Cancer doctors usually treat cancer with radiation therapy, surgery or medications including chemotherapy, hormonal therapy and/or biologic therapy, either alone or in combination.
Radiation oncology is one of the three main oncology specialties involved in the successful treatment of cancer.
Whether radiation therapy is right for you can only be determined by a radiation oncologist.
A radiation oncologist is a doctor who has gone through specialized education and training on the appropriate and safe use of radiation therapy.
Listen in as Paul Mandelin, MD discusses what you need to know about Radiation oncology.
What is Radiation Oncology?
Featured Speaker:
Paul Mandelin, MD
Specializing in radiation oncology, Paul Mandelin, M.D., is a board certified radiation oncologist. He is educated in radiation psychics. His motto is: “I treat the patient, not the symptoms. It’s a team approach that helps patients deal with their treatment course and recovery.” Transcription:
What is Radiation Oncology?
Melanie Cole (Host): Radiation oncology is one of the three main oncology specialties involved in the successful treatment of cancer. This specialty provides expert opinion on whether radiation therapy will be used for your cancer and how best to safely and effectively deliver it. My guest today is Dr. Paul Mandelin. He’s a board-certified radiation oncologist with City of Hope. Welcome to the show, Dr. Mandelin. How does radiation therapy work and what is radiotherapy?
Dr. Paul Mandelin (Guest): Basically, radiation therapy is high-energy X-ray, so it’s very similar to what you would get with a CT scan or a standard chest X-ray, but it’s very high energy and very focused and just on the area that we’re treating.
Melanie: Are there different kinds of radiation?
Dr. Mandelin: There are several different types of radiation available. The main type that is used is called the photon and that’s basically a high-energy X-ray. There’s also particle types of radiation called electron or in certain centers, proton, and all used for different things, treating different types of tumors or different locations in the body.
Melanie: Give us some examples of what types might be used for what types of cancer.
Dr. Mandelin: The typical cancers like breast cancer, prostate cancer, lung cancer are treated with standard photon radiation, which is a high-energy X-ray that penetrates right through the body. The best way I like to describe radiation therapy is it’s similar to pointing a whole bunch of flashlights all across the paper where those flashlights meet in the center is very bright. That’s the area we’re concentrating on, the tumor and the regional lymph node. Around the outside of the area is dull because we have to get the radiation in there somehow, but we’re not aiming at the other critical structures that could be in the way.
Melanie: Okay, is this a safe type of procedure to have?
Dr. Mandelin: Nowadays, radiation therapy is very safe. We use multiple imaging modalities including CT scans, MRIs, PET scans, to help us really focus radiation on the tumor and stay away from those critical structures like the spinal cord or normal tissues and normal organs that are in the area.
Melanie: What about skin problems, Dr. Mandelin? People are worried about the skin around the radiated area.
Dr. Mandelin: Skin can be an issue in radiation therapy if we’re treating something on the outside. The most common thing in breast cancer therapy is getting a skin reaction and we actually expect that to some degree. When we treat something deep inside the body, like the prostate and the lung, it’s uncommon to actually get a skin reaction. We have multiple medications and creams and recommendations to help make that skin reaction less and more tolerable.
Melanie: Tell us about some of the side effects that result from radiation therapy. Is fatigue – people know about chemotherapy side effects, but what are the side effects from radiation therapy?
Dr. Mandelin: The side effects from radiation therapy really depend on the area that we’re treating, or the local therapy. That’s why I like to use the flashlight analogy. Chemotherapy, as you mentioned, goes through the whole body, and that can have side effects like hair loss and nausea and vomiting and things like that. With radiation, we affect only the area we’re treating. If we’re treating in the breasts, it’s really the skin. If we’re treating in the head and neck, unfortunately, it can be pain and difficulty with swallowing or sores in the mouth and things like that. From the radiation standpoint, all of the side effects are well tolerated depending upon if you’re getting chemotherapy at the same time or the area that we’re treating.
Melanie: Now, radiation, just the word scares some people, Dr. Mandelin. Are there late side effects or external side effects that come from using radiation on somebody?
Dr. Mandelin: Long-term side effects are the things we try and avoid the most. The acute side effects like skin reaction, pain and difficulty with swallowing, or the urinary symptoms if we’re treating the prostate, typically go away about four to six weeks after radiation is completed. Again, I like to use a sunburn type of analogy; when you see that skin reaction, the same thing is happening on the inside and that can cause them irritation. Once that sunburn goes away, you can have some residual tanning and then the tan slowly fades and kind of blends in with the normal skin color, but sometimes that can take a little longer than the standard sunburn to go away.
Melanie: Now, tell us a little bit about what radiation therapy really is intended to do and give a little bit of what people can expect if they are going in for radiation therapy for breast cancer, for example.
Dr. Mandelin: Taking the breasts as an example, the way we plan radiation therapy is we do our own CT scan and that’s again we want to mark the area that we’re going to treat. We want to use all the information we can, the mammograms, the biopsy results, the pathology results, and really focus in just treating the breast tissue and exactly where they took the tumor out. There’s multiple appointments before we’re actually able to start. We do that CT scan to plan it. It goes into the computer. We can draw in the area that we want to treat and we draw in the areas that we don’t want to treat so we can avoid those with the radiation. Then there’s the setup session where again we’re kind of double checking everything to make sure everything matches from the CT scan to the computerized treatment plan to the real setup in the actual treatment room. Then usually there’s a marking process involved, too, and that can be prominent marks where we can line you up with lasers every day to make sure we’re only treating the area that we want and able to avoid those critical areas. The unfortunate thing about radiation is that we do have to give it in little pieces. If we give radiation in larger amounts, the side effects go up. We just fractionationate it, meaning that we give daily, Monday through Friday, and that can take up to four to six weeks, and depending on the area we’re treating, sometimes longer and of course sometimes less.
Melanie: Now, prostate cancer is so common, but there’s a few different types of radiation you use for prostate cancer. Explain a little bit about the external beam and then what the seed is, how that differs from something you might do for say a woman with breast cancer.
Dr. Mandelin: Right. The prostate, you can treat with surgery or you can treat with radiation therapy, and with radiation therapy, there’s the internal type which is the seeding and then there’s external beam and also proton. The seeding involves an operative procedure so it’s under ultrasound-guidance. Again, it’s all based on a CT plan. You draw in the prostate, you estimate the amount of those radioactive seeds which is a little grain of rice you’re going to need and then you implant those seeds into a prostate and afterwards you do another CT scan to see where they actually wound up. That’s basically the opposite of the flashlight analogy. Instead of having all these beams coming from the outside pointing towards the middle, you’re putting the light bulb right into the prostate and then the dose fall off for the range of that radiation is very short so you can protect both the bladder and the rectum, which are the two structures right adjacent to the prostate. External beam radiation therapy, again, is that flashlight analogy where you’re taking multiple angles and coming around the whole pelvis focusing in just on the prostate. Again, being able to release the exact dose with the computerized planning and the CT scans that we use to avoid the bladder and the rectum.
Melanie: The main goal is to spare all the surrounding tissues. Does radiation actually kill the cells, Dr. Mandelin? What happens once they’ve been radiated?
Dr. Mandelin: With radiation, that’s the goal. We want to kill the cancer cell. We want to make sure that the cancer doesn’t grow back or doesn’t spread. Again, we’re the local therapy, so when we treat with say, prostate cancer, we’re treating the whole prostate gland. We want to eradicate the tumor cells and give the least amount of radiation we can to the bladder and to the rectum, which is where we get our two main side effects after radiation therapy is done, urinary symptoms or rectal symptoms that typically go away in about four to six weeks. Then we follow with PSA or other tests to see how effective we’ve been. There’s a very good control rate for early stage prostate cancer.
Melanie: What happens to the cells once you’ve killed them?
Dr. Mandelin: Basically, when you eradicate the tumor cells, you have scar tissue left behind. Sometimes, if you were to get an imaging study, you wouldn’t see any kind of tissue left behind. If it’s a little bit of a larger tumor or something that’s more invasive, you might see some scar tissue left behind. I like to describe radiation as like doing surgery without a knife. There are some side effects. You can get scar tissue and you can get changes on imaging studies but the main goal is that you have no active tumor cells left behind.
Melanie: In just the last few minutes, Dr. Mandelin, if you would, please give us your horizon. What’s going on in the world of radiation and why people should come to City of Hope for their radiation oncology services?
Dr. Mandelin: Basically, radiation is a very technology-driven field, so our main goals are to be able to focus the radiation in exactly where we want and again, reduce the dose in all the critical structures in the area and decrease the side effects. We do that with advancing imaging techniques, advancing treatment techniques, and enrolling people on clinical trials. We have clinical trials that involve different types of radiation, different amounts of radiation, different techniques of delivering radiation and we also enroll people in clinical trials that use chemotherapy concurrently and also using different imaging studies to follow tumor and try and do early detection and screening studies.
Melanie: Thank you so much, Dr. Mandelin, for such great information. For more information on radiation oncology, you can go to cityofhope.org. That’s cityofhope.org. You’re listening to City of Hope Radio. This is Melanie Cole. Thanks so much for listening.
What is Radiation Oncology?
Melanie Cole (Host): Radiation oncology is one of the three main oncology specialties involved in the successful treatment of cancer. This specialty provides expert opinion on whether radiation therapy will be used for your cancer and how best to safely and effectively deliver it. My guest today is Dr. Paul Mandelin. He’s a board-certified radiation oncologist with City of Hope. Welcome to the show, Dr. Mandelin. How does radiation therapy work and what is radiotherapy?
Dr. Paul Mandelin (Guest): Basically, radiation therapy is high-energy X-ray, so it’s very similar to what you would get with a CT scan or a standard chest X-ray, but it’s very high energy and very focused and just on the area that we’re treating.
Melanie: Are there different kinds of radiation?
Dr. Mandelin: There are several different types of radiation available. The main type that is used is called the photon and that’s basically a high-energy X-ray. There’s also particle types of radiation called electron or in certain centers, proton, and all used for different things, treating different types of tumors or different locations in the body.
Melanie: Give us some examples of what types might be used for what types of cancer.
Dr. Mandelin: The typical cancers like breast cancer, prostate cancer, lung cancer are treated with standard photon radiation, which is a high-energy X-ray that penetrates right through the body. The best way I like to describe radiation therapy is it’s similar to pointing a whole bunch of flashlights all across the paper where those flashlights meet in the center is very bright. That’s the area we’re concentrating on, the tumor and the regional lymph node. Around the outside of the area is dull because we have to get the radiation in there somehow, but we’re not aiming at the other critical structures that could be in the way.
Melanie: Okay, is this a safe type of procedure to have?
Dr. Mandelin: Nowadays, radiation therapy is very safe. We use multiple imaging modalities including CT scans, MRIs, PET scans, to help us really focus radiation on the tumor and stay away from those critical structures like the spinal cord or normal tissues and normal organs that are in the area.
Melanie: What about skin problems, Dr. Mandelin? People are worried about the skin around the radiated area.
Dr. Mandelin: Skin can be an issue in radiation therapy if we’re treating something on the outside. The most common thing in breast cancer therapy is getting a skin reaction and we actually expect that to some degree. When we treat something deep inside the body, like the prostate and the lung, it’s uncommon to actually get a skin reaction. We have multiple medications and creams and recommendations to help make that skin reaction less and more tolerable.
Melanie: Tell us about some of the side effects that result from radiation therapy. Is fatigue – people know about chemotherapy side effects, but what are the side effects from radiation therapy?
Dr. Mandelin: The side effects from radiation therapy really depend on the area that we’re treating, or the local therapy. That’s why I like to use the flashlight analogy. Chemotherapy, as you mentioned, goes through the whole body, and that can have side effects like hair loss and nausea and vomiting and things like that. With radiation, we affect only the area we’re treating. If we’re treating in the breasts, it’s really the skin. If we’re treating in the head and neck, unfortunately, it can be pain and difficulty with swallowing or sores in the mouth and things like that. From the radiation standpoint, all of the side effects are well tolerated depending upon if you’re getting chemotherapy at the same time or the area that we’re treating.
Melanie: Now, radiation, just the word scares some people, Dr. Mandelin. Are there late side effects or external side effects that come from using radiation on somebody?
Dr. Mandelin: Long-term side effects are the things we try and avoid the most. The acute side effects like skin reaction, pain and difficulty with swallowing, or the urinary symptoms if we’re treating the prostate, typically go away about four to six weeks after radiation is completed. Again, I like to use a sunburn type of analogy; when you see that skin reaction, the same thing is happening on the inside and that can cause them irritation. Once that sunburn goes away, you can have some residual tanning and then the tan slowly fades and kind of blends in with the normal skin color, but sometimes that can take a little longer than the standard sunburn to go away.
Melanie: Now, tell us a little bit about what radiation therapy really is intended to do and give a little bit of what people can expect if they are going in for radiation therapy for breast cancer, for example.
Dr. Mandelin: Taking the breasts as an example, the way we plan radiation therapy is we do our own CT scan and that’s again we want to mark the area that we’re going to treat. We want to use all the information we can, the mammograms, the biopsy results, the pathology results, and really focus in just treating the breast tissue and exactly where they took the tumor out. There’s multiple appointments before we’re actually able to start. We do that CT scan to plan it. It goes into the computer. We can draw in the area that we want to treat and we draw in the areas that we don’t want to treat so we can avoid those with the radiation. Then there’s the setup session where again we’re kind of double checking everything to make sure everything matches from the CT scan to the computerized treatment plan to the real setup in the actual treatment room. Then usually there’s a marking process involved, too, and that can be prominent marks where we can line you up with lasers every day to make sure we’re only treating the area that we want and able to avoid those critical areas. The unfortunate thing about radiation is that we do have to give it in little pieces. If we give radiation in larger amounts, the side effects go up. We just fractionationate it, meaning that we give daily, Monday through Friday, and that can take up to four to six weeks, and depending on the area we’re treating, sometimes longer and of course sometimes less.
Melanie: Now, prostate cancer is so common, but there’s a few different types of radiation you use for prostate cancer. Explain a little bit about the external beam and then what the seed is, how that differs from something you might do for say a woman with breast cancer.
Dr. Mandelin: Right. The prostate, you can treat with surgery or you can treat with radiation therapy, and with radiation therapy, there’s the internal type which is the seeding and then there’s external beam and also proton. The seeding involves an operative procedure so it’s under ultrasound-guidance. Again, it’s all based on a CT plan. You draw in the prostate, you estimate the amount of those radioactive seeds which is a little grain of rice you’re going to need and then you implant those seeds into a prostate and afterwards you do another CT scan to see where they actually wound up. That’s basically the opposite of the flashlight analogy. Instead of having all these beams coming from the outside pointing towards the middle, you’re putting the light bulb right into the prostate and then the dose fall off for the range of that radiation is very short so you can protect both the bladder and the rectum, which are the two structures right adjacent to the prostate. External beam radiation therapy, again, is that flashlight analogy where you’re taking multiple angles and coming around the whole pelvis focusing in just on the prostate. Again, being able to release the exact dose with the computerized planning and the CT scans that we use to avoid the bladder and the rectum.
Melanie: The main goal is to spare all the surrounding tissues. Does radiation actually kill the cells, Dr. Mandelin? What happens once they’ve been radiated?
Dr. Mandelin: With radiation, that’s the goal. We want to kill the cancer cell. We want to make sure that the cancer doesn’t grow back or doesn’t spread. Again, we’re the local therapy, so when we treat with say, prostate cancer, we’re treating the whole prostate gland. We want to eradicate the tumor cells and give the least amount of radiation we can to the bladder and to the rectum, which is where we get our two main side effects after radiation therapy is done, urinary symptoms or rectal symptoms that typically go away in about four to six weeks. Then we follow with PSA or other tests to see how effective we’ve been. There’s a very good control rate for early stage prostate cancer.
Melanie: What happens to the cells once you’ve killed them?
Dr. Mandelin: Basically, when you eradicate the tumor cells, you have scar tissue left behind. Sometimes, if you were to get an imaging study, you wouldn’t see any kind of tissue left behind. If it’s a little bit of a larger tumor or something that’s more invasive, you might see some scar tissue left behind. I like to describe radiation as like doing surgery without a knife. There are some side effects. You can get scar tissue and you can get changes on imaging studies but the main goal is that you have no active tumor cells left behind.
Melanie: In just the last few minutes, Dr. Mandelin, if you would, please give us your horizon. What’s going on in the world of radiation and why people should come to City of Hope for their radiation oncology services?
Dr. Mandelin: Basically, radiation is a very technology-driven field, so our main goals are to be able to focus the radiation in exactly where we want and again, reduce the dose in all the critical structures in the area and decrease the side effects. We do that with advancing imaging techniques, advancing treatment techniques, and enrolling people on clinical trials. We have clinical trials that involve different types of radiation, different amounts of radiation, different techniques of delivering radiation and we also enroll people in clinical trials that use chemotherapy concurrently and also using different imaging studies to follow tumor and try and do early detection and screening studies.
Melanie: Thank you so much, Dr. Mandelin, for such great information. For more information on radiation oncology, you can go to cityofhope.org. That’s cityofhope.org. You’re listening to City of Hope Radio. This is Melanie Cole. Thanks so much for listening.