Radiation treatment plays an important role in most breast cancer patients, particularly those seeking breast conserving therapy. Radiation is also used in patients with high risk disease after a mastectomy.
At City of Hope, our image-driven planning using computed tomography (CT) and magnetic resonance imaging (MRI) scans means that radiation is accurately delivered to tumor sites, increasing the therapy's effectiveness while reducing exposure to normal tissue.
Our radiation oncologists also work closely with breast surgeons and medical oncologists (who prepare and deliver drug therapies) to plan and provide customized care to each patient for optimal outcome
Listen as Daniel H. Kim, MD explains that for those who have been diagnosed with breast cancer, City of Hope's Breast Cancer Program provides state-of-the-art surgical, medical and radiation therapies.
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Radiation Therapy and Breast Cancer
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Learn more about Daniel Kim, MD
Daniel H. Kim, MD
Daniel Kim, MD., is an assistant clinical professor and radiation oncologist in the Department of Radiation Oncology at City of Hope Arcadia.Learn more about Daniel Kim, MD
Transcription:
Radiation Therapy and Breast Cancer
Melanie Cole (Host): City of Hope is a leader in image driven radiation planning using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site while minimizing exposure to nearby normal tissue. My guest today is Dr. Daniel Kim. He's an Assistant Clinical Professor in the Department of Radiation Oncology at City of Hope. Welcome to the show, Dr. Kim. When is it a patient comes to see you? At what point in their diagnosis would you be involved?
Dr. Daniel Kim (Guest): For the most part, I like to see patients as soon as possible. For the most part, though, we usually see them after they’ve completed their surgery along with the Medical Oncologist who would be the one to discuss systemic therapy, such as chemotherapy or antiestrogen or antihormone types of therapy.
Melanie: Tell us what’s going on in the world of radiation therapy for breast cancer now, including standard radiation therapy and maybe hypofractionated radiotherapy.
Dr. Kim: Certainly. For the most part, radiation is the same radiation that we’ve been using for decades. The major advances in radiation treatment have been better ways to plan the radiation treatment to avoid things that really don’t need radiation, such as the heart and lung, and to also better visualize the targets of radiation involved, too. A lot of the planning aspects have improved dramatically over the last few years, and you mentioned one of the more recent advances is the hypofractionated radiation treatment. This is essentially the same radiation again, but rather than deliver the treatment over the standard six-week course of treatment, we are prescribing shorter courses of treatment that we finish on the order of three to four weeks. Overall, the total dose is the same, so it’s not like we’re delivering a lower dose of radiation, but because of our improved planning techniques, and the greater safety of our treatment, we can deliver a higher dose per day to get things done sooner, or faster than the standard six-week course.
Melanie: And what about intraoperative radiation therapy, IORT?
Dr. Kim: IORT is a way of delivering radiation at the same time that you’re getting your cancer surgery in the operating room. Certainly, there are major advantages of getting – we call that a one-stop-shop, getting all your treatments done on the same day. Currently, this would still be considered an experimental type of treatment, not because we don’t know what’s going on, but mainly because we want to know what the long-term safety implications are, as well as the long-term outcomes in terms of how well does this actually treat the cancer.
Melanie: So speak about the difference -- when you mentioned that it’s done at the same time, so it’s quite beneficial as far as convenience for the patient -- but actually what are you doing?
Dr. Kim: First of all, not every patient would be considered an ideal candidate for this type of treatment, but for the right type of patient, after the lumpectomy, or the cancer surgeries performed in the operating room, there’s a device that’s brought into the operating suite that places a radiation applicator actually in the cavity where the tumor used to be. Then, through the use of the specialized radiation treatment delivery device, there’s a focused node of radiation that’s delivered around the surgical cavity. It’s a very concentrated dose of radiation, one that someone says delivers the equivalent of a six-week course of radiation in a one-time treatment. Once the radiation treatment is completed, which takes no more than a few minutes, the device is removed, and the rest of the surgery proceeds just like it normally would with closure by the surgeon.
Melanie: Where do you see the world of radiation therapy going in the future? What’s on the horizon? What are you doing very exciting at City of Hope?
Dr. Kim: Certainly, a lot of our treatments and advances in our field have been driven by improved imaging techniques, improved ways to localize tumors, and improved ways to identify non-target areas, things we don’t want to treat with the radiation. So certainly those will push our field forward, but I think more importantly with the advent of what we call molecular diagnostics, or genetic testing, what I see in the future is selecting patients who may benefit more from radiation and selecting patients, therefore, that may not need radiation in the future. The same could be said for certain types of chemotherapies or other drug therapies as well too. This is going into the realm of personalized medicine.
Melanie: And then, wrap it up for us. What do you want women to know because they have so many questions about radiation therapy Dr. Kim? They’re afraid of the radiation itself as far as the surrounding tissues. They’re not sure how long it’s going to take or if it’s going to make them feel sick, so give us a background on radiation therapy and what women can expect when they’re going through this type of treatment.
Dr. Kim: Certainly, so one thing I advise is doesn't look to the internet for this kind of information. Certainly, you would want to get this information from your cancer specialist because this is what we do and it’s our job to counsel patients appropriately. With the radiation, it’s something we control – we try to control the delivery of radiation because we, ourselves know that radiation can be dangerous in the wrong hands. What I tell all patients is, first of all, radiation is not something that you feel. It’s not something that’s painful. It's not something that you can see, and as far as most types of external radiation go, there’s no radiation left inside your body, so there’s no danger to the people around you or to the surrounding areas. There are side-effects to radiation treatment. Specifically for breast cancer, the skin reaction can progress along the lines of a mild sunburn over the course of your three, four, or six-week treatment course. There’s some tiredness or fatigue that comes along with the treatment. The long-term risks we minimize with improved -- as I’ve already mentioned -- imaging and planning techniques so that we can better target the area that we want to target with the radiation and avoid areas that don’t need radiation such as the heart, portions of the lung, etcetera, etcetera.
Melanie: Tell us about your team at City of Hope.
Dr. Kim: Certainly, City of Hope is a multispecialty cancer center, and we work very well together in teams -- as far as breast cancer goes -- with the breast surgeon, the medical oncologist who deliver chemotherapy and endocrine or hormonal therapies, and the radiation oncologists. Certainly, we work well with a reconstructive surgery colleagues, pathologist, radiologist, and we feel that coming to City of Hope the patient gets everything under one roof. Doctors who coordinate together, talk to each other and provide the best patient experience possible.
Melanie: Thank you, so much, Dr. Kim, 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.
Radiation Therapy and Breast Cancer
Melanie Cole (Host): City of Hope is a leader in image driven radiation planning using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site while minimizing exposure to nearby normal tissue. My guest today is Dr. Daniel Kim. He's an Assistant Clinical Professor in the Department of Radiation Oncology at City of Hope. Welcome to the show, Dr. Kim. When is it a patient comes to see you? At what point in their diagnosis would you be involved?
Dr. Daniel Kim (Guest): For the most part, I like to see patients as soon as possible. For the most part, though, we usually see them after they’ve completed their surgery along with the Medical Oncologist who would be the one to discuss systemic therapy, such as chemotherapy or antiestrogen or antihormone types of therapy.
Melanie: Tell us what’s going on in the world of radiation therapy for breast cancer now, including standard radiation therapy and maybe hypofractionated radiotherapy.
Dr. Kim: Certainly. For the most part, radiation is the same radiation that we’ve been using for decades. The major advances in radiation treatment have been better ways to plan the radiation treatment to avoid things that really don’t need radiation, such as the heart and lung, and to also better visualize the targets of radiation involved, too. A lot of the planning aspects have improved dramatically over the last few years, and you mentioned one of the more recent advances is the hypofractionated radiation treatment. This is essentially the same radiation again, but rather than deliver the treatment over the standard six-week course of treatment, we are prescribing shorter courses of treatment that we finish on the order of three to four weeks. Overall, the total dose is the same, so it’s not like we’re delivering a lower dose of radiation, but because of our improved planning techniques, and the greater safety of our treatment, we can deliver a higher dose per day to get things done sooner, or faster than the standard six-week course.
Melanie: And what about intraoperative radiation therapy, IORT?
Dr. Kim: IORT is a way of delivering radiation at the same time that you’re getting your cancer surgery in the operating room. Certainly, there are major advantages of getting – we call that a one-stop-shop, getting all your treatments done on the same day. Currently, this would still be considered an experimental type of treatment, not because we don’t know what’s going on, but mainly because we want to know what the long-term safety implications are, as well as the long-term outcomes in terms of how well does this actually treat the cancer.
Melanie: So speak about the difference -- when you mentioned that it’s done at the same time, so it’s quite beneficial as far as convenience for the patient -- but actually what are you doing?
Dr. Kim: First of all, not every patient would be considered an ideal candidate for this type of treatment, but for the right type of patient, after the lumpectomy, or the cancer surgeries performed in the operating room, there’s a device that’s brought into the operating suite that places a radiation applicator actually in the cavity where the tumor used to be. Then, through the use of the specialized radiation treatment delivery device, there’s a focused node of radiation that’s delivered around the surgical cavity. It’s a very concentrated dose of radiation, one that someone says delivers the equivalent of a six-week course of radiation in a one-time treatment. Once the radiation treatment is completed, which takes no more than a few minutes, the device is removed, and the rest of the surgery proceeds just like it normally would with closure by the surgeon.
Melanie: Where do you see the world of radiation therapy going in the future? What’s on the horizon? What are you doing very exciting at City of Hope?
Dr. Kim: Certainly, a lot of our treatments and advances in our field have been driven by improved imaging techniques, improved ways to localize tumors, and improved ways to identify non-target areas, things we don’t want to treat with the radiation. So certainly those will push our field forward, but I think more importantly with the advent of what we call molecular diagnostics, or genetic testing, what I see in the future is selecting patients who may benefit more from radiation and selecting patients, therefore, that may not need radiation in the future. The same could be said for certain types of chemotherapies or other drug therapies as well too. This is going into the realm of personalized medicine.
Melanie: And then, wrap it up for us. What do you want women to know because they have so many questions about radiation therapy Dr. Kim? They’re afraid of the radiation itself as far as the surrounding tissues. They’re not sure how long it’s going to take or if it’s going to make them feel sick, so give us a background on radiation therapy and what women can expect when they’re going through this type of treatment.
Dr. Kim: Certainly, so one thing I advise is doesn't look to the internet for this kind of information. Certainly, you would want to get this information from your cancer specialist because this is what we do and it’s our job to counsel patients appropriately. With the radiation, it’s something we control – we try to control the delivery of radiation because we, ourselves know that radiation can be dangerous in the wrong hands. What I tell all patients is, first of all, radiation is not something that you feel. It’s not something that’s painful. It's not something that you can see, and as far as most types of external radiation go, there’s no radiation left inside your body, so there’s no danger to the people around you or to the surrounding areas. There are side-effects to radiation treatment. Specifically for breast cancer, the skin reaction can progress along the lines of a mild sunburn over the course of your three, four, or six-week treatment course. There’s some tiredness or fatigue that comes along with the treatment. The long-term risks we minimize with improved -- as I’ve already mentioned -- imaging and planning techniques so that we can better target the area that we want to target with the radiation and avoid areas that don’t need radiation such as the heart, portions of the lung, etcetera, etcetera.
Melanie: Tell us about your team at City of Hope.
Dr. Kim: Certainly, City of Hope is a multispecialty cancer center, and we work very well together in teams -- as far as breast cancer goes -- with the breast surgeon, the medical oncologist who deliver chemotherapy and endocrine or hormonal therapies, and the radiation oncologists. Certainly, we work well with a reconstructive surgery colleagues, pathologist, radiologist, and we feel that coming to City of Hope the patient gets everything under one roof. Doctors who coordinate together, talk to each other and provide the best patient experience possible.
Melanie: Thank you, so much, Dr. Kim, 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.