Selected Podcast
Radiation Therapy for Cancer Treatment
Dr. Bhooshan discusses general information on radiation therapy for cancer treatment.
Featuring:
Dr. Bhooshan holds bachelor and master degrees in computer science and electrical engineering from Massachusetts Institute of Technology and also served as a teaching assistant at the University of Chicago’s Committee on Medical Physics.
Neha Bhooshan, MD
Dr. Bhooshan received her PhD in medical physics from the University of Chicago Biological Sciences Division and completed medical school at the University of Chicago Pritzker school of Medicine. She served as chief resident at the University of Maryland’s department of Radiation Oncology. In addition to being published in peer-reviewed journals,Dr. Bhooshan holds bachelor and master degrees in computer science and electrical engineering from Massachusetts Institute of Technology and also served as a teaching assistant at the University of Chicago’s Committee on Medical Physics.
Transcription:
Bill Klaproth: (Host) Radiation oncology also called radiation therapy is a major part of cancer care. So what is it and how does it work? Well, let's learn more with Dr. Neha Bhooshan a radiation oncologist at UPMC Hillman Cancer Center in Harrisburg. This is Healthier You a podcast from UPMC Pinnacle, I'm Bill Klaproth. Dr. Bhooshan thank you so much for your time, it is great to talk with you. So let's start with this. What is radiation therapy?
Dr. Neha Bhooshan: (Guest) Great place to start. I think it helps to take a step back and talk about cancer care first. So when we talk about cancer treatment, there are three main pillars of cancer care. The first pillar is surgery. Physically taking out the tumor, wherever it is. We consider that to be a local treatment. The second pillar is a systemic therapy. It is medicine that can be given through an IV or taken by mouth with a pill. And it goes everywhere in the body to try to kill the cancer cells wherever they may be. The most common type of systemic therapy that most people know about his chemotherapy, but there are a lot of different therapies that fall under that umbrella, including hormone therapy, immunotherapy, targeted therapy, et cetera. And the third pillar is radiation therapy, which is what I do. And radiation therapy is also local treatment like surgery because wherever the beams go is where the radiation goes. And so speaking now specifically about radiation therapy. Radiation therapy can be used to treat many different types of cancers. So depending on the type of cancer and where it is, based on the imaging. We then determine the stage of the cancer. And then this helps us decide what is the best combination of treatments for that patient's particular cancer diagnosis. Is it surgery alone, surgery followed by chemotherapy, chemotherapy, and radiation therapy at the same time, you know, there are endless combinations that we can do again among these three pillars, to make sure we're getting the optimal treatment to our patients. And at UPMC Pinnacle, we always strive to follow the national comprehensive cancer network guidelines or the NCCN guidelines when deciding on cancer treatments for our patients.
Host: So the three main pillars of cancer care surgery, systemic therapy, and then radiation therapy. And they can all be used in conjunction with each other, depending on what the patient needs. So how does radiation therapy work? Then I have this image in my mind, but I'm sure I'm incorrect. how does this work to treat cancer?
Dr. Bhooshan: Excellent question. So the most common form of radiation therapy that we use is x-rays, the same as you get a chest X-Ray, CT scan. Same kind of x-rays but we use a higher energy x-ray beam because the purpose is to kill tumor cells. We're not trying to take an image of your body with the radiation therapy. And specifically what happens is that when these high energy x-rays enter the body, ions are produced, which caused DNA damage to the tumor cells, either directly through radical production, or indirectly. So when the tumor cells try to multiply, since that's what tumor cells like to do, they like to grow and keep growing. They cannot because the DNA has been damaged by the radiation x-rays and the tumor cells die. And we use a machine called a linear accelerator to deliver the radiation therapy.
Host: I was envisioning like a Ray gun and you're shooting at the cancer. And I know now after you said that, I am wrong.
Dr. Bhooshan: It's a very fancy Ray gun.
Host: Right, So Dr. Bhooshan, for someone who has been diagnosed with cancer and they need radiation therapy, what is the next step?
Dr. Bhooshan: So they will meet with a radiation oncologist like myself. We determined what is the target for our treatment. Cause again, radiation is a local treatment. And radiations, like any other type of medicine, there is a certain dose we need to go to make sure we're being effective with the treatment. However, if we try to get that dose and only one treatment, it can be potentially harmful. So typically the radiation is given in small doses, delivered every day, over a certain number of weeks to then deliver the total dose of requires radiation therapy. So the radiation oncologist will determine exactly the number of treatments that are needed based on the type and the stage of the cancer. So for example, a breast cancer patient typically requires about three to six weeks of treatment while a prostate cancer patient may require six to nine weeks of treatment. And again, the radiation oncologist will go over with the patient, the exact number of treatments when they see them.
Host: And then can the treatment start right away?
Dr. Bhooshan: Not quite, cause first we have to plan the radiation. We do customize radiation. Everyone's tumor and body anatomy is different. So we fit the radiation beams to a patient's specific tumor and anatomy. The other issue is that if the patient is laying on the radiation treatment table and then starts moving, the radiation machine or linear accelerator cannot track a patient's body in real-time. And we want to make sure that the patient is in the same position every time for a treatment, so we can be confident the radiation is going where it's supposed to go. So to address those two issues, we have patients undergo what is called a CP simulation scan or planning scan. Every radiation oncology clinic in the UPMCs Pinnacle network has its own CT scanner for this purpose. So the patient will come in, will be placed in the treatment position, maybe using a mold or a mask if needed. And then the patient will be scanned. Sometimes our radiation therapists will place very small permanent tattoos, they're the size of a freckle on the patient because we have lasers in the treatment room and use those tattoos to ensure accurate set up every day. Our therapists will then look at our treatment calendar and provide the patient with all the dates and times for the radiation treatments. And they will also meet with our nurses to go over general education for the radiation treatment. So all of that happens on that day in preparation for the radiation treatment.
Host: So when that day is done, after all that preparation and the CT scan, what happens then?
Dr. Bhooshan: The patient goes home and, on our end, we then plan the radiation treatment. So we count for where the tumor is on that CT scan, we will also contour the nearby normal organs or structures as well. We then place the radiation beams to give the prescribed dose to the target, to the tumor while minimizing the radiation dose to those near Organs, in order to minimize this potential side effects of the radiation treatment. We have physicians on staff who do a QA or quality assurance safety check on the radiation plan to make sure everything is safe before the patient gets on the table. We also review all new radiation plans within our group of radiation oncologists here at UPMC pinnacle as another QA check again, to make sure everything is safe before the patient gets on the table. Once the radiation plan is ready, the patient will return to our clinic and we will then start the radiation therapy.
Host: So then how long is a radiation therapy session at that point?
Dr. Bhooshan: So the typical radiation treatment is actually typically 10, 15 minutes, with a beam on, it's not like you think chemotherapy being all day in an infusion clinic. Most of the treatments are actually quite quick at only 10, 15 minutes of the beam on, there are some certain specialized radiation treatments, which may take longer, maybe up to 30, 45 minutes but again the typical treatment time is 10, 15 minutes. Checking in, changing, getting on, and off the table. We counsel our patients that they'll typically be in our radiation clinic for about 30 minutes or one treatment. at UPMC Pinnacle, our radiation oncology clinics are open 7: 30 in the morning to four o'clock in the afternoon, Monday through Friday. So we will give them a time thought to come in for their treatments. And during the treatment itself, we check on the patient at least once a week, again, just to make sure that we check on them for any potential side effects. So just on that day, that may add an extra 10, 15 minutes, but again, overall, it's a pretty quick, to come in for radiation treatments.
Host: Yeah, it sounds like it's. So during the session again, I was imagining how you do this. Does the patient feel anything?
Dr. Bhooshan: Nothing. It really is just like getting an X-Ray or a CT scan. You will not feel, hear, smell anything with the beam being on during a radiation treatments. And I know, some patients get concerned if they're radioactive, can they be safe around family? Patients are not radioactive with getting radiation therapy. It is completely safe to be around their family and pets while they're receiving radiation treatment, here at UPMC Pinnacle.
Host: And are there any side effects at all that come with this?
Dr. Bhooshan: A common side effect with radiation therapy is mild fatigue. from my experience is it's not severe fatigue. Like you think chemotherapy, you know unless patients are getting chemotherapy with their radiation. But, I typically counsel patients, you may need to take an extra nap or sleep an extra hour at night to help with that fatigue. But we have patients who are able to work during radiation, and so again, it's tolerable. All other side effects of the radiation therapy are determined by where the radiation is going. Since radiation is a local treatment for example, for a breast cancer patient, the most common side effect is skin irritation on the treated breast. And we counsel patients that the skin in the radiation field you may get pink or red or blister, but they will heal after the radiation treatment is done. For prostate cancer patients that there can be radiation dose to the bladder and rectum. So patients can have side effects like pain with urination or frequent urination or loose stools or diarrhea. Say again, we check in on our patients at least once during the week and manage those side effects with medication as needed. Finally, the side effects during radiation therapy are cumulative. So typically the first couple of weeks of treatment, patients may not experience any side effects, but as they get more treatments as the weeks go on, they may slowly develop those. And again, we keep a close eye on them so we can manage them appropriately.
Host: This is really fascinating, Dr. Bhooshan. And thank you for your time. Last question for someone learning about this or listening to this, who's about to undergo radiation therapy treatment. Can you share any guidance or assurance for that person?
Dr. Bhooshan: I know for cancer patients, it can be a very scary time with a cancer diagnosis, understandably. So I think the most important thing to remember is that you have an excellent cancer team, of surgeons, medical oncologists, radiation oncologists, who are going to come up with the best treatment plan for you. And if that treatment requires radiation therapy, we have a lot of experience with giving radiation therapy and our goal is to give the best radiation care while also treating our patients safely and getting our patients through treatment.
Host: What a great message. Dr. Bhooshan, thank you so much for your time. This has really been interesting and informative. Thank you again.
Dr. Bhooshan: Thank you so much.
Host: That's Dr. Neha Bhooshan and for more information, please visit UPMCpinnacle.com/cancer. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You a podcast from UPMC Pinnacle, I'm Bill Klaproth. Thanks for listening.
Bill Klaproth: (Host) Radiation oncology also called radiation therapy is a major part of cancer care. So what is it and how does it work? Well, let's learn more with Dr. Neha Bhooshan a radiation oncologist at UPMC Hillman Cancer Center in Harrisburg. This is Healthier You a podcast from UPMC Pinnacle, I'm Bill Klaproth. Dr. Bhooshan thank you so much for your time, it is great to talk with you. So let's start with this. What is radiation therapy?
Dr. Neha Bhooshan: (Guest) Great place to start. I think it helps to take a step back and talk about cancer care first. So when we talk about cancer treatment, there are three main pillars of cancer care. The first pillar is surgery. Physically taking out the tumor, wherever it is. We consider that to be a local treatment. The second pillar is a systemic therapy. It is medicine that can be given through an IV or taken by mouth with a pill. And it goes everywhere in the body to try to kill the cancer cells wherever they may be. The most common type of systemic therapy that most people know about his chemotherapy, but there are a lot of different therapies that fall under that umbrella, including hormone therapy, immunotherapy, targeted therapy, et cetera. And the third pillar is radiation therapy, which is what I do. And radiation therapy is also local treatment like surgery because wherever the beams go is where the radiation goes. And so speaking now specifically about radiation therapy. Radiation therapy can be used to treat many different types of cancers. So depending on the type of cancer and where it is, based on the imaging. We then determine the stage of the cancer. And then this helps us decide what is the best combination of treatments for that patient's particular cancer diagnosis. Is it surgery alone, surgery followed by chemotherapy, chemotherapy, and radiation therapy at the same time, you know, there are endless combinations that we can do again among these three pillars, to make sure we're getting the optimal treatment to our patients. And at UPMC Pinnacle, we always strive to follow the national comprehensive cancer network guidelines or the NCCN guidelines when deciding on cancer treatments for our patients.
Host: So the three main pillars of cancer care surgery, systemic therapy, and then radiation therapy. And they can all be used in conjunction with each other, depending on what the patient needs. So how does radiation therapy work? Then I have this image in my mind, but I'm sure I'm incorrect. how does this work to treat cancer?
Dr. Bhooshan: Excellent question. So the most common form of radiation therapy that we use is x-rays, the same as you get a chest X-Ray, CT scan. Same kind of x-rays but we use a higher energy x-ray beam because the purpose is to kill tumor cells. We're not trying to take an image of your body with the radiation therapy. And specifically what happens is that when these high energy x-rays enter the body, ions are produced, which caused DNA damage to the tumor cells, either directly through radical production, or indirectly. So when the tumor cells try to multiply, since that's what tumor cells like to do, they like to grow and keep growing. They cannot because the DNA has been damaged by the radiation x-rays and the tumor cells die. And we use a machine called a linear accelerator to deliver the radiation therapy.
Host: I was envisioning like a Ray gun and you're shooting at the cancer. And I know now after you said that, I am wrong.
Dr. Bhooshan: It's a very fancy Ray gun.
Host: Right, So Dr. Bhooshan, for someone who has been diagnosed with cancer and they need radiation therapy, what is the next step?
Dr. Bhooshan: So they will meet with a radiation oncologist like myself. We determined what is the target for our treatment. Cause again, radiation is a local treatment. And radiations, like any other type of medicine, there is a certain dose we need to go to make sure we're being effective with the treatment. However, if we try to get that dose and only one treatment, it can be potentially harmful. So typically the radiation is given in small doses, delivered every day, over a certain number of weeks to then deliver the total dose of requires radiation therapy. So the radiation oncologist will determine exactly the number of treatments that are needed based on the type and the stage of the cancer. So for example, a breast cancer patient typically requires about three to six weeks of treatment while a prostate cancer patient may require six to nine weeks of treatment. And again, the radiation oncologist will go over with the patient, the exact number of treatments when they see them.
Host: And then can the treatment start right away?
Dr. Bhooshan: Not quite, cause first we have to plan the radiation. We do customize radiation. Everyone's tumor and body anatomy is different. So we fit the radiation beams to a patient's specific tumor and anatomy. The other issue is that if the patient is laying on the radiation treatment table and then starts moving, the radiation machine or linear accelerator cannot track a patient's body in real-time. And we want to make sure that the patient is in the same position every time for a treatment, so we can be confident the radiation is going where it's supposed to go. So to address those two issues, we have patients undergo what is called a CP simulation scan or planning scan. Every radiation oncology clinic in the UPMCs Pinnacle network has its own CT scanner for this purpose. So the patient will come in, will be placed in the treatment position, maybe using a mold or a mask if needed. And then the patient will be scanned. Sometimes our radiation therapists will place very small permanent tattoos, they're the size of a freckle on the patient because we have lasers in the treatment room and use those tattoos to ensure accurate set up every day. Our therapists will then look at our treatment calendar and provide the patient with all the dates and times for the radiation treatments. And they will also meet with our nurses to go over general education for the radiation treatment. So all of that happens on that day in preparation for the radiation treatment.
Host: So when that day is done, after all that preparation and the CT scan, what happens then?
Dr. Bhooshan: The patient goes home and, on our end, we then plan the radiation treatment. So we count for where the tumor is on that CT scan, we will also contour the nearby normal organs or structures as well. We then place the radiation beams to give the prescribed dose to the target, to the tumor while minimizing the radiation dose to those near Organs, in order to minimize this potential side effects of the radiation treatment. We have physicians on staff who do a QA or quality assurance safety check on the radiation plan to make sure everything is safe before the patient gets on the table. We also review all new radiation plans within our group of radiation oncologists here at UPMC pinnacle as another QA check again, to make sure everything is safe before the patient gets on the table. Once the radiation plan is ready, the patient will return to our clinic and we will then start the radiation therapy.
Host: So then how long is a radiation therapy session at that point?
Dr. Bhooshan: So the typical radiation treatment is actually typically 10, 15 minutes, with a beam on, it's not like you think chemotherapy being all day in an infusion clinic. Most of the treatments are actually quite quick at only 10, 15 minutes of the beam on, there are some certain specialized radiation treatments, which may take longer, maybe up to 30, 45 minutes but again the typical treatment time is 10, 15 minutes. Checking in, changing, getting on, and off the table. We counsel our patients that they'll typically be in our radiation clinic for about 30 minutes or one treatment. at UPMC Pinnacle, our radiation oncology clinics are open 7: 30 in the morning to four o'clock in the afternoon, Monday through Friday. So we will give them a time thought to come in for their treatments. And during the treatment itself, we check on the patient at least once a week, again, just to make sure that we check on them for any potential side effects. So just on that day, that may add an extra 10, 15 minutes, but again, overall, it's a pretty quick, to come in for radiation treatments.
Host: Yeah, it sounds like it's. So during the session again, I was imagining how you do this. Does the patient feel anything?
Dr. Bhooshan: Nothing. It really is just like getting an X-Ray or a CT scan. You will not feel, hear, smell anything with the beam being on during a radiation treatments. And I know, some patients get concerned if they're radioactive, can they be safe around family? Patients are not radioactive with getting radiation therapy. It is completely safe to be around their family and pets while they're receiving radiation treatment, here at UPMC Pinnacle.
Host: And are there any side effects at all that come with this?
Dr. Bhooshan: A common side effect with radiation therapy is mild fatigue. from my experience is it's not severe fatigue. Like you think chemotherapy, you know unless patients are getting chemotherapy with their radiation. But, I typically counsel patients, you may need to take an extra nap or sleep an extra hour at night to help with that fatigue. But we have patients who are able to work during radiation, and so again, it's tolerable. All other side effects of the radiation therapy are determined by where the radiation is going. Since radiation is a local treatment for example, for a breast cancer patient, the most common side effect is skin irritation on the treated breast. And we counsel patients that the skin in the radiation field you may get pink or red or blister, but they will heal after the radiation treatment is done. For prostate cancer patients that there can be radiation dose to the bladder and rectum. So patients can have side effects like pain with urination or frequent urination or loose stools or diarrhea. Say again, we check in on our patients at least once during the week and manage those side effects with medication as needed. Finally, the side effects during radiation therapy are cumulative. So typically the first couple of weeks of treatment, patients may not experience any side effects, but as they get more treatments as the weeks go on, they may slowly develop those. And again, we keep a close eye on them so we can manage them appropriately.
Host: This is really fascinating, Dr. Bhooshan. And thank you for your time. Last question for someone learning about this or listening to this, who's about to undergo radiation therapy treatment. Can you share any guidance or assurance for that person?
Dr. Bhooshan: I know for cancer patients, it can be a very scary time with a cancer diagnosis, understandably. So I think the most important thing to remember is that you have an excellent cancer team, of surgeons, medical oncologists, radiation oncologists, who are going to come up with the best treatment plan for you. And if that treatment requires radiation therapy, we have a lot of experience with giving radiation therapy and our goal is to give the best radiation care while also treating our patients safely and getting our patients through treatment.
Host: What a great message. Dr. Bhooshan, thank you so much for your time. This has really been interesting and informative. Thank you again.
Dr. Bhooshan: Thank you so much.
Host: That's Dr. Neha Bhooshan and for more information, please visit UPMCpinnacle.com/cancer. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You a podcast from UPMC Pinnacle, I'm Bill Klaproth. Thanks for listening.