes, he looks at all of our scans. He makes sure we have everything he needs to make the plan. He picks the center where treatment's going to be. We'll mark up the patients. Sometimes they get small permanent tattoos. They're just little dots. And we use paint markers to kind of mark the spot and line them up the same way every day.

After the simulation's done, we send those scans over to get their plan made, which we have a whole team, usually the doctor, our dosimetrist and our physicist. And these treatment plans are individually designed to deliver a high dose to the tumor while sparing their normal tissue. So the patient typically comes back about a week later once that plan is done for their first treatment.

So then on their first treatment day, I know it can be really scary for patients. We bring them back to our treatment area. We show them our console where we sit and deliver the treatments. After, we bring them to the treatment room where for many patients, it's the first time seeing this treatment machine. The equipment can be very intimidating, but we always make sure we take the time to explain everything so that the patients can be comfortable and confident because the most important thing is always that patient.

So once the patient is comfortable, we've answered any questions they have, we set them up in that same position that we did the first day in their simulation. We use those marks that we gave them to line them up. And then once they're lined up, we step outside of the room and that's where we take some images such as x-rays. We can do small CT scans and we do that for accuracy to make sure they're lined up perfect to the plan that was created for them by the doctor and our whole team.

So once everything's perfect, that's when we begin treatment. During the treatment, they might hear some clicking sound, some buzzing from the machine. But nothing will touch them. Nothing will hurt. They don't feel really anything from the radiation as this machine rotates around them. Once the treatment is done, they usually get treatment about five days a week. And this can go on for several weeks depending on types of cancer and how long they need to be there.

The treatments typically lasts about 15 to 30 minutes and they do get to see the doctor once a week while they're on treatment, just to check in and he monitors any side effects they might have.

Gabby Cinnamon: So it sounds like, you know, every cancer journey is different and that radiation process is also different it sounds like for everyone. You kind of mentioned side effects. Could you talk a little bit about the side effects from radiation? Because as we know, unfortunately, with cancer treatment, there are side effects.

Amanda Kaczkowski: Sure. Yeah. Every area has different side effects, but radiation side effects are very localized to the area we're treating. So the main side effects patients can expect are fatigue is a big one. And also like skin redness or irritation in the area that we're treating.

Gabby Cinnamon: Yeah. So it's more general just to that area as opposed to the whole.

Amanda Kaczkowski: So every area will have different side effects depending on where they're being treated.

Gabby Cinnamon: Yeah. So you've also mentioned too it can be overwhelming. You know, we walk in and see the radiation machine. And you know, especially if it's a recent cancer diagnosis, the patient might be very overwhelmed. What advice do you give patients before they get radiation therapy for the first time? Or what would advice would you have for a patient if they've just been prescribed radiation therapy for their treatment plan?

Amanda Kaczkowski: Yeah, my biggest advice would be for them to just try and take a breath and relax. I know it's hard. It's very overwhelming. The first day can be intimidating and scary, but we guide them through each step and keep them informed and comfortable.

Gabby Cinnamon: Yeah. I'm sure that helps them make them feel a little bit better.

Amanda Kaczkowski: Yeah, definitely.

Gabby Cinnamon: So there's a lot of information out there about different forms of cancer treatment, which you know is good, but also it can be scary, I'm sure, because you search something on the internet and you're like, "Oh my goodness." You know, as you said, everyone reacts differently to things. So someone might search radiation therapy and see like all the side effects or, you know, things that might not end up happening to them. But when patients come in for the first time, are there any like common misconceptions that you notice about radiation therapy that they have?

Amanda Kaczkowski: Yeah, there are a few. Touching on the Google, I will recommend do not Google. If you have questions, they can call us. They can ask us any day, any time. Just ask questions because everything is so different and individual based for patients, that Google usually can do more harm than good.

Gabby Cinnamon: Dr. Google is not a good place to go.

Amanda Kaczkowski: But common misconceptions, first one would probably be kind of touching back on the side effects is it gets confused for like chemotherapy, which is systemic and all over. Radiation is not like that. It is very localized and it doesn't affect other places of the body that we're not treating.

Another big one, I get people come in and say, you know, "Can I be around my grandkids?" "Am I going to be giving radiation if I hold a baby?" External radiation that we use is you're not radioactive. You can hold a baby. You can be around everyone safely. It's not a problem at all.

Gabby Cinnamon: Yeah. No, that's definitely good to know. I've heard that from several people that they were nervous about being radioactive after having treatment, which is understandable. Because like you talked about there's so much that goes into it you don't really know that t he patients might not fully understand, especially right at first.

Amanda Kaczkowski: Right. Yeah. And they get a lot of information right off the bat that it's really hard for them to remember everything. So, I mean, we will go over things as many times as we need, answer as many questions as we need to, because it is a lot of information.

Gabby Cinnamon: Yeah. It sounds like you guys put a lot of time into that, which I'm sure the patients appreciate and helps them.

Amanda Kaczkowski: Yeah. That's what we do it for, is for the patients. So that's the most important thing to us. So we always make sure that they are informed and comfortable.

Gabby Cinnamon: Yeah, that's great. Thank you so much for joining us today, Amanda, to talk about radiation therapy.

Amanda Kaczkowski: No problem.

Gabby Cinnamon: And thank you listeners for tuning in to the Conversations on Cancer Podcast brought to you by the Riverside Cancer institute. For more information about radiation therapy and cancer treatment at Riverside, visit riversidehealthcare.org/cancer.