Targeted treatment for breast cancer through external beam radiation is offering hope for those newly diagnosed with the disease. Dr. Christine Fang, radiation oncologist at the Seattle Cancer Care Alliance, details how this important approach allows for greater precision during radiation, offers protection for the heart and great benefit for patients.
Transcript
Andrew Schorr:
Hello and welcome to Patient Power sponsored by the Seattle Cancer Care Alliance. I’m Andrew Schorr.
Each year in the United States approximately 200,000 people are diagnosed with breast cancer, mostly women of course, and a few men. And fortunately we are doing much better. Most people are cured. And when breast cancer has spread, people are being helped to live longer, fuller lives. The modalities that come into play of course are surgery, chemotherapy and targeted drug therapies and also radiation.
In this program we’ll discuss the new developments in radiation, and to help us understand them we have with us Dr. Christine Fang. She’s an expert radiation oncologist from the Seattle Cancer Care Alliance. She specializes in breast and gynecologic cancers. Dr. Fang, welcome to Patient Power.
Dr. Fang:
Thank you for having me.
Andrew Schorr:
Dr. Fang, tell us about the new developments in radiation to help people who are diagnosed with breast cancer.
Dr. Fang:
Sure. There have been many advances in radiation treatment, modern radiation actually has very little resemblance to what our grandmothers would have received. With modern radiotherapy technology we are now able to spare the healthy surrounding tissues much more than in the past. The side effects to the skin in general are significantly reduced, and the surrounding organs also receive much less radiation exposure.
Andrew Schorr:
Side effects are always something that concerns us, doctors and patients. Dr. Fang, what side effects of radiation are you most concerned about?
Dr. Fang:
Well, one of the most concerning long-term side effects from radiation is heart disease that is caused by unnecessary radiation exposure to the heart. Radiation exposure to the heart has been shown in several studies to be associated with a higher risk of developing coronary artery disease down the line, 10, 15-plus years later. As a radiation oncologist my goal is not only treat the cancer that is in the present but to protect the future of surrounding vital organs such as the heart.
Andrew Schorr:
Dr. Fang, I know this is all about precision medicine, precision radiation, having it hit the cancer cells and kill them while sparing healthy tissue. How are you doing this to limit side effects for women who go to the Seattle Cancer Care Alliance?
Dr. Fang:
What radiation oncologists have been doing for many years now is protecting the heart by having patients take a deep breath during their treatments. What this does is it expands the lungs and in doing so the heart naturally moves away from the breast and out of the radiation path. But to do this we need to ensure that the breath hold is consistent on a day-to-day basis as well as steady during each of the 30 or so treatments.
The way that we do this at the Seattle Cancer Care Alliance is actually quite unique. We are using a highly precise system called Calypso. Calypso consists of an infrared camera, actually three of them that are mounted in the ceiling, radiofrequency detectors and safe electromagnetic beacons about the size of a grain of rice. I’ve actually got one with me just to show everybody.
Andrew Schorr:
Wow. This is tiny.
Dr. Fang:
Yeah. And what we do is by placing these small transponders just on the surface, typically they would sit about right here between the breasts, it allows us to have real-time, continuous tracking so that while the radiation beam is on we can monitor the position of the patient with millimeter accuracy.
Andrew Schorr:
Let me see if I’ve got this right. You fire the radiation right where you want it to go and when you want it be there.
Dr. Fang:
Well, with the transponder it can tell us where the position of the patient is with very high accuracy, and this is really important when we’re having patients take a deep breath because by taking a deep breath the heart then moves to a certain position, and we’re designing our radiation beam to avoid the heart. By having this accuracy we can ensure that the heart stays out of the radiation beam.
Andrew Schorr:
Now, I’ve heard about this. I think it’s used for prostate cancer. Am I right?
Dr. Fang:
That’s correct. This was developed for prostate cancer, but the big difference here is that this is completely noninvasive. For prostate cancer these beacons are actually implanted into the prostate. For breast cancer we don’t need to implant these transponders. They just sit on the skin surface.
Andrew Schorr:
Dr. Fang, what stage of breast cancer is this right for? I understand you’ve used it in early-stage breast cancer, but can it be used in later-stage breast cancer as well?
Dr. Fang:
That is true. When we first developed the program we started with early-stage breast cancer. However, with our brilliant team of radiation therapists, dosimetrists and physicists, we have now expanded the program to also include some of our more advanced patients so that this new technology isn’t just limited to our early-stage patients.
Andrew Schorr:
Dr. Fang, when it comes to additional new technologies for radiation for breast cancer is there another one you’re excited about?
Dr. Fang:
Yes, there is. We have actually completed the construction of the SCCA Proton Therapy Center that’s located at our Northwest campus. We’re in the final stages of commissioning the cyclotron, and we’ll be ready to treat our first patient in March of 2013. The unique properties of proton therapy will allow us to substantially reduce radiation exposure to surrounding organs such as the heart, the lung and the opposite breast. This will particularly be beneficial in our more advanced breast cancer patients, where we have to not only treat the breast or chest wall but also the surrounding lymph nodes. It makes the radiation planning more complex. We will be opening up breast cancer clinical trials in which our patients can participate.
Andrew Schorr:
Dr. Fang, when you put it all together, how do you feel about radiation for the treatment of breast cancer now being ever more safe, more precise and with fewer side effects so people can live better?
Dr. Fang:
I think that, no matter how precise we have become over the years with all of our advances, radiation is always something that we do not want to give unless we have to. But with these advances I think that there is a lot less concern and worry about the long-term side effects. We have really come a long way but we’ll continue to do work and further research to protect our patients as best as possible.
Andrew Schorr:
Dr. Fang, it seems like these are real advances, the Calypso approach that you spoke about and also the coming use of protons.
Dr. Fang:
Yes. We are really excited about both of these technologies.
Andrew Schorr:
Dr. Christine Fang, radiation oncologist and specialist in breast and gynecologic cancers at the Seattle Cancer Care Alliance, thanks for all you do, your devotion to advancing approaches and also reducing side effects for patients. We appreciate you being with us on Patient Power.
Dr. Fang:
Thank you.
Andrew Schorr:
I’m Andrew Schorr. Thank you for being with us. And remember, knowledge can be the best medicine of all.
Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.
Published By :
Patient Power
Date :
Dec 09, 2012
