Scott Webb (Host): Welcome to UK HealthCast, a podcast presented by UK HealthCare. I'm Scott Webb. And today, we're discussing the latest in radiation oncology with Dr. Weisi Yan. He's a radiation oncologist and Associate Professor of Radiation Medicine with UK HealthCare Doctor, welcome to the podcast.

Weisi Yan, MD, PhD: Thank you. Scott. It's an honor to be here.

Host: It's great to have you here. You look the part, you look like a doctor, you look like a radiation oncologist, and that's always a good thing for viewers especially. I want to have you start by just telling us about yourself, your journey to UK HealthCare, what led you into medicine, why radiation oncology, all those good things.

Weisi Yan, MD, PhD: So, what brought me to UK is very interesting. So initially, I went to Corbin, Kentucky. And then, there's one day in the town of London, I was like, "How come I'm in Kentucky myself?" Because one of my friends invited me down here. And you know, rural Kentucky can be a little bit rough. So because my wife got pregnant, she wants to stay in Lexington, and then naturally I came to UK. So, that's a sweet surprise.

And as far as why I became a physician, I am more interested in finance, economics, and trade. I want to be in Wall Street. But as you probably know that since my great grandpa-- we were a family of four generations of physicians from private practice, lab medicine, med-onc, rad-onc. So for me, it's pretty much like fixed by the Asian families, right? You just have to be a physician. The road is paved that way.

Why radiation medicine is that when I was in graduate school, my neighbor was trying to get into radiation oncology. Before, I knew nothing about radiation oncology. My father is a medical oncologist. And my PhD is in pharmacology. Naturally, you would use drugs. But when he gets into radiation medicine and started to explore a little bit, it seems to be more surgical related. It has more anatomy, graphics, computer. Looking back 10 years down the road, I think it's much better to be a radiation oncologist. I mean, med-onc is great. But for me, it could be boring. I don't want to stand there and run for three hours. I'd rather just be like in front of a computer and do what we call countering and we have a word for it that's called painting, right? So, the anatomy, physics, biology, and they started the immune therapy this year. So, I think this is a good field. And in the beginning, it is really rough, but now I'm enjoying my career.

Host: You mentioned immunotherapy there. I know that's one of the latest, coolest things. And I think, you know, I say radiation oncology and most of us sort of nod our heads, like we know what that means. But I want to have you talk about some of the cancers that you treat most often, what is radiation therapy typically, like why is it particularly effective with one cancer versus another? And just generally speaking, what are the cancers that you see most often that you treat most often?

Weisi Yan, MD, PhD: What I personally see and treat most often is the head and neck, lung and metastatic cancers, which I do radiosurgery, and the GYN-onc cancers that I do brachytherapy. So for lots of people, even in the medical field, they know very few about the radiation. They think we're just hiding in the bunkers. And it's really hard for people outside, even in the medical specialties, to understand what radiation is about.

But briefly, in old school radiation, you kill the cancer cells by bombarding their DNA. So, the cancer cells, when they're dividing really fast, they have issues repairing themselves when you damage their DNA by the radiation, just like nuclear bombs. But now, we know more and more because radiation at a high dose where when we do radiosurgery, it can kill the cancers by blasting the cells in the neurovasculature, right? And you take away the nutrition from them.

And also, there are more and more things that we find out we can kill by apoptosis, by the death signals, by recruiting T cells to attack the cancer just like immunotherapy, which is of course it's a small field, but definitely have a lot to do with the immune system. So, combined together, that makes radiation sometimes as effective as surgery, as a local therapy. For example, for prostate, for early stage lung cancers, these can be cured by radiation. Especially for GYN cases, like if you have, say, advanced stage cervical cancers, you cannot treat by surgery alone, and then the tumor becomes so extensive, you need the internal radiation and that works really well at the same time. So, radiation can be fairly useful as a local therapy.

The reason why some tumors don't work is that most of the times we cannot give enough radiation dose. For example, if the tumor is next door to your guts, you have to reduce radiation dose and then that makes it less effective. But if you have a tumor in the body that we can safely deliver enough radiation, we can ablate 80-90% of the solid tumors. It's a really cool tool. And if you study really carefully, and this year we have more and more combination therapy with immunotherapy and possibly cell therapy, it can work in the whole human body, although that part is understudied and being explored.

Host: Yeah. Studies are ongoing. And you just brought a smile to my face when I heard the word cure associated and connected with cancer. Of course, we all want that. And I know that's what you and all the experts at UK HealthCare are working towards.

And, Doctor, I like to bust myths when I can. I want to do a little myth-busting, because I know we hear the word radiation and we get scared, of course. So, what are some of the biggest myths that you encounter from patients about radiation therapy and how do you bust those myths? How do you demystify them?

Weisi Yan, MD, PhD: Majority of patients, they know very little about it. So, majority of them will say, "Hey, I'll listen. Whatever you say, Doc." The other part of the spectrum got really scared because the nuclear bomb, right? You can just like kind shine in the night or can become ninja turtles, all the things, because they don't know much.

But for the layman, I think the key thing for toxicity is, yes, in the long-term, there are some chronic late damages. For example, for young patients, you have higher chance of getting a second cancer down the road. And we do have damage to the heart or to the immune cells in the body. And sometimes when you radiate in the pelvis, you do have an increased chance of fracture, yes. So, what's damaging to the cancer also can be damaging to a body.

But if we define the toxicity and the consequences for you, you will make an educated guess. So, it's more of a balance of risk versus return, right? And for a majority of people, the biggest risk-- there are two things-- one is you're going to get a cancer down the road 10 to 20 years, although the chance is low, less than 10-15%. But yes, the danger is real. The other one, especially for thoracic radiation, is that we kill the cancer; at the same time, your immune cells can be really fragile. So, we may be doing collateral damage that make your immune system even weakened, right? And when you have immunotherapy, you're probably going to have more distant metastatic disease because we've killed too many of your lymphocytes. So, these things are real. But again, you can have an educated guess before you take, say, radiation. But number one, you are not radioactive most of the times. Number two, you don't shine in the dark. Number three, we cannot make you have the mutation and pass it to your children. That doesn't work like that. So, in regard to races is, okay, it's not a hundred percent great, but it's not as bad as you think.

Host: I see what you mean. Most of us, when we're in the hands of the care of an expert, we say, "Whatever you say, Doc. That sounds good." But good to know that we're not going to glow in the dark, because I wanted to talk to you about some of the innovations and what's going on, the latest, greatest things, recent changes in radiation oncology that are significantly impacting patient care. So, take us through that as best you can in podcast form. Like, what are you excited about?

Weisi Yan, MD, PhD: The field has a major advancement about 20 years ago when Dr. McGarry, who's here in UK and then another one in University of Indiana, Timmerman, they invented SBRT. So, they use high-dose radiation as a surgical tool to ablate the lung tumors. Now, it is used for pancreatic, prostate, so that we changed radiation from an adjuvant tool to a curing tool like surgery. That's 20 years ago.

But these days there are two major advancements. One is the hardware, like protons, FLASH therapy by machines that's more precise. Give you more radiation, less radiation to the normal tissue. Faster treatment, there's better user experience. The other part that's developing is the software when people know more about radiation and gives you a combination of how to protect your immune system, at the same time, prime the tumor, to let your whole body fight together with the drugs for the tumor.

So, we have updates from hardware and software interface. So, there are improvements and we are learning more and more. And for at least, especially for lung, we are knowing more. So, we are actually in this institution trying to improve heart toxicity and spare your immune system so that our patient, theoretically, if you do the same radiation, our patients should live longer.

Host: I see what you mean. Yeah. There's just so much room for optimism. And speaking with experts from UK HealthCare and speaking with you today, I feel like I want to smile a lot, because this all sounds like good stuff, cool stuff, amazing technology. As you say, software, hardware. I want to get a sense from you, Doctor, when we think about the UK Markey Cancer Center, how do you help prepare patients for radiation therapy and the after effects of treatment?

Weisi Yan, MD, PhD: The good part is this is an intellectual environment. We have tumor boards, we have medical oncologists, surgery, pulmonologists, radiation oncologists. Lots of decisions are made in the group manner. And also, it's much better to have specialists. When I was in Corbin, I'm the only rad-onc in town and our tumor board, we don't have so many physicians.

In the end, there's no dynamic environment to give you intellectual environment for you to improve and think. Here, you know, you have people operating all the time. So, you have the influx and efflux of ideas. And even in our department, sometimes I take a look at the other people's plan, that gives you some inspirations. Actually, the relationship between the heart and immune system is developed here at the UK because of the intellectual environment. So when you have specialists dealing with lung cancer all the time, it's much better than a general practitioner who sees everything. So, like you go to a steak restaurant for a steak versus a fast food for a steak, that's different. So, I think it's the environment, also the expertise that can definitely give you a better quality of care.

Host: Patients are in great hands. Families are in great hands. Experts, of course. I know we're going to speak again in the near future. But in the short term here, let's finish up. Let's talk about the importance of prevention, early detection, and what role radiation oncology plays when we do catch cancers early versus later stage cancers. And like, what should we know? What should potential patients know about screening, risk reduction, lifestyle changes that we can make to reduce our likelihood of needing, let's say, those more aggressive treatments?

Weisi Yan, MD, PhD: For example, we can cure early stage. It's really hard for us to cure at advanced stage. For stage IV, we can extend your life but we cannot cure it. The bad thing is you never got to see us, right? Not seeing us is best blessing. So, we try to prevent. You can do low-dose CT lung screening, which can find nodules from really early. You start monitoring that. And if that's real, you try to ablate them and then that's like 90% of cure.

And also, in your real life, you know, smoking is a big thing here. Probably everybody smokes. We tell them, it's like, "Oh, I'm going to quit," they won't. The problem is if you keep on smoking, doesn't matter what we do, it's going to kill you. We can slow down a little bit, but it's ultimately your body.

The other thing that's very interesting is radon here. I got a patient, the whole family got lung cancer, one after the other. So, they told me that after the second case, they started to go to the basement, do the radon reading, and then their reading was really high. So, living exposed to that thing for a low-dose radon radiation for 20, 30 years. That's something you can do definitely to help yourself. If your air is dirty, if you are cooking a lot, get the air purifier. For the housewives who don't smoke, if you're exposed to the fumes, the small droplets of cooking oil, you can get the lung cancer as well. So, it's not only for smokers. So, this kind of lifestyles, screening, actual environment, right, can go a long, long way to prevent this from happening. So, you rather do it before and you don't want to see us. Like, there's a Chinese saying that the best doctor cures the disease before they start.

Host: That's perfect. Well said by an expert. Of course, I know we're going to speak again in the future, but appreciate your time today. I love the room for optimism. There's things, of course, that we can do. We busted some myths today. All good stuff. Thank you so much.

Weisi Yan, MD, PhD: Oh, thank you, Scott. Great pleasure.

Host: And for more information, go to ukhealthcare.com/markey. And if you enjoyed this podcast, please share on your social channels. And don't forget to check out our entire podcast library for other topics of interest. This is UK HealthCast, a podcast from UK HealthCare. Thanks for listening.