Radiosurgery Program at the MemorialCare Cancer Institute at Saddleback Medical Center

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. Our guest today is Dr. Linda Chan, Medical Director of Radiation Oncology at the MemorialCare Cancer Institute at Saddleback Medical Center. Among other things, we'll be talking about the benefits of the radio surgery program at Saddleback and who might be a good candidate for radio surgery. Welcome, Dr. Chan.

Linda Chan, MD: Thank you so much for having me.

Deborah Howell (Host): What a pleasure. Can you tell me in a nutshell what is radiosurgery?

Linda Chan, MD: Radiosurgery, despite the name, is actually not a type of surgery at all. It's basically a non-invasive treatment to target cancer cells with a high dose of radiation. So in other words, it's not a surgical procedure. It does not require incision or anesthesia. It is basically a combination of multiple tiny, invisible, painless radiation beams that all converge right at the tumor site, so that we can kill the tumor safely and not invasively.

Deborah Howell (Host): Well what's not to love about that? And for which types of cancer is radiosurgery a good treatment option?

Linda Chan, MD: Well, we can actually use it for almost every type of cancer now. It first was invented, oh goodness, more than fifty years ago for treatment of brain tumors and spine tumors. But since then we've expanded the treatment regimen to include lung cancer, gastrointestinal cancer such as pancreatic tumors or liver tumors. There's also a robust body of literature now for treating prostate cancer for radiosurgery and in fact I do have an open clinical trial at Saddleback and Royal to treat prostate cancer.

Deborah Howell (Host): Incredible. So what can a patient expect during a radiosurgery treatment?

Linda Chan, MD: Well it's actually much easier and simpler than what they might imagine, especially for treatment in the body. So for instance if we're treating a patient with lung cancer or prostate cancer, then that patient simply walks in, lies down on a table, they don't feel anything, no one's touching them, there's nothing invasive at all. And this machine moves around the patient, sometimes gets a little bit close to the patient, but never touches the patient. And it delivers this invisible but incredibly precise focused beam of energy, almost like a laser beam that goes directly into the body and treats the cancer. It usually takes between five minutes, maybe as long as thirty minutes, but most of my patients tell me they can't feel anything. Some people even take a nap because they say it's so boring and so easy that they don't feel anything at all.

Deborah Howell (Host): Sure, who wouldn't? Well, that's pretty much incredible and a little bit futuristic.

Linda Chan, MD: Mm-hmm. I mean I think one other term that radiosurgery folks such as myself use is something called SABR. It's an acronym. It's S A B R. But I like to laugh that it’s akin to a lightsaber that one might imagine from Star Wars, the movie. Because it's very similar in concept. It's basically again this very focused beam of energy that delivers very high power directly to the enemy, which in this case is not Darth Vader like the movie, but a cancer cell.

Deborah Howell (Host): Wow. Okay, so I'm sure it's not all fun and games for the patient. Are there some common side effects associated with radiosurgery?

Linda Chan, MD: Yes, there are still unfortunately some toxicities associated with radiosurgery. The most common side effects are actually feeling tired after the treatment. Usually the tiredness, the fatigue, only lasts maybe a week, maybe up to a month or so after. But there are some risk of side effects based on the location of the tumor that we might be treating. So for instance, if I were treating a gentleman with prostate cancer, there is a small risk of collateral damage to the normal tissue surrounding the target. In this case, if we were treating the prostate, the normal tissues around the prostate might be the gentleman's bladder or rectum. So there might be some side effects such as increased frequency of urination or some loose stool or diarrhea. But by and large, the benefit of the radiosurgery option is that there is a lot less collateral damage to the normal tissue around it. It's a lot safer, it's a lot more precise, there's a lot less opportunity for us to actually damage the normal tissue. So I have some patients that actually don't believe me when I tell them the machine was on because they tell me they don't have any side effects afterwards.

Deborah Howell (Host): Wow, we've come a long way, have we not?

Linda Chan, MD: We have.

Deborah Howell (Host): So you talked about some of the benefits of radiosurgery. Are there others?

Linda Chan, MD: There are. So traditional radiation is a small baby dose of radiation spread out over many days and many weeks. So for instance, again, going back to a patient with prostate cancer, traditional radiation is actually about a five-minute daily dose of radiation, but spread out over 44 days. That means the patient is traveling to a radiation oncology center for nine weeks in total, Monday through Friday, like a job. So that obviously can be very onerous to a patient. It's a big impact on their quality of life. It can impact their work schedule or their ability to do other normal activities. But with radiosurgery, the benefit is that we can deliver the treatment sometimes as short as one day and usually the longest course is five days. So treatment of a brain tumor, which before might have been a six-week daily radiation Monday through Friday, is now done in a single day. Treatment for that prostate cancer is just five days. So it's a lot easier, a lot safer, and honestly a lot more convenient for the patient as well.

Deborah Howell (Host): That is just unbelievable.

Linda Chan, MD: Mm-hmm.

Deborah Howell (Host): So how does the radiosurgery program at the MemorialCare Cancer Institute at Saddleback Medical Center differ from maybe some other radiosurgery programs?

Linda Chan, MD: Well, I'm proud to say that we have the latest version of a system called Exact Track. And as the name might imply, it actually tracks the movement very precisely, exactly, as they might say, the movement of the tumor within the patient. So if I might give another example. Let's say we're treating a patient, unfortunately, with lung cancer. Now the tumor is moving continually because the patient is breathing. So that tumor is moving within the normal lung. So every time the patient inhales, exhales, then that means the lung is expanding and deflating and everything inside of it, including the tumor, is moving. Now traditional radiation just gives this broad swath of radiation that covers the entire pathway of movement. So if that tumor is wiggling up and down a few inches, then you know what? We're treating that entire pathway, those inches, with traditional radiation. But with our radiosurgery program we have Exact Track, which means that we can see with X-ray vision, almost like Superman, internally into the patient so we see exactly where the lung cancer is. So we move our radiation beam to match the movement of the tumor inside. So instead of radiating a broad swath of area where the tumor might be, because that's where it might be going, we're actually tracking exactly where it is. So we can be much more pinpoint and precise.

Deborah Howell (Host): So they're not lying when they say gamers make great radiosurgeons.

Linda Chan, MD: That's true. Sometimes people joke that we're almost playing a video game. Now I don't want to make light of this because obviously every patient is important and this is very serious. But we have utilized a lot of military technology. Some of this was derived from Star Wars. Earlier I referenced the movie. But now I'm referencing when Ronald Reagan was our president, as you know, we developed the Star Wars Missile Defense Program to protect our country from missiles fired from Russia during the height of the Cold War. We utilize similar technology to track, instead of a missile coming towards us, in this case, a tumor moving within a patient, to try to be more precise at shooting that down and killing it.

Deborah Howell (Host): You've pretty much blown my mind. So can it, you know, treat multiple sites in the same treatment if there are more than one tumor?

Linda Chan, MD: Yes, it can. We can treat multiple sites at the same time. Or depending on particular details of a patient, we might treat some areas first and reserve some areas for a second course, depending on what is the safest and most efficacious way to treat that person.

Deborah Howell (Host): Incredible. I have a final question for you, Doctor. What other radiation treatment options does the MemorialCare Cancer Institute offer?

Linda Chan, MD: Well, I think of all the different disease sites that I mentioned, one big one that I did not mention was breast cancer. And I'm also very proud to say that we have something called Deep Inspiration Breath Hold with Vision RT, which is a mouthful. But that's specifically used for breast cancer patients, particularly left-sided breast cancer. Again, we're one of the only centers in Orange County that offers this program. And what it does is it essentially again tracks the internal movement of the heart and the lung, which normally lie right underneath the woman's breast, to help protect those organs from the radiation beam. To again try to deliver radiation in the safest and most effective way possible, but minimizing the risk of collateral damage. So a young woman who comes in with breast cancer, one of the biggest risks we always worry about is damaging the normal tissue around the breast, which in this case was lung and heart underneath. But here we have something which helps to cut down dose by more than half. So again, we protect these women from side effect and toxicity that they might otherwise have received with traditional radiation options.

Deborah Howell (Host): Such good news for patients these days. Thank you so much, Dr. Chan, for taking the time to be on the show with us today.

Linda Chan, MD: Thank you so much for having me. I enjoyed it.

Deborah Howell (Host): For more info or to listen to a podcast of this show, go to memorialcare.org. That's memorialcare.org. I'm Deborah Howell. That's all for this time. Have yourself a terrific day.