Gabby Cinnamon (Host): Welcome back to Conversations on Cancer, brought to you by the Riverside Cancer Institute. I'm your host, Gabby Cinnamon. And today, I'm very excited to be joined by Dr. Isrra Rashed, a radiation oncologist at the Riverside Cancer Institute to talk about the new and exciting technology we have here to treat cancer.

Intro: Welcome to Conversations on Cancer, brought to you by the Riverside Cancer Institute. Providing answers, debunking myths, and sharing patient stories.

Host: I'm here with Dr. Rashed. Thank you so much for coming on the podcast.

Dr. Issra Rashed: Of course. I'm so glad to be here. Thank you for having me.

Host: So, this is I believe your second or third episode with us. Can you remind people who you are and kind of what you do here before we get into today's topic?

Dr. Issra Rashed: Yeah. So, I'm a radiation oncologist. I work out of Bourbonnais here for Riverside. And we provide radiation services at this clinic to the community and anyone else who wants to get radiation here.

Host: Awesome. So on the topic of radiation, for those who don't know, can you kind of explain what radiation therapy is?

Dr. Issra Rashed: Yeah. So, radiation is the use of high-energy x-rays to treat cancer. So, very similar to kind of the low-dose radiation that we use to kind of image people with CTs and mammograms or chest x-rays for instance. Ours are just much stronger.

Host: Are there certain types of cancers treated more frequently with radiation therapy than others?

Dr. Issra Rashed: There are some cancers for which radiation does not play a big role in. But for most cancers, there is a role for radiation depending on the stage and the type. The most common cancers we see, like breast, prostate, and lung, are often treated with radiation, as are many other cancers, including colorectal, head and neck cancers, esophageal, stomach, pancreas, liver, gallbladder, list goes on, even some skin cancers. Some of the more rare cancers are also often treated with radiation, depending on the type, like brain and even sarcomas.

Host: Wow. So, a wide array.

Dr. Issra Rashed: Yes. Yeah.

Host: So, Riverside recently purchased a new TrueBeam linear accelerator, kind of a mouthful, in late summer of 2023. So, for the average person like myself and those listening, can you kind of explain what that technology is and why that is honestly incredible that we have this right here?

Dr. Issra Rashed: Yeah. So, the radiation we use to deliver the treatment to cancer patients is given in a very controlled fashion. It comes out of a machine that's called a linear accelerator. And there's a lot of different companies that make a lot of different linear accelerators, kind of like Reebok, Nike, and Adidas all make kind of similar tennis shoes for whatever need. That's kind of what the TrueBeam is. It's a company that makes the TrueBeam. It's called Varian. And that's the technology we have, kind of just hot off the press with a lot of features. And so, that's kind of what the TrueBeam is.

We have an older TrueBeam still here, and this continues to be used very often in this practice. Pretty much there's a need for it, and it's actually advantageous in certain situations. But the new TrueBeam adds to that. And it also allows us to treat using the same kind of radiation, but with added technology just kind of enhances how we delivered it.

So, what does that mean? So, this newer technology comes with the ability to monitor the treatment and the tumor motion in real time. And so, we can see tumor and organs and assess kind of where they are during treatment and use that to kind of account for changes during treatment as we treat. So, it's really important. This helps us protect nearby organs, probably better than we have before. It also can make the treatment more effective, less side effects and the complication rates much lower. That's kind of in a nutshell.

Host: That's very cool. And one thing too, I think it was an episode that we did recently with Kirsten about just all the different things that you guys offer here. She mentioned like the breathing aspect of it, which I thought was cool, the breath holds.

Dr. Issra Rashed: I think it's really cool. I mean, it's just such a simple thing. You literally take a deep breath, not to be too deep, but a decent breath. Just by doing that, you push your heart out of the way and you fill your lungs with a bunch of air. And so, it makes sense for certain cancers that are really close to these structures. I've had a number of very young women with breast cancer who are athletes. And so, even if their heart's not nearby, they're worried about their lungs, because they want to make sure that their lungs are in tip top shape for their next marathon. And it's just an easy thing that we can now do here.

Host: That's very cool. You kind of touched on this, but what treatments are you able to provide patients now that maybe we weren't able to offer them before?

Dr. Issra Rashed: Yeah. So, we really have always been able to treat all cancers that require radiation, even with our older TrueBeam. The difference now is really the ability to track our target or things we don't want to treat while the treatment is being delivered. And then, we've also got some additional accessories with the new TrueBeam that helps us kind of better individualize each person's radiation plan to their unique anatomy and cancer needs. This allows us to kind of better shape the radiation beam as it's exiting out of the linear accelerator, while still designing it around the tumor and still protecting the nearby organ depending on where it is. And this is something that we can do actually better than we have before.

, that I think is really the key part of what the new TrueBeam kind of adds for our clinic. This is in part due to the ability to monitor surface anatomy. So basically, we can kind of watch the body contour and use that to assess for any motion during treatment. So if a target moves based on the body contour and a pre-specified number, then that can happen. You know, you can just cough, you can sneeze, you might take a big deep breath because you need a break during treatment. We can see all that, and we can kind of pause the radiation delivery of treatment until things are back to the appropriate position.

We can also now gate treatment, which we just talked about, this breath hold type treatment. And so, we talked about how it's kind of used in breast cancer for heart and lung stuff. It's also used in other areas. For instance, lung cancer sometimes, if it moves too much, you're treating too much healthy lung because it's moving a lot because some tumors can move like a centimeter, two centimeters or so, especially in the lower lung field. So, you can actually treat with a breath hold. And that way, your volume is much smaller with the radiation and you're able to protect more lung. Similarly, the liver, which also sits right below the diaphragm, some superior tumors there, you can kind of treat a patient in the breath hold position and you can kind of account for that two-centimeter of motion you otherwise would have to treat healthy tissue. So, all that's really incredible for our patients.

Host: That's very cool. One other thing that we've talked about with this new technology is the time-saving aspect. So, there's less time on the table. Can you talk about that?

Dr. Issra Rashed: Yeah. So, the new TrueBeam gantry, the gantry is kind of where the radiation beam exits out of the linear accelerator. So, that is actually pretty much double the size of what our old TrueBeam was, which means you can treat double the area at a single moment.

Host: Oh, wow.

Dr. Issra Rashed: So, that just means that if you've got a tumor that previously, you could only treat 20 centimeters of it at a time, and then you have to do it sequentially, now we can do that all at once. So, it cuts the treatment time in half. This is really important, because laying on the table for a long time, believe it or not, it's actually really hard. You know, it's different than sleeping and kind of passing out. It's really hard when you tell somebody to hold still, not to have an itch, not to cough, not to sneeze. If they've got a bad shoulder or something like this, a bad back, it can be really hard. So, I think it's really important to get anything we can do to kind of speed up the process. And that's kind of the big thing. The treatment sometimes is quicker.

We have some newer technology where you can treat cancer in two separate areas at the same time. So, it's called HyperArc technology. And that's something that we can do where at the same time the beam can come out of one area and come out of another area and treat two spots at the same time, whereas before we did them sequentially, which would take double the time.

Host: That's very cool and very exciting for patients. You definitely wouldn't think, oh, like laying there. But like you said, centimeters count. So, you know, any movement, and people love to save time. You don't want to be doing something for longer than you need to.

Dr. Issra Rashed: Exactly. In radiation, oftentimes we're operating within three millimeters. So, I mean, we're talking like sit tight and don't move, I mean, for real. And it's really hard. If you take a ruler, I use it all the time with my patients, like that is what we're operating within.

Host: Wow, oh my gosh. So, we're going to take a quick break to talk about primary care at Riverside.

Riverside knows that health is your greatest asset, and keeping up with regular screenings plays a huge role in overall health and wellness. Primary care is your starting point to better health. Don't have a primary care provider? Good news! Riverside has a team of primary care providers who are ready to partner with you on your health journey. Visit riversidehealthcare.org/primarycare to find a primary care provider today.

Now, back to the episode with Dr. Rashed. So, can you talk about some of the positive aspects or effects you've seen so far? Any successes come to mind that you guys have had?

Dr. Issra Rashed: Yeah. So, sometimes cancers are in really tough areas to treat. So, a cancer might need a certain dose of radiation to treat it effectively, but is sitting on or close to another organ that could be damaged by such doses. The newer TrueBeam allows us to kind of better individualize the treatment and shape the beam so you can kind of treat a tumor full dose that it needs while still protecting the healthy tissue. This really, I think, made a big difference in our patients with especially abdominal tumors or like head and neck tumors or spinal tumors, for instance, where you're trying to treat for something in the the C spine, but your esophagus or your pharynx is sitting right there. Patients can get a really bad sore throat because essentially those structures are seeing the full dose the spine is needing. We just see less of it. The side effects are not as bad. And similarly, like a patient who comes in with sometimes like a spinal lesion in the belly or the pelvis, bowel is literally sitting right on the bones there. And so, sometimes if we didn't have the technology we have, you were treating a lot of that bowel to try to get that tumor treated, but that's causing a lot of side effects for patients. I mean, diarrhea, gas, all that stuff that can be actually very, very disruptive to a patient's quality of life. We don't see as much of it or it's not as severe anymore. So, that's like one.

And then, like I said, the athletes especially that we treat and our young breast patients, it's just being able to really protect them because their lungs, their hearts, a lot of these younger patients, they do very well. They're cancer-free. And the question is always at what cost? And by protecting their heart better, they're protecting their lungs better. I think the cost goes down significantly.

Host: That's amazing. I know a concern for a lot of patients, is the side effects of whether it be radiation, chemo. So whenever you guys are able to reduce that, I'm sure that just it's great for them to hear that.

Dr. Issra Rashed: Yeah, of course. Anything we can do, I think that's what we're here to do. We're always here to do what's best for the patient.

Host: So, can you talk about the overall impact that having this technology has on our community, and why it's so important for Riverside to have this?

Dr. Issra Rashed: Yeah. Technology, it's always being improved. There's always going to be innovations and being able to constantly stay on top of it, which Riverside does so well so that the patients in the community have access to the latest and bestest in radiation or other cancer treatment. So, these advances can improve cancer treatment outcomes, because we can get better treatment into a tumor. And they can also improve the quality of life, the cost, what cost is a treatment going to have for a patient. And so, these technological advances, like we've already hit on, sometimes can improve that patient's quality of life, acute and long term.

Being able to better control how radiation is delivered has changed cancer treatment over the last few decades. Side effects and complications, we used to see more than decades ago, we just see less of now. Sometimes these problems from treatment used to stand in the way of actually being able to treat a patient, because the risk of having a severe problem was so high, it just far outweighed any benefit you would see from treating the cancer. And now, we just improve access, we improve the ability to actually treat cancers without having to worry about some of these really bad detrimental effects.

Sometimes patients would walk into a clinic and be like, "Well, you know, all this sounds really great, but the numbers just don't add up because the risk is so high." And now, it's just not like that anymore for the most part. Patients can actually get their treatment and still maintain their quality of life. They can still work. They can still spend time with their grandkids. They can still cook if they're cooks, or whatever it is and drive and do whatever they need to do because the quality of life and the balance is just much better in their favor.

Just ask yourself, why wouldn't you want this for our patients or our community? Of course, you would. Of course, you'd want the newer technology because it's just the best possible outcome for you. And if anybody was given the option to choose between two equally effective treatments, you know, one that you might walk away from with little to no side effects and one that you might have lifelong scars from. You know, naturally, you're going to choose the one that's just as effective with less problems.

Host: I think, yeah, just in talking with all of you guys in these podcasts and just in general, just the sense of hope that there is, I think is amazing things, even, you know, like you were just saying a decade ago, the outlook was more grim and just the hope that you guys are able to provide through these treatments is truly incredible. Like even just looking back, having loved ones, you know, who had a cancer diagnosis, now their lifespan might've been increased just because there's so much more that you guys can do and provide and this only adds to that.

Dr. Issra Rashed: Exactly. And you see it sometimes, like, firsthand, you know, you'll have multiple generations in a room for a patient with a new diagnosis of cancer, but their mom's there, and she had cancer 20 years ago, and she's still dealing with the side effects of treatment. So, patients come in obviously scared as a result of that, because they don't know what's changed. But yeah, you definitely still see it.

Host: I think this is a great place to end off. Thank you so much, Dr. Rashed, for coming back on the podcast, and thank you listeners for tuning in to Conversations on Cancer, brought to you by the Riverside Cancer Institute. For more information about cancer care at Riverside, visit riversidehealthcare.org/cancer. Also, make sure to rate and leave a review for Conversations on Cancer on Apple, Spotify, or wherever you listen to the podcast.