In addition to standard radiation therapy delivery options, City of Hope offers a wide range of advanced technologies and specialized services to ensure precise treatment delivery for optimal outcomes.
What is an mri, cat scan, mammorgram, x ray,,how much radiation do you get? Are these tests necessary?
Ji Hyun Kim, MD is here to discuss some general concepts of radiation treatment for cancer such as how radiation work to treat cancer, types of radiation used for cancer treatments and different ways of delivering the radiation.
Selected Podcast
How Radiation Works to Treat Cancer: Should You Be Concerned?
Featured Speaker:
Learn more about Ji Hyun Kim, M.D
Ji Hyun Kim, MD
Ji Hyun Kim, M.D. is a radiation oncologist at City of Hope Antelope Valley. Dr. Kim received her undergraduate degree in biochemistry from the University of California at Davis. She went on to earn a masters of medical sciences degree followed by her medical doctorate from Drexel University College of Medicine in Philadelphia. She completed an internship in internal medicine at the University of Nevada School of Medicine in Las Vegas before going on to complete her radiation oncology residency at City of Hope. Dr. Kim is board certified in Radiation Oncology, and is a member in good standing with numerous professional societies including the American Society for Clinical Oncology, the American Society for Radiation Oncology and the Radiological Society of North America, to name a few. She has published in the peer reviewed literature and has been involved with several innovative translational research protocols here at City of Hope.Learn more about Ji Hyun Kim, M.D
Transcription:
How Radiation Works to Treat Cancer: Should You Be Concerned?
Melanie Cole (Host): Radiation treatment plays an important role in many cancer patients. My guest today is Dr. Jae Young Kim. She’s an Assistant Clinical Professor of Radiation Oncology at City of Hope here to help us understand what radiation is, how it works and how radiation oncologists use this tool to help treat cancer. Welcome to the show, Dr. Kim. Tell us a little bit about how radiation works. What is it? What does it do?
Dr. Jae Young Kim (Guest): Radiation works in two parts. There is a minor component of how it really works and this is what most people imagine the cancer to do is to directly kill the cancer or zap the cancer cell. That’s actually a minor component of how it works. A majority of how radiation works is it damages the DNA in the cancer cell and then over time, the cancer cell then dies off. So, oftentimes, patients do hear that the radiation continues to work after they’re even done with their treatment. It’s not that the radiation stays in their body. It’s more that the cancer’s DNA is damaged by the radiation treatment. It lays that foundation and then, over time the cancer will die off.
Melanie: When these damaged cancer cells die does the body naturally remove them? What happens to the normal cells that might be affected by the radiation?
Dr. Kim: The normal cells do have the ability to repair; to stop when it realizes that it has been damaged and then, to really repair it before it moves on. Certainly, some of the normal cells aren’t able to recover and some of that can lead to the side effects or risks involved with the radiation treatment. But, we are constantly trying to reduce that risk or long-term side effects in radiation treatment.
Melanie: Is the goal of radiation treatment to shrink and eliminate these cancer cells or is it usually an adjunct to other cancer treatments?
Dr. Kim: Absolutely. All of those things. Radiation sometimes is used by itself as the definitive treatment such as in prostate cancer but a lot of times in cancer care, it’s oftentimes used in conjunction with other treatment. So, a lot of patients are getting multiple treatments or multi-modality of treatments. So, they might get radiation with chemotherapy or chemotherapy prior to their radiation or radiation might come first. In terms of with surgery, oftentimes, the radiation can be done prior to the surgery or done as a new adjuvant treatment or done after surgery or, otherwise called “adjuvant therapy”.
Melanie: So, we hear about different types of radiation – external beam and brachytherapy. There are all these different terms that are thrown around and it’s very hard to understand the differences. Tell us about the types of radiation therapy that you use.
Dr. Kim: Certainly. The radiation treatments are often divided into external beam radiation or internal or otherwise called “brachytherapy.” The majority of patients are going to be going to be getting the external radiation treatments. These are all done from the outside where, from the machine, the radiation is delivered, goes to where it needs to go and the radiation is gone in that instant. Brachytherapy, or internal radiation treatments, are done with either an applicator or a seed placement or different ways of placing the radioactive source inside the patient, whether it’s temporary or permanent. If it is permanent, placement the radiation is lost over time. In the temporary situation, the radiation source is placed through the applicator for a temporary time and then removed. So, the radiation in those scenarios is not remaining inside the patient. In external beam radiation treatment, there is different ways of delivering that treatment as well. A lot of the acronym we hear is 3D CRT or 3D Conformal Radiation Therapy as well as IMRT which is Intensity Modulated Radiation Therapy. So, 3D Conformal Radiation Therapy is where a scan or image is done to map out the tumor or the location of the treatment that needs to be targeted to and then the radiation beam can be shaped to that target. IMRT takes it a step further where it doesn’t involve that shaping or targeting of the target itself but now we’re able to not only do a shape that’s tumor targeted to the area that needs to get the radiation treatment, we can also do what’s called “dose paint” or give different doses within the target. If there’s multiple targets, we can give different dose to each area. So, it does allow for more precise treatment, it allows to reduce the dose to surrounding critical organs that might be very close to the target that we are trying to treat.
Melanie: Are these all types of photon treatments? What’s a photon?
Dr. Kim: Radiation is essentially divided into two main groupings. These are non-charged radiation which includes photons and charged particle radiation which includes things such as electrons or protons which we often hear as well. The majority of patients will be getting photon radiation treatments. They all do essentially the same thing to eradicate the cancer or to kill the cancer cells but they all have their own advantages in terms of their physical properties. So, oftentimes they’re all considered in the scenario of the specific case of the patient before the radiation oncologist decides to use one or the other for the treatment.
Melanie: What are some of the side effects? People worry. They hear the word “radiation” and they worry about side effects from these types of treatments. Which treatments have sort of the least side effects and what are some of those?
Dr. Kim: Certainly, all of these ionizing radiation or treatments have side effects. But they are all local. So, patients do need to keep in mind that it all depends on where the radiation treatment is being aimed at or targeted to. Based on what the nearby sensitive organs may be is what the treatment side effects may end up being. Certainly, these don’t happen immediately as they get the treatments but as the dose builds up over time the treatment can cause some of these side effects but the majority are manageable with medications or different diet modifications and they are temporary. So, acute side effects do go away after they’re done. Certainly, not immediately after they’re done but over time. About 2-4 weeks after their done, a lot of those side effects do go away.
Melanie: How is radiation therapy planned for any patient? How do they decide between external beam and brachytherapy and stereotactic radiation and all of these things you’ve mentioned? IMRT and these things are names to patients. How do they make that decision or do you help them make that decision?
Dr. Kim: I think that the patient should definitely start at consultations with their radiation oncologist. So, having that open dialogue, having that full consultation where they are discussing the recommendations, the indications for their treatment, the alternatives to their treatments. What are the risks involved or the side effects that they might potentially see? Then, the dialogue between the patient and the radiation oncologist as to really what is the best modality for treating that specific scenario? The radiation oncologist will consider all of the treatment options or ways to deliver that radiation in terms of whether it’s theratactic radio surgery or IMRT or 3D conformal. Certainly, the fancier the name or the fancier the way the treatments are given, it does sound like it would have all the advantages and why shouldn’t everyone get those types of treatments? But, there are some scenarios where the more simple way of delivering the radiation can be advantageous compared to, let’s say, IMRT or SRS way of treatment. Those all will be considered by the radiation oncologist and discussed at the time of consultation.
Melanie: In just the last few minutes, Dr. Kim, and it’s great information. It’s so important and you’re putting it out there so very well, give your best advice for how a patient should care for themselves during radiation therapy and why they should come to City of Hope for their care.
Dr. Kim: The one main thing that patients can do during their care and certainly whatever is specific for their specific side of treatment, the radiation oncologist as well as the nurse involved with their care oftentimes do go over things that they can be doing to minimize side effects, to minimize or care for their treatment during this time but I think the number one thing that patients can do to help along their treatment process is really nutrition. We have every patient that goes through radiation treatment involve a nutritionist because I think it’s very important for them to upkeep their weight, to make sure that their eating healthy during this time so that the body does have the resources to repair and to recover once they’re done so that they definitely get through the treatment and that they recover after the treatment.
Melanie: That’s so important. Thank you so very much, Dr. Kim. You’re listening to City of Hope Radio. For more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.
How Radiation Works to Treat Cancer: Should You Be Concerned?
Melanie Cole (Host): Radiation treatment plays an important role in many cancer patients. My guest today is Dr. Jae Young Kim. She’s an Assistant Clinical Professor of Radiation Oncology at City of Hope here to help us understand what radiation is, how it works and how radiation oncologists use this tool to help treat cancer. Welcome to the show, Dr. Kim. Tell us a little bit about how radiation works. What is it? What does it do?
Dr. Jae Young Kim (Guest): Radiation works in two parts. There is a minor component of how it really works and this is what most people imagine the cancer to do is to directly kill the cancer or zap the cancer cell. That’s actually a minor component of how it works. A majority of how radiation works is it damages the DNA in the cancer cell and then over time, the cancer cell then dies off. So, oftentimes, patients do hear that the radiation continues to work after they’re even done with their treatment. It’s not that the radiation stays in their body. It’s more that the cancer’s DNA is damaged by the radiation treatment. It lays that foundation and then, over time the cancer will die off.
Melanie: When these damaged cancer cells die does the body naturally remove them? What happens to the normal cells that might be affected by the radiation?
Dr. Kim: The normal cells do have the ability to repair; to stop when it realizes that it has been damaged and then, to really repair it before it moves on. Certainly, some of the normal cells aren’t able to recover and some of that can lead to the side effects or risks involved with the radiation treatment. But, we are constantly trying to reduce that risk or long-term side effects in radiation treatment.
Melanie: Is the goal of radiation treatment to shrink and eliminate these cancer cells or is it usually an adjunct to other cancer treatments?
Dr. Kim: Absolutely. All of those things. Radiation sometimes is used by itself as the definitive treatment such as in prostate cancer but a lot of times in cancer care, it’s oftentimes used in conjunction with other treatment. So, a lot of patients are getting multiple treatments or multi-modality of treatments. So, they might get radiation with chemotherapy or chemotherapy prior to their radiation or radiation might come first. In terms of with surgery, oftentimes, the radiation can be done prior to the surgery or done as a new adjuvant treatment or done after surgery or, otherwise called “adjuvant therapy”.
Melanie: So, we hear about different types of radiation – external beam and brachytherapy. There are all these different terms that are thrown around and it’s very hard to understand the differences. Tell us about the types of radiation therapy that you use.
Dr. Kim: Certainly. The radiation treatments are often divided into external beam radiation or internal or otherwise called “brachytherapy.” The majority of patients are going to be going to be getting the external radiation treatments. These are all done from the outside where, from the machine, the radiation is delivered, goes to where it needs to go and the radiation is gone in that instant. Brachytherapy, or internal radiation treatments, are done with either an applicator or a seed placement or different ways of placing the radioactive source inside the patient, whether it’s temporary or permanent. If it is permanent, placement the radiation is lost over time. In the temporary situation, the radiation source is placed through the applicator for a temporary time and then removed. So, the radiation in those scenarios is not remaining inside the patient. In external beam radiation treatment, there is different ways of delivering that treatment as well. A lot of the acronym we hear is 3D CRT or 3D Conformal Radiation Therapy as well as IMRT which is Intensity Modulated Radiation Therapy. So, 3D Conformal Radiation Therapy is where a scan or image is done to map out the tumor or the location of the treatment that needs to be targeted to and then the radiation beam can be shaped to that target. IMRT takes it a step further where it doesn’t involve that shaping or targeting of the target itself but now we’re able to not only do a shape that’s tumor targeted to the area that needs to get the radiation treatment, we can also do what’s called “dose paint” or give different doses within the target. If there’s multiple targets, we can give different dose to each area. So, it does allow for more precise treatment, it allows to reduce the dose to surrounding critical organs that might be very close to the target that we are trying to treat.
Melanie: Are these all types of photon treatments? What’s a photon?
Dr. Kim: Radiation is essentially divided into two main groupings. These are non-charged radiation which includes photons and charged particle radiation which includes things such as electrons or protons which we often hear as well. The majority of patients will be getting photon radiation treatments. They all do essentially the same thing to eradicate the cancer or to kill the cancer cells but they all have their own advantages in terms of their physical properties. So, oftentimes they’re all considered in the scenario of the specific case of the patient before the radiation oncologist decides to use one or the other for the treatment.
Melanie: What are some of the side effects? People worry. They hear the word “radiation” and they worry about side effects from these types of treatments. Which treatments have sort of the least side effects and what are some of those?
Dr. Kim: Certainly, all of these ionizing radiation or treatments have side effects. But they are all local. So, patients do need to keep in mind that it all depends on where the radiation treatment is being aimed at or targeted to. Based on what the nearby sensitive organs may be is what the treatment side effects may end up being. Certainly, these don’t happen immediately as they get the treatments but as the dose builds up over time the treatment can cause some of these side effects but the majority are manageable with medications or different diet modifications and they are temporary. So, acute side effects do go away after they’re done. Certainly, not immediately after they’re done but over time. About 2-4 weeks after their done, a lot of those side effects do go away.
Melanie: How is radiation therapy planned for any patient? How do they decide between external beam and brachytherapy and stereotactic radiation and all of these things you’ve mentioned? IMRT and these things are names to patients. How do they make that decision or do you help them make that decision?
Dr. Kim: I think that the patient should definitely start at consultations with their radiation oncologist. So, having that open dialogue, having that full consultation where they are discussing the recommendations, the indications for their treatment, the alternatives to their treatments. What are the risks involved or the side effects that they might potentially see? Then, the dialogue between the patient and the radiation oncologist as to really what is the best modality for treating that specific scenario? The radiation oncologist will consider all of the treatment options or ways to deliver that radiation in terms of whether it’s theratactic radio surgery or IMRT or 3D conformal. Certainly, the fancier the name or the fancier the way the treatments are given, it does sound like it would have all the advantages and why shouldn’t everyone get those types of treatments? But, there are some scenarios where the more simple way of delivering the radiation can be advantageous compared to, let’s say, IMRT or SRS way of treatment. Those all will be considered by the radiation oncologist and discussed at the time of consultation.
Melanie: In just the last few minutes, Dr. Kim, and it’s great information. It’s so important and you’re putting it out there so very well, give your best advice for how a patient should care for themselves during radiation therapy and why they should come to City of Hope for their care.
Dr. Kim: The one main thing that patients can do during their care and certainly whatever is specific for their specific side of treatment, the radiation oncologist as well as the nurse involved with their care oftentimes do go over things that they can be doing to minimize side effects, to minimize or care for their treatment during this time but I think the number one thing that patients can do to help along their treatment process is really nutrition. We have every patient that goes through radiation treatment involve a nutritionist because I think it’s very important for them to upkeep their weight, to make sure that their eating healthy during this time so that the body does have the resources to repair and to recover once they’re done so that they definitely get through the treatment and that they recover after the treatment.
Melanie: That’s so important. Thank you so very much, Dr. Kim. You’re listening to City of Hope Radio. For more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.