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Taylor Leddin-McMaster (Host): Hello, listeners. Thanks for tuning in to the Well Within Reach podcast brought to you by Riverside HealthCare. I'm your host, Taylor Leddin-McMaster. And joining me today is Dr. Issra Rashed, radiation-oncologist with the Riverside Cancer Institute. Dr. Rashed is here to discuss the latest cancer treatment offering at Riverside, brachytherapy. Welcome!

Dr. Issra Rashed: Thank you so much. Happy to be here.

Host: Before we get into the episode, we're going to take a quick break for a message about myChart.

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Host: We're back to talk about brachytherapy, and I want to note that that is not the same as Reiki therapy. What we're talking about is B-R-A-C-H-Y therapy. Now, before we get into what that is and how it works, Doctor, could you tell us a bit about your background and your work as a radiation-oncologist?

Dr. Issra Rashed: I grew up in the Chicagoland suburbs. I studied and trained in Hyde Park, as well as Maywood, and then transitioned into independent practice at Community Care Center, first in Chicago, later in Indiana, and then more recently at Riverside, where I've been for three years.

Host: Wonderful. All right. So, brachytherapy is what we're talking about today, and that's the newest of treatments Riverside Cancer Institute offers. Can you explain how the treatment works?

Dr. Issra Rashed: So, what we have been offering at our center for the last many years is external beam radiation. It's essentially a totally non-invasive radiation technique in which radiation is delivered to your internal organs from a linear accelerator that goes through air, through skin to get to its target in your body.

Brachytherapy is different than external beam therapy. And it's best suited for cancer near the surface of the body. Usually, it's a cancer that we can feel or we can see with our own eyes on exam. In this situation, we can actually place a radiation applicator on the tumor, and then you radiate it that way. If you've ever heard about radiation seeds, this is essentially the treatment we are talking about. The seeds were different, in that they were placed permanently in the body inside a tumor, which isn't what we do now, or at least not at this center, and most places no longer use seeds.

Brachytherapy is advantageous for tumors that we can see or feel, because the seed itself is not as penetrating. What that means is that the radiation can only travel a small finite distance. And this works wonderfully for tumor, for example, of the skin, where the radiation seed is put on the skin tumor. And by the time it travels a couple centimeters, the dose is too low to give any meaningful dose to the nearby muscle or bone. This makes the treatment better tolerated because you have side effects confined to just the skin where the cancer is and doesn't have spillover into tissues you don't want it to be in.

Other tumors, it's great for is cervical cancer, vaginal cancers, because you can place the seed again at these orifices. And by the time you get done with treating the tumor with full dose, the radiation dose gets to near-zero levels by the rectum, or by the bladder, so you don't have as many side effects in these organs from that.

Host: That's incredible, and that's really interesting too. I think that'll be a very useful thing for patients.

Dr. Issra Rashed: Agree. I think it's going to be wonderful. I think just having this here to offer patients and being able to now actually provide choices for patients in where before we only had this one treatment approach.

Host: Yeah, absolutely. You had talked about the differences from external beam radiation. How does the recovery time differ with brachytherapy versus external?

Dr. Issra Rashed: So, this depends on a number of different factors. So, you're still going to have side effects from radiating the tumor and anything in its immediate vicinity, right? So, the skin cancers will still have a skin reaction. Vaginal cancers will still have vaginal irritation. The nice thing is that you don't have a spillover in the organs nearby. So, for like a skin cancer, your risk of a broken bone in the future is much, much lower. It's nearly zero, probably. Having issues with urination or bowel movements from vaginal cancer radiation is also nearly zero. It can be higher depending on where your tumor is and that kind of thing. But things are overall much less severe, sometimes just not seen anymore, which means that also the recovery is much quicker.

Host: Yeah. Thank you. I'm curious, I know that the Riverside Cancer Institute really prides itself on personalized care for each patient, creating a certain path of treatment to take for each patient. Is brachytherapy ever used in conjunction with other radiation therapies or even chemotherapy?

Dr. Issra Rashed: Of course. So, brachytherapy is great for superficial tumors, but it cannot treat tumors or targets that are too deep. It's really only great for things that are less than 0.5 centimeters from the surface of the body for anything that is 5 centimeters or more. The only real way to get the radiation in adequately to treat the tumor is external beam radiation, which can penetrate depths of five, ten, twenty more centimeters probably. So oftentimes, it depends on where your cancer is, what type of cancer it is. Some just need brachytherapy, some need brachytherapy and external beam, some you can choose either way. And at this point, if both can get the job done, but the brachytherapy is done in less treatments with less side effects, of course, you're going to choose the brachytherapy for the patient. That's what's better for them.

Other times, the data says that radiation alone is not enough. And sometimes radiation only comes after surgery to improve outcomes with chemo or after chemo or something like that. So, it really becomes an informed discussion with an entire multidisciplinary team of expert surgeons, expert medical-oncologists, as well as me and radiation and my team here to individualize the plan for the patient based on all the factors we know.

Host: Yeah. Yeah, that's great because I think there might be some confusion if somebody hears that this is offered. They'll be like, "I want that." And then, you'll be like, "Well, no, it might not be the best fit for you." So, I appreciate that thorough answer that helps cover some ground there.

Before we continue this conversation, we're going to take a moment to talk about the importance of primary care.

At Riverside HealthCare, your primary care provider is dedicated to being in your corner, helping you and your family stay healthy and thrive. Find the right primary care provider for you at myrhc.net/acceptingnew. From annual screenings to well checks and everything in between, having a primary care provider that you can trust makes all the difference.

All right. Now, we're back with Dr. Rashed to talk about brachytherapy a bit more. You talked about the types of cancers that brachytherapy can treat. Since this is starting out here, it's a new service, what is the Cancer Institute going to be using brachytherapy for?

Dr. Issra Rashed: Correct. So, this is a great question actually, because brachytherapy has many, many, many different types of applicators. What we're going to be doing here is something called intracavitary radiation, which essentially is totally non-invasive. It's very similar to external beam that we don't do any poking, needles, nothing going through the skin. And the applicators are either gently laid on the skin or in the vagina for the most part.

Skin cancer is one of the cancers we'll definitely be able to treat. Vaginal cancers, sometimes uterine and cervical cancer after surgery are also tumors that we can treat with the radiation we'll have here. Other types of cancers might still need different kinds of brachytherapy that we currently will not provide here. But we work with the Rush team as well as others in the Chicagoland area to bring those services to our patients.

Host: So, you touched on the type of brachytherapy that Riverside will be offering. Are there future types? What's planned to be used, or other types that exist currently? And what is the timeline of treatment like for the different types?

Dr. Issra Rashed: I'll give you a little history lesson. So, the historic way of doing the brachytherapy was with the seeds I alluded to. We still call them seeds in some form or another. But in general, the seeds that we used to do more commonly, which really fell out of practice now, just have a lot of disadvantages, despite being great brachytherapy treatments back in the years we used to use them.

So, one example of this is prostate brachytherapy, seeds is what a lot of patients know them as. And essentially, you would undergo kind of a mini-surgery of sorts where needles actually go in through your skin to get through the prostate and then they leave these seeds in the prostate. Hundreds of seeds, probably. The seeds sometimes can move and migrate though, because you've just had a needle. Many of them actually are placed in the prostate, and the prostate gets swollen. And so, then that causes the seeds to move. And so, sometimes you'll get hot spots in areas because the seeds move too close to each other, even though you place them beautifully. And other times, you get cold spots because the swelling has changed the configuration of the seeds to cause some seeds to be far away from each other, more so than planned. And so then, patients would have problems where cancer sometimes came back in the cold spots or they had more side effects in the hot spots. So, that's something that really fell out of practice, but that's one of the forms of low-dose brachytherapy that you might read about or you might hear about that we won't be offering here, mostly because HDR brachytherapy has so many advantages over that.

In that type of radiation, you were radioactive. So, those seeds were in you. They had radiation coming out of them for a period of months where you were radioactive, exposing others potentially if you were too close for the first month, sometimes two. The radiation here, you're completely not radioactive, so you would get your treatment here. It would be done in a few months. You're not radiating a patient for months anymore. Okay, the seeds go in you and they come out right away. So, you go on with life as normal and there's no real disruption to your life aside from some mild side effects that may or may not occur.

Big picture here, I think we're definitely starting with intracavity radiation, so these more topical treatments without any kind of invasive placement of the brachytherapy seeds in the body. In the future, we do hope to obviously always expand our practice and technology and, in the future, hope to be offering HDR forms of prostate brachytherapy or even cervical cancer interstitial implants of that kind. Definitely not there just yet. We're trying to just get our feet wet in the water with the first inner cavity here.

Host: Yeah. Absolutely. And this is going to vary patient to patient. But what can patients expect in terms of maybe how can they prepare for the treatment? How long does it take in terms like sitting in the chair, laying on the bed per treatment? And what can they do to kind of best aid in the recovery of that treatment?

Dr. Issra Rashed: Honestly, for the most part, all a patient has to worry about is just showing up to their treatment time at whatever schedule that's been arranged with our department and them. So for them, once they get here, there's going to always be a team member here that kind of guides them through the process. You have to get undressed oftentimes or at least get the area exposed. And then, they just kind of lay on a table while our therapists or experts in physics. And me, I'll make sure that things are setting up and doing what they're supposed to be and looking like they're supposed to be before then the treatment.

The treatment itself, it'll be somewhere between probably three, maybe 20 minutes. Most people will probably be more in the nine, 10-minute range. Many less, many a little bit more. And then after, they'll usually put some music on in the room I've had patients actually fall asleep. It's not painful or anything like that. You don't feel the radiation. You don't hear it or anything like that. And then, you're done you get out of here and you go on to life as normal. Get your coffee or dinner or whatever it is.

Host: Yeah. Great. Bourbonnais is currently the only campus Riverside is offering brachytherapy. How can patients at other locations find out if it's a right fit for them?

Dr. Issra Rashed: So, a lot of the patients are already established in our Oncology departments with various medical oncologists or surgeons and that kind of thing, and so you could always bring it up to your surgeons who almost always can reach me by phone or text message or secure EPIC message, whatever it is, just to have me look at your stuff and see if that's something you're a candidate for. I'm always happy to see patients. We've got a great team over here. Afton Swanson is actually one of our nurse practitioners who's wonderful, and really helps to just kind of make sure that we get patients in as quickly as possible with all their concerns addressed.

Host: And this is a really unique service in the area. Riverside is the only place in the region that offers brachytherapy at this time. So, how do you feel this benefits the community?

Dr. Issra Rashed: There's no reason not to have this technology here. I mean, we have the expertise. We have the facility. We now have the technology here. There is absolutely no reason to be sending patients that can be treated just minutes from home to Chicago or Northwest Indiana or Peoria for this treatment. I think historically they used to actually send to a different facility a little bit up in some of the southwest suburbs, but that's no longer in operation. And so, we really are the only place within probably maybe hour radius, probably more than that.

Host: Yeah. So, it's a big deal to have this.

Dr. Issra Rashed: It's a big deal. Yeah, I think so. And these treatments aren't just one and done. So, some of them are four, some of them are two, some of them you need ten treatments. Sometimes you need more or something like that. So, it's a hike to go to Chicago for ten treatments.

Host: Absolutely, yeah. Especially if you're just trying to get everything in everyday life done, and then adding that on to it.

Dr. Issra Rashed: The treatments themselves are so quick, so you drive up there and, you know, spend maybe three hours, if not more, on the road figuring out the parking situation for a 20-minute treatment, if that.

Host: Yeah. So, this is definitely a benefit in many ways. Is there anything else you'd like listeners to know about, this subject as a whole or what it means to you as a provider to be able to give this treatment to patients?

Dr. Issra Rashed: You know, anytime you see a patient and you know that there's a technology that might be able to treat them just as effective as mine with less side effects, you know, less logistical requirements, not having to come in for treatment as much, it's always a bummer when you can't give that treatment and you have to do either a more toxic one or a less optimal one, because the patient's unable to go north or south or something like that for the other type of treatment.

So now, that we can do that here, it's going to make me feel a lot better about, you know, the patients that I'm treating, knowing that I'm giving them the best possible treatment for their cancer. So, that's something that's exciting.

Host: That's wonderful. Well, thank you so much for your time. And thank you listeners for tuning in to the Well Within Reach podcast with Dr. Issra Rashed, radiation-oncologist at Riverside Cancer Institute and your host, Taylor Leddin-McMaster. To learn more about the services provided by the Riverside Cancer Institute, visit myrhc.net/cancer or call 815-933-9660.