Radiation Therapy

This is Roswell. Rookie by Roswell Park Cancer Institute. Your team opinion or your total options. Your host Tim winter welcome back to runs -- on this are continuing conversation about all aspects of cancer care treatment and diagnosis. With the vast resources of --

cancer institute. A truly comprehensive cancer treatment and research facility in Buffalo, New York welcome to the program here at Roswell I'm Tim linger and today we're talking about. Radiation therapy many of us certainly have heard of -- and know about it firsthand but what is it and what are some of the latest technologies. We've got some folks here who know all of that and then some and also. Breast cancer survivor with us today to. We'll start with doctor David Manson he's assistant professor in the department of radiation medicine at Roswell park. Also the director of the press program at Roswell doctor Mattson thank you so much for taking some time to name coming on down play well. I appreciate it with you today -- Thompson's supervising. Radiation therapist at Roswell park. -- thank you for being here as well. You're welcome and Bridget Thompson came in today two time. Two time breast cancer survivor and Bridget thank you for taken some time today in look forward to hearing your story thank you very doctor Manson. I mean you know radiation chemotherapy. Surgery you know we hear those all the time thrown around with anybody that's stealing. You know with with a cancer diagnosis today we're talking about radiation therapy it's your it's certainly area of expertise what is it percent of the most.

It's no -- so well what I like to tell my patients is that radiation is a lot like sunlight. Just some higher energy particle. And radiation. Like surgery is is a formal local therapy where we can actually directive being too specific come. Point in in a patient's body. Including the tumor itself. And to kill it off. Is it still. What are you know I mentioned eighth a throughout the three you know radiation chemotherapy surgery is it's still one of the the most popular for lack of a better word treatment options for where many cancers. So actually every cancers just a little bit different. Some cancers. Are treated primarily with surgery. Others with chemotherapy. And and radiation. You know in some cases. Looking at all. Cancer patients throughout our country about two thirds are better. Visitor radiation oncologists sometime during the course of their treatment. A lot of times in irradiation can be combined with surgery. Combined with chemotherapy as well. It's. To treat the patient has cancer and it's changed incredibly bright and mean from. You know the word go radiation it seems every time I look you know as I look through the notes today. You know I understood one thing -- and -- it it just seems like you're continually are earn a state of development as -- first technology is concerned. No absolutely. In in my generation I gave. Trained using you know all of all the great new technologies that we have to -- radiation better including the CT scan. Which gives us a really. A really good and accurate look at the patient's anatomy and allows us to use computer beasts treatment. Planning approaches to really cheap deals around. The cancer in the areas that we want -- at the same time. Reducing in limiting those two two structures that that we don't wanna include. Or. Did to give too much -- to play hard and alarms are an important sort of thing. -- when he said in our generation do you think he was saying he's younger than you and me.

I ask I'm still very active like at that same feeling all right I think that's that I am here and I know you've been doing. You're young too but you've been doing radiation before we we started today you mentioned. You know back to a 1981 I'm sure you've seen incredible should come out to change.

I'm there are an incredible changes on we have a mobilization devices. That are used to. For the patient to get in the same position every day that really expedite their time in the treatment room or in the department. We have pumped lasers that are on the low intensity lasers says. Are mounted on it strategically in the treatment rooms and help patients. Also get in the same position and straight every day to therapists can. Minimize the time that they have to spend hesitation because of -- on new updated tools. I won't tell you when I started but in my days in mobilization was maybe some silk tape. And that was about it and now we spend thousands and thousands of dollars on these devices and when new ones come out. We have. Really nice budget director pedal doesn't limit us to. Chinese new on devices out and should we as a team approach like come and like what they do. We are able to purchase them quickly.

Folks probably not a good place to budget right you want me. You've got the best and that in the greatest and I'm I'm sure bridges have been here that this is you know it's not a budgetary. But he Roswell does have the latest in and the greatest of all that you were here about some of these different. Hi tech radiation type devices but I think it's important to point out that really the best of the best is available on this campus we do.

And end the vendors that are are approaching us with new. New ideas and and new fabrications of something they've tweaked a little listen that. We've. Bring a -- that came together we look at numb and I'm certainly. To get the latest in the best for the best outcomes.

Now on a daily basis here he is he your position you're dealing with the patient first hand right now Kyra we're dealing with patients. And in radiation and every patient is different right I mean their their treatment is different there there dosage practiced as -- and put it.

Rounds yes everything. Is customized to their patient. We set those devices there are a lot of who are movable. Arms so I'm heights adjustments that we can make on these devices which you'll allow undocumented and that -- symmetry changed to. -- to develop the best plan treatment plan for that patient according to their anatomy.

I wanna get to that process and -- kind of you've you've given me the flow you know we'll talk to a doctor Manson about you know coming up with a plan with the -- symmetry dream. -- and how it's actually implemented -- from your standpoint but first I wanna. Move on to Bridget Thomson two times you have have come through this process and successfully Sosa congratulations saying I don't to that. Tell me -- a little bit about your story you know how you were diagnosed and how you came to Roswell park.

I'm I was diagnosed originally was diagnosed in 2004 cell I've been appease Iran's loss since nine cents on that's what seven years. On the in and this last diagnose diagnosis that I received a wise mom. Her two positive tumor in the left breast which was my reconstructive breast a little unheard on -- we caught it early. And -- went to room. Four and half months of chemotherapy eon has some time off and we started radiation therapy. Sally -- a half weeks daily. On in on and it's my experience has been amazing on the radiation therapy was done with such precision. That my skin integrity was just incredible. On my hand you know some some common side effects -- the burning and 19 on some tenderness. But it it was amazing it was really amazing I was so we're fortunate to not see a whole lot of change with and a.

And then that was the first. Treatment and you view had a recurrence.

Now that that was most recent agreement is onlookers team that was in 2004 and a sister common DCI asked that the carcinoma ensign to end the milk ducts in my left for us. And we caught it early but it -- and you know we had to go for the mastectomy with reconstruction just because it was. We were trying to get clear marginal tissue and -- even know wasn't completely invasive it was just enough to where there isn't a question my doctors are really. Proactive you know -- intent to take care ability of future re occurrence on bill you know there's none for seeing things to happen mom. And some unsolved. Questions but we've we've really tackled and I think aggressively. However the first time was reconstruction without any therapies outdoors so we didn't do any treatment plans. Com this second time that I found and it is actually. I Connecticut and a hug from my husband he has a tendency and can around in London -- pop on the back and -- clocking in just the right way. And it balloons on the area on the left France to spend to immediately swallowed up sell. On the I immediately contacted Roswell and the yourself proactive in trying to figure out you know -- you know what it was I was dealing -- And then we were able to determine his or her to constant humor it's amazing how of the you know yeah it's very fortunate that her husband and this guy now it's.

You know you know you said that Roswell you -- your doctors were very proactive obviously you -- to -- thrown around the terminology here is so you know at work here and you've been through an -- after you've done your research -- yeah. He really did some you know some hard thinking about. Coming here and why you chose here.

Yeah I was. I was and aim and it fusion likes to have answers sailing to understand things so. It helps for me to remove that fear of the unknown. On the by doing research going reliable sources -- and -- not usually there -- sources that are from medical institutions. Or medical resources. And I tried to read up as much as I could just to prepare myself mentally and emotionally for awhile it was coming. And time and so I didn't have -- you know doubts on the I think along with 36 that I found it and especially the radiation. Fear of these the the rate of effectiveness for that. Along with the dialogue I had with my doctors. Really helped to -- prepare me for awhile as the hand.

Well it's a great story in I'm I'm happy took some time to come in here today because you probably have been here enough that you don't wanna compare.

Yeah China and the pink -- and is likely to be your for a long time.

This is a good a good visit when you can commandN and interiors story and and and help educate one kind of walk through the process of where this all begins and I guess doctor -- and begins. With you and we'll just move right on down to you know where it ends up with the patient and what that experience. May have been like for Bridget. Doctor Manson when someone is. You know diagnosed and radiation is an option how old is that radiation therapy plan constructed.

or so -- so after after -- meet with the patient and consoles and determine that there is you know really an indication for recommending radiation. The next step is to begin treatment. Or begin treatment planning with the CT scan. So I set up an appointment for them to. To have a CT scan done we ever -- scanner and our apartment and Galen and therapy staff actually. Guide the patient through that process. Once the CT scan is complete. We take. That image said it and send it over -- computer system where we've got -- actress who I work with. In order to to generate a treatment plan that that accomplishes two. Two main goals one is to deliver. Treatments or deliver the radiation dose that I want to get -- the target. And the other thing is that I wanna make sure that ghosts to sensitive structures like hard for loan. -- spinal cord and so forth are limited. To basically as low as possible but definitely. Within within. You're below safe limit. Once once that's done. Who physicist who comment and review the plan check it. And actually for for my patients they actually. Run the plan on offense -- to mrs. Certainly command again but made of tissue equivalent material replace. Detectors. With in the Manning can hand placement treatment table and deliver the treatment. And after the treatments delivered were able to you know. By those those radiation detectors how much Dole's got to that point in the body and verify. That. The treatment planning and calculations and everything are correct. Once that's done and and that entire process takes. About a week or so. To complete. And after that -- we bring our patient back the first day. It is Spence. Setting them up on the treatment table in the exact same position that they were placed. In the CT scanner for the this CD simulations Stan and once that's done. We bring back the next day in and actually start to treatments. For breast cancer it's about 33 treatments. And how long does that take -- we'll hear about it from Bridget I'm sure you know how long is each of those 33. So there's there's two ways to look at it one is the actual beam on time. And depending on how many -- were treating you can vary from anywhere from a couple of minutes to as much as five to eight minutes. The actual time that patients -- department though which is important for planning their day closer to what happened now resorting to war.

Okay that's amazing moved to -- right now focused skill is there and paying -- You know I know you are two veteran thinks tennis and -- Gail is that you know dealing -- that you know getting the patient all set to go and then there for the actual and you know administration. What is that like I mean you're dealing with people that are are going through an awful lot and you got a very complex plan. You know coming from over here and you gotta get that right.

Well. With our training and and updated. Southerners that we go to the national seminars. We learn how to do this on for efficiently and sure that was our staff. We explained we we find that on the more explanation you can get to the patient what I'm going to do and this is what I'm gonna do next. We're gonna do a cat scan the tables going to be moving your going to be holding still you're gonna hold your breath you're not gonna hold your breath. The more instructions and education we can. Share with the patient at the time the more relaxed and and uncooperative. And easier they can. Get through that simulation and the treatment. So we do a lot of explaining we have. Teams that we work quiz. We never work alone and surface we find that two guys are good but for six -- are much better. So we work in teams and everybody is hands on eyes on. And work together to maintain the same treatment status every day the tables and the same position that patients in the same position. And the beam goes done correctly.

Erin and Bridget you know I'm sure after dozens of these you've you know you understand. And in do what to expect obviously but do you know -- walked back to me that first time when you went in and and had radiation and what their processes like.

of the first time you really -- money that you're pizzas but. I careful yeah -- time I I went through all my initial console where I went like doctor Manson's is you we go through the process and in India where we can only where you'll be rehashed the week before you go and Allen and this first day of my actual radiation treatment I ended up sitting in the lobby waiting for them to come get me think that's not really the drill. So even now I knew though. I just had it is absent minded moment our eyes and staying there at the front talking away wondering when I was next -- and they all came and looking for me laughing because we -- on I was ready to go all the day before and then today I was like. A wall guns. There anyway but it typically you just you know I would go and and changed my clothes didn't and a gallon in England in my waiting area but. Cell in the and we would go banking and.

The actual. I wanna say the actual treatment was meaning not even ten minutes. It was you know it was that there -- such precision and they will go through my measurements making sure I was. Blame properly and that the measurements are exact and we go through the treatment and it was painless which is important -- to note on. And afterward and and you know be done and good teams close in I was on my wing it was really an inefficient process and on -- Columns to explain ahead on. And then. There is the -- patience that I. The other patients as when they were. You know I have to say they're experiencing. Com probably the same everybody was so friendly and such a good mood from the time we got scared to timely locked on. I made friends outside about cell you know there's no complaining no no no negative. Reactions to the treatment that that I heard than I did talk a lot within the patients.

It's great doctor Manson and you know let's use the word precision has been product here a couple of times most recently by Bridget. You know and I know there are some incredibly complex and different tools that you have at your disposal. You know the gamma knife trilogy. Whole bunch of different things. And I guess we can't explain them in intricacies because we won't understand them but you talk about some of those new technologies how important they are and how precisely --

So he. There's there's a lot of different. You know. Treatment equipment that we have to work with and in the gamma knife for instance is his a large large. Dedicated. Machine that that actually is able to to pinpoint -- Sub millimeter accuracy. Tumors with. Primarily used within the brain because there's so many. Important structures -- that that we really don't want overdose that. The precision of the gamma knife. Really allows us to to to treat what we need to treat while avoiding you know structure is very in very very close proximity. But there are a lot of other other. Forms of of targeting and globalizing. And improving the precision of work. Our treatment that that we have our disposal for deferred general use like. -- the the trilogy machine has some. Actual onboard imaging which allows us to. -- capture images. In real time and actually see you or visualize. The target for instance -- prostate. -- were able to. Police he's within the prostate and and see the seeds. So that were able unimpeded date basis. Confirm. And verify that that the target is actually. You know exactly within a field of.

Treat the image guided technology is important now does that mean that something -- you know when when you started. We didn't have that means someone someone received radiation therapy and then perhaps went there to. Some sort of a diagnostic tool to find out what happened rate that's correct and now we're doing it all the same time in some cases we do we do have the image guidance is right on the treatment table.

The patient is. Setup for daily treatment. And images so.

And that cone -- are taken. Right at the time up.

Pre treatment. I'm verified to ships are made usually within a couple millimeters. Good table is shifted to. To align the patient exactly the way it was on the computer plan and on the -- CT scan from day one. And treatment begins on that takes three minutes perhaps. To five minutes before each treatment and we often image guide. A lot of patients must -- for patients -- image guided daily.

What kind of safety. Concerns we have I mean radiation is is is not our our friend in general you know livelihood right it's obviously her friend when we're trying to beat cancer. So there there must be some pretty serious safety concerns and any guidelines that he need to follow. Sure yes so there's some. -- you're absolutely right. Radiation is is something that places there's been a stigma -- for you know for decades some. Permanently because it's it's hard to to really understand.

And even before. A a you know began training in radiation oncology. I didn't have nearly. Comfortable grasp on. On what radiation is how to contain that and you know it's it's valuable uses. But Tom you know for those reasons. To radiation community both found in diagnostic radiology and radiation oncology have always. Been proactive about. Optimizing safety. Procedures that that we go through. It's two to really minimize the chance of any kind of errors or -- in this administration's. Occurring very. You may have seen in the there recent strike a series of articles that have been published in New York Times photo radiation this administration. And -- You know when when they first broke who we. -- were surprised. Com but we took it very very seriously that there's a lot of responses throughout. Radiation community to to address it's. To -- To get the word out that that it is something that. That's we we take very seriously and something that some we we wanted to address aggressively one of the things that we get Russell. Was. We we already articles and we. Performed in an internal. Review of our safety procedures. And after comparing what we -- to the article on how. In this administration's played out. What we realized was that they would never have happened -- The safety checks that we have in place including. Reviewing the plan like I talked about what to physicist. And running those more complicated plans like come. Press plan with the electronic compensation and I Marti which is a more complex plan using not just two fields but. You know many fields of mine are more. They're actually run an offense. So those checks would of identify those plans is being inaccurate and would we wouldn't even use them. Tom in addition to that you know national societies over the -- American society for radiation oncology. As well as the American college of radiation oncology and the American College of Radiology a lot of a lot of big national societies have done things like come organizing. Conference is dedicated to identifying. Areas it can be improved with regard to the safety of radiation delivery. There's also. Accreditation that. Departments can. Apply through the American College of Radiology. And the American college of radiation oncology. Who you know who actually come to the department. Audit of what we to look at everything from the patient's physical charts for treatment plans and not only make. Make suggestions on how we can improve things if there is any room for improvement but also providing accreditation and and our department is accredited by the American College of Radiology and American college of radiation on.

how much of this did you. Really understand before you started undergo this and this is pretty complex radiation therapy and understanding all the different. Nuances you know external internal and you know these different these technologies are -- how much of that did you understand.

Little -- actually I mean I just I name. I think based on my initial introduction to radiation. I went online and and looked up I looked up terms and intend to understand a little bit more -- and -- all the different types of radiation. Then -- are used today on the cell. I I have a little little grounds on the you know identifying our understanding what it -- deal with the -- are and what things mean. Com and it's really just by asking questions and talking to my my staff the staff -- Mom sell I have to say. You know I think my concern was just being as informed as possible and understanding really what the rate of effectiveness was for radiation on the type of tumor I had.

Com. Being -- we've you know doctor Manson has pointed out you know the gamma knife and trilogy and made the external internal all of the different things how do you is is. A therapist keep up with all that I mean it's it's a lot of moving parts and moving technology the need to understand.

Well Russell isn't. Educational facility and that includes our department we have. I'm rotating residents we have a resident program we have until symmetry program within our department we have a therapy program within our department. And there's a lot of education. On a daily basis it's it's an unending. And in. Posting those programs in our department we. Our world heard a bit and work questions arise it's not just within one disciplined. The dose and matures you'll often confer with. Therapists and therapists with physics and is a collaboration of perfection and everybody comes --

cheese thank you all for being here appreciate your time today in education indeed. Just a little sliver of the information that's that's in the room today thank you appreciate it thank you -- Doctor David -- assistant professor department of radiation medicine also -- director of the breast program at Roswell park. -- Thompson with us today supervising the radiation therapist at Roswell park. And Bridget Thompson two time breast cancer survivor. Explaining what she has gone through successfully and how the radiation program. Impacts the patient and patient's life. That is Roswell -- if you'd like to hear the program in its entirety if you missed part of it or he'd like to find out more information you can do so. And the great Roswell website and that's Roswell park. --

Listen to Roswell this Sunday mornings at 630 young WB -- by Roswell Park Cancer Institute your team opinion for your total options online at Roswell this god of war.

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