How do you initially prepare a patient for radiation oncology treatment?
Many people think that the surgeon or the medical oncologist just refers the patient for radiation; that the decision has already been made by someone else, and that we’re more or less technicians. Actually, this is changing, and now patients are referred for consultation. The surgeon or the medical oncologist might have an idea that radiation is appropriate, but we’re the ones who make the final decision. We see the patient, do a complete consultation which includes a history and physical, look at all the records, and then we consult with the surgeon and the medical oncologist to determine the total treatment plan. We then decide when the radiation treatment will occur. We talk with the patient and explain the indiCTions for radiation and why we think it’s appropriate, and then go over the actual procedure so the patient knows what to expect. It’s important for patients to know about any side effects, which can include immediate and late effects. We see very few of these late effects, but have to explain everything to the patient just in case.

The next two appointments would be for radiation planning. The first appointment is a radiation treatment CT scan, which is where we scan the part of the body we’re going to treat. The information from the CT scan is linked to our treatment planning computer, which allows us to see the images in three dimensions. Then a physicist and I will sit down and plan the treatment for that site, and we will determine how many beams need to be aimed at that part of the body. A radiation beam is similar to the beam of light that comes from a flashlight. It’s very defined and focused, and we can shape it and angle it in any direction. With the breast, for example, we usually use two beams aiming in from each side. The treatment is customized to each patient’s anatomy. The computer allows instant access to information and more flexibility to change the radiation planning. The second appointment involves mapping the computer plan onto the patient; we put tattoo markings on the patient where the radiation beams will go. The radiation therapist centers the beams on the dots marked on the patient’s skin.

Treatment can last anywhere from two to eight weeks, based on the kind of tumor and part of the body, and is usually done four to five days a week. One day each week the patient will also see the doctor so we can evaluate side effects and prescribe mediCTions if needed. We have around 80 patients a day at Cedars. We develop very close relationships with our patients because we see them so often during this treatment.

What are some of the most common misconceptions about radiation oncology? How do you dispel the myths, and what are the most important facts patients need to know?
One big misconception is that radiation therapists are the doctors. They are actually the technicians, and the doctors are now called radiation oncologists. Another misconception that occurs even among other doctors is that radiation can cause side effects outside the area of the body that’s being treated. If we irradiate the breast, the patient won’t have problems in other parts of the body. The radiation is very focused. Originally, radiation treatment would sCTter to other parts of the body, but that’s no longer an issue. Side effects only occur at the target area. It’s very different from chemotherapy, which goes through the blood stream and can cause side effects all over the body.

Another myth is that radiation causes cancer. This can be true in cases where people are exposed to long-term, concentrated radiation, like the atomic bomb survivors, or people who live near Chernobyl. A short, targeted treatment to one area of the body is very unlikely to cause cancer. Microwaves and cell phones are not a risk because these devices use non-ionizing forms of radiation. They don’t affect basic cell structure. Ionizing radiation causes an electron to be released from the outer shell of the atom to form an ion. Other forms of radiation don't do any damage.

What new developments have been made in treatment?
Intensity Modulated Radiotherapy (IMRT) allows further targeting of radiation beams. Normally, the intensity of a radiation beam is uniform throughout the treatment area. Intensity modulation means that we can now vary the intensity within the beams, making them most intense in the tumor area. This reduces side effects and gives higher doses to the tumor.

Three-dimensional conformal radiation treatment (3D CRT), using the computer and 3D CT scan images, allows us to conform the beam to the shape of the target area.

Of the specific types of cancer that you treat, are there areas where you see a lot of progress? What kinds of new technologies are being used?
We’ve seen a lot of progress in treatment planning using computer technology. We’ve also seen a lot of improvement in the treatment of all cancers in the last few years, and in prostate cancer in particular. It’s being caught much earlier now and can be cured more often.

We’re doing coronary artery radiation now, which is separate from oncology treatment. The arteries that supply the heart with blood get clogged with plaque, which can cause heart attacks. Cardiologists can go into the arteries with a CTheter and clean the plaque out, but it often builds up again within six months. Now, we are able to radiate the arteries using radioactive seeds. We give just a few minutes of radiation to the area, and it reduces the amount of plaque that forms. The treatment, called coronary artery brachytherapy, is now FDA approved and will be used more routinely in the next few months.

What is special and unique about the Cedars Sinai Comprehensive Cancer Center in your view?
We offer state-of-the-art equipment and treatment planning. Cedars also offers all of the services for the patient in one place. The social workers and pharmacists are right down the hall, which makes things easier for the patients.

By Heather Pitre