About half of all cancer patients receive some type of radiation therapy during the course of their treatment. Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells.
In this segment, Dr. Pamela Randolph-Jackson, Chair of the Department of Radiation at MedStar Washington Hospital Center, discusses advances in radiation oncology treatments
and the types of cancer treated with the Edge system.
Selected Podcast
Treating Cancer With The Edge System
Featured Speaker:
Learn more about Pamela D. Randolph-Jackson, MD
Pamela D. Randolph-Jackson, MD
Pamela D. Randolph-Jackson, MD, is chair of the Department of Radiation, MedStar Washington Hospital Center. Her research focuses on radiation oncology, especially for use in treating breast, lung and gastrointestinal malignancies. She specifically is interested in treatments using positron emission tomography/computed tomography (PET/CT); magnetic resonance imaging (MRI)/CT fusion; three-dimensional conformal radiation therapy; and intensity-modulated radiation therapy (IMRT) for breast, rectal, uterine, prostate and lung cancer.Learn more about Pamela D. Randolph-Jackson, MD
Transcription:
Treating Cancer With The Edge System
Melanie Cole (Host): About half of all cancer patients receive some type of radiation therapy during the course of their treatment. Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. My guest today, is Dr. Pamela Randolph-Jackson. She’s the Chair of the Department of Radiation at MedStar Washington Hospital Center. Welcome to the show, Dr. Randolph-Jackson. Tell us about some of the latest advances in Radiation Oncology treatments going on today.
Dr. Pamela Randolph-Jackson (Guest): Well, thank you for having me. I’m glad to be here. I would say that the latest and the greatest is Stereotactic Radiation Therapy. We call it either Stereotactic Radio Surgery or Stereotactic Body Radiation Therapy. The reason why it’s such a great modality is that it’s a quick source of treatment. Usually, patients are here for six to seven weeks with conventional radiation therapy when you use IMRT or 3D Conformal Therapy, but with the Stereotactic Radio Surgery, you can be in the radiation oncology department anywhere from one to five days.
Melanie: And what about minimizing dose exposure to the surrounding healthy tissue? Is this something that’s taken care of very well with Stereotactic Radiation?
Dr. Randolph-Jackson: That is definitely one of the pluses of this form of treatment. It’s a fast treatment; it’s accurate. The precision is within millimeters – we call it submillimeter accuracy. You do minimize any radiation dose to normal tissue.
Melanie: Is this a little bit more intense than past radiation? Are there less treatments administered?
Dr. Randolph-Jackson: There are less treatments, but the great thing about the Edge, which is the modality that we use here, is that – when you think about radiation therapy, we call it a biological dose. Although you’re giving fewer treatments, the dose per treatment is higher than you would be giving if you were treating the person over the six to seven weeks’ time period. Biologically, it’s equivalent to the same dose.
Melanie: And what are some of the types of cancers that can be treated with the Edge?
Dr. Randolph-Jackson: Almost anything. Mainly, if you’re going to treat Stereotactic Radiosurgery, that pertains the head or the brain. We can treat all benign entities like acoustic neuromas. You can treat metastatic lesions involving the brain. You can treat prostate cancers, pancreatic cancers, liver metastasis from any cancer – spine metastasis from pretty much any cancer.
Melanie: What about some of the advantages of treating tumors with the Edge versus some other radiation treatments? Is it more comfortable for the patient, real-time imaging? Explain some of the advantages.
Dr. Randolph-Jackson: The main advantages, I would say, are just as you pointed out. We have the accuracy and precision, also the speed. This machine has the highest dose rate of any machine that is in the industry. It’s 2,400 MUs per minute. Just the dose rate by itself means that the radiation dose is given quickly, which means the patient is in a position for less of a time period, and the probability of that patient moving is less as well. The main advantage is the time spent on the machine and the time spent in the Radiation Oncology Department. The patient can get on with other things – if it’s chemo or other things such as that, it just makes it a lot easier.
Melanie: How long, approximately, generally, is a patient under this type of radiation?
Dr. Randolph-Jackson: Ten to fifteen minutes. You can actually fit it within a regular treatment timeslot.
Melanie: What about the cost-effectiveness of the Edge and the Stereotactic Radiation? Is this better than what we’ve seen in the past?
Dr. Randolph-Jackson: It’s actually cheaper because radiation therapy is billed by the number of treatments delivered. Because you’re delivering fewer treatments, it’s actually a cheaper treatment than say a 30 to 40-session course of radiation therapy.
Melanie: And speak about motion management capabilities. For example, if you’re treating a tumor for lung cancer, and the lung is a moving organ – constantly moving. Does this help with that?
Dr. Randolph-Jackson: It does. We do something called respiratory gating, which gates where the lung is. That, with the administration of fiducial, when needed, which is a marker that the Radiology Department puts in the tumor itself. It’s easy enough to track the tumor, and because of the speed of which the radiation is delivered, you really can’t breathe as fast as the radiation is being delivered. The fact that the machine tracks your movement, your respiratory movement, and the speed of the machine, it adds to the accuracy and decreases the time on the machine.
Melanie: Dr. Randolph-Jackson, people have heard Gamma Knife and Cyber Knife treatments. What’s the difference between the Edge, Gamma, and Cyber?
Dr. Randolph-Jackson: Well, the difference in terms of Gamma Knife, is that Gamma Knife can only treat any malignancy in the head or benign entity in the head. You can’t treat the body – anything in the body -- nothing in the liver, the lung, or the pancreas with the Gamma Knife. That’s one thing.
The difference in Cyber Knife is that the Edge treats it quicker. In other words, we don’t have to place fiducials in everybody part that we want to treat. The planning is quicker, and the treatment course is quicker. Cyber Knife takes longer treatment times and usually, it’s based on fiducial placement.
Melanie: Going back to the Edge, how is the procedure performed? What can the patient expect from their day?
Dr. Randolph-Jackson: It’s very easy for a patient. They come in for simulation, which is how we plan a patient for any type of radiation therapy. We use immobilization devices because, as you know, it adds to our accuracy if the person is not moving. If we’re treating a head and neck tumor, then a mask is made just for that patient, which keeps them from moving from side to side. The planning space is CT-based. We plan on our CT scan that we get that day. If we need more information, then we will fuse other studies like an MRI. The planning is done, the patient comes back, and they receive their treatment.
Melanie: And is there any reason to look back to SBRT or Gamma at this point, now? Not Gamma necessarily, but Cyber, as well, is there any reason to look back to those for some people who may not be candidates for the Edge system?
Dr. Randolph-Jackson: I think that when you look at all three modalities if you think about head – anything in the head like acoustic neuromas, trigeminal neuralgia, brain metastases -- I think that all three treats with the same accuracy and outcome. When you look at body treatments, so Stereotactic Body Radiation Therapy, Cyber Knife and the Edge treat with the same outcomes. However, the Edge is faster in the delivery of the treatment and more comfortable for the patient than Cyber Knife would be.
Melanie: Is there any difference after these treatments have been administered?
Dr. Randolph-Jackson: No.
Melanie: So radiation is radiation?
Dr. Randolph-Jackson: Radiation is radiation.
Melanie: What might they feel as side-effects?
Dr. Randolph-Jackson: They really shouldn’t feel anything at all. If you’re treating anything in the head, you can have swelling from radiation. That’s one of the side-effects from any form of radiation. Usually, we put these patients on steroids, which stops that from happening or prevents that from happening. They won’t have headaches or blurred vision or anything of that sort. You can have a flair from the treatment of the spine after radiation therapy – a flair in your pain. Steroids have a tendency from preventing that from happening as well. Everything can be pre-medicated, such that the side-effects are very inconsequential.
Melanie: Wrap it up for us, with your best advice and what questions you would like patients to ask about these forms of radiation therapy and what you tell them every day?
Dr. Randolph-Jackson: What I would say is that radiation therapy may not be for your particular cancer. It’s very specific, and there are specific size criteria needed to be treated using radiosurgery. However, I think that if you go to a Radiation Oncologist or you’re seen in an office of a Radiation Oncologist, you should ask the question whether or not you may be a candidate for radiosurgery versus traditional radiation therapy.
Melanie: Thank you, so much, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much for listening.
Treating Cancer With The Edge System
Melanie Cole (Host): About half of all cancer patients receive some type of radiation therapy during the course of their treatment. Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. My guest today, is Dr. Pamela Randolph-Jackson. She’s the Chair of the Department of Radiation at MedStar Washington Hospital Center. Welcome to the show, Dr. Randolph-Jackson. Tell us about some of the latest advances in Radiation Oncology treatments going on today.
Dr. Pamela Randolph-Jackson (Guest): Well, thank you for having me. I’m glad to be here. I would say that the latest and the greatest is Stereotactic Radiation Therapy. We call it either Stereotactic Radio Surgery or Stereotactic Body Radiation Therapy. The reason why it’s such a great modality is that it’s a quick source of treatment. Usually, patients are here for six to seven weeks with conventional radiation therapy when you use IMRT or 3D Conformal Therapy, but with the Stereotactic Radio Surgery, you can be in the radiation oncology department anywhere from one to five days.
Melanie: And what about minimizing dose exposure to the surrounding healthy tissue? Is this something that’s taken care of very well with Stereotactic Radiation?
Dr. Randolph-Jackson: That is definitely one of the pluses of this form of treatment. It’s a fast treatment; it’s accurate. The precision is within millimeters – we call it submillimeter accuracy. You do minimize any radiation dose to normal tissue.
Melanie: Is this a little bit more intense than past radiation? Are there less treatments administered?
Dr. Randolph-Jackson: There are less treatments, but the great thing about the Edge, which is the modality that we use here, is that – when you think about radiation therapy, we call it a biological dose. Although you’re giving fewer treatments, the dose per treatment is higher than you would be giving if you were treating the person over the six to seven weeks’ time period. Biologically, it’s equivalent to the same dose.
Melanie: And what are some of the types of cancers that can be treated with the Edge?
Dr. Randolph-Jackson: Almost anything. Mainly, if you’re going to treat Stereotactic Radiosurgery, that pertains the head or the brain. We can treat all benign entities like acoustic neuromas. You can treat metastatic lesions involving the brain. You can treat prostate cancers, pancreatic cancers, liver metastasis from any cancer – spine metastasis from pretty much any cancer.
Melanie: What about some of the advantages of treating tumors with the Edge versus some other radiation treatments? Is it more comfortable for the patient, real-time imaging? Explain some of the advantages.
Dr. Randolph-Jackson: The main advantages, I would say, are just as you pointed out. We have the accuracy and precision, also the speed. This machine has the highest dose rate of any machine that is in the industry. It’s 2,400 MUs per minute. Just the dose rate by itself means that the radiation dose is given quickly, which means the patient is in a position for less of a time period, and the probability of that patient moving is less as well. The main advantage is the time spent on the machine and the time spent in the Radiation Oncology Department. The patient can get on with other things – if it’s chemo or other things such as that, it just makes it a lot easier.
Melanie: How long, approximately, generally, is a patient under this type of radiation?
Dr. Randolph-Jackson: Ten to fifteen minutes. You can actually fit it within a regular treatment timeslot.
Melanie: What about the cost-effectiveness of the Edge and the Stereotactic Radiation? Is this better than what we’ve seen in the past?
Dr. Randolph-Jackson: It’s actually cheaper because radiation therapy is billed by the number of treatments delivered. Because you’re delivering fewer treatments, it’s actually a cheaper treatment than say a 30 to 40-session course of radiation therapy.
Melanie: And speak about motion management capabilities. For example, if you’re treating a tumor for lung cancer, and the lung is a moving organ – constantly moving. Does this help with that?
Dr. Randolph-Jackson: It does. We do something called respiratory gating, which gates where the lung is. That, with the administration of fiducial, when needed, which is a marker that the Radiology Department puts in the tumor itself. It’s easy enough to track the tumor, and because of the speed of which the radiation is delivered, you really can’t breathe as fast as the radiation is being delivered. The fact that the machine tracks your movement, your respiratory movement, and the speed of the machine, it adds to the accuracy and decreases the time on the machine.
Melanie: Dr. Randolph-Jackson, people have heard Gamma Knife and Cyber Knife treatments. What’s the difference between the Edge, Gamma, and Cyber?
Dr. Randolph-Jackson: Well, the difference in terms of Gamma Knife, is that Gamma Knife can only treat any malignancy in the head or benign entity in the head. You can’t treat the body – anything in the body -- nothing in the liver, the lung, or the pancreas with the Gamma Knife. That’s one thing.
The difference in Cyber Knife is that the Edge treats it quicker. In other words, we don’t have to place fiducials in everybody part that we want to treat. The planning is quicker, and the treatment course is quicker. Cyber Knife takes longer treatment times and usually, it’s based on fiducial placement.
Melanie: Going back to the Edge, how is the procedure performed? What can the patient expect from their day?
Dr. Randolph-Jackson: It’s very easy for a patient. They come in for simulation, which is how we plan a patient for any type of radiation therapy. We use immobilization devices because, as you know, it adds to our accuracy if the person is not moving. If we’re treating a head and neck tumor, then a mask is made just for that patient, which keeps them from moving from side to side. The planning space is CT-based. We plan on our CT scan that we get that day. If we need more information, then we will fuse other studies like an MRI. The planning is done, the patient comes back, and they receive their treatment.
Melanie: And is there any reason to look back to SBRT or Gamma at this point, now? Not Gamma necessarily, but Cyber, as well, is there any reason to look back to those for some people who may not be candidates for the Edge system?
Dr. Randolph-Jackson: I think that when you look at all three modalities if you think about head – anything in the head like acoustic neuromas, trigeminal neuralgia, brain metastases -- I think that all three treats with the same accuracy and outcome. When you look at body treatments, so Stereotactic Body Radiation Therapy, Cyber Knife and the Edge treat with the same outcomes. However, the Edge is faster in the delivery of the treatment and more comfortable for the patient than Cyber Knife would be.
Melanie: Is there any difference after these treatments have been administered?
Dr. Randolph-Jackson: No.
Melanie: So radiation is radiation?
Dr. Randolph-Jackson: Radiation is radiation.
Melanie: What might they feel as side-effects?
Dr. Randolph-Jackson: They really shouldn’t feel anything at all. If you’re treating anything in the head, you can have swelling from radiation. That’s one of the side-effects from any form of radiation. Usually, we put these patients on steroids, which stops that from happening or prevents that from happening. They won’t have headaches or blurred vision or anything of that sort. You can have a flair from the treatment of the spine after radiation therapy – a flair in your pain. Steroids have a tendency from preventing that from happening as well. Everything can be pre-medicated, such that the side-effects are very inconsequential.
Melanie: Wrap it up for us, with your best advice and what questions you would like patients to ask about these forms of radiation therapy and what you tell them every day?
Dr. Randolph-Jackson: What I would say is that radiation therapy may not be for your particular cancer. It’s very specific, and there are specific size criteria needed to be treated using radiosurgery. However, I think that if you go to a Radiation Oncologist or you’re seen in an office of a Radiation Oncologist, you should ask the question whether or not you may be a candidate for radiosurgery versus traditional radiation therapy.
Melanie: Thank you, so much, for being with us today. You’re listening to Medical Intel with MedStar Washington Hospital Center. For more information, you can go to MedStarWashington.org, that’s MedStarWashington.org. This is Melanie Cole. Thanks, so much for listening.