Radiation Therapy for Lung Cancer | Q&A with Russell Hales, M.D.


[MUSIC] Well, radiation is used to treat
lung cancer in a variety of settings. I think before we talk
about when it’s used, we first have to
talk about stage. When we think about cancer, we think about what
the stage of the cancer is. Stage is critical because it
drives the therapy we give. And somebody with the earliest
stage of cancer, a tumor just in the lung itself that hasn’t
spread any further, a surgery or radiation can be given to
entirely get rid of that cancer. In tumors that
are more advanced, say those that have spread to
lymph nodes or to other parts of the body, the role of
radiation is more limited. It can be used in tumors that
have spread to lymph nodes. When tumors spread
more distantly, we can use radiation to
help with the symptoms. But when a tumor has spread
outside of the chest, the backbone of therapy is
a therapy that can go all throughout the body. An example of this would be
chemotherapy or immunotherapy. So radiation can actually be
used in the earliest stages of cancer, and
in more later stages of cancer, with different goals in mind. [MUSIC] One of the exciting parts
about radiation treatment for our patients is that it marries
the best of technology with medicine to help patients have
the best chance of a cure, while at the same time minimizing
toxicity or side effects. When we specifically
think about technology, our radiation treatments
are customized for each patient. We have a team of physicists and
dosimetrists. These are specialists who help
design how to bring in radiation beams. They will help us to identify
how to best avoid normal tissues. I like to tell patients that
the chest is the Manhattan of the body. The heart, the lungs,
the spinal cord, the esophagus, there’s a lot
of critical structures there. And so our team of physicists
can help us optimize a treatment plan which can avoid these
normal tissues, while at the same time, targeting
the area of concern, the tumor. [MUSIC] We were just talking
about technology and about how technology allows us
to enhance our ability to bring in radiation beams. We can now go in and locate normal tissues in the
chest, we’re close to the heart, the spinal chord,
the lungs, the esophagus. We can locate those structures
and also identify targets. We then use super computers
to help us plan how to hit the target,
that is in this case, the tumor, while at the same time, avoiding
these normal structures. This is why a team of physicists
is so critical in our treatment. We can also track
how tumors move. In lung cancer, one of the
challenges we have is that as a patient breathes in and
out, a tumor is moving up and down in the chest. In essence, we’re targeting
something that is moving. We can use sophisticated
technologies to track how a tumor moves so that we can do
a better job of staying off of normal tissues and make the treatment as safe as
possible for our patients. [MUSIC] When we think about
the benefits of any therapy, our goal is always to get
the best possible outcome. And when we think about cancer,
that goal is cure. In some situations that is
a goal that can be realized. In other situations we’re
trying to control a cancer for as long as possible. Radiation treatment helps
us to decrease the chance of a tumor ever coming
back in the chest, which is normally
what we’re targeting. While at the same time,
doing this without a surgery, without blades,
without an operation. What this means is that we can
get the best chance of giving the patient a good outcome
in terms of their cancer, while at the same time
minimizing toxicity. [MUSIC] As is the case with
any medical procedure, there are risks to
that procedure. Our goal is to
minimize those risks. But I tell patients even in the
safest of hands, when everything is going right, there
are intrinsic risks in therapy. If we were to list the possible
side effects, they could go on for a long time, just as if you
read the back of an aspirin bottle, you’d see a lot
of potential risks. In reality, the side effects of
treatment very much depend on what we’re targeting. If we have a tumor that is in
the lung that’s an early stage cancer, and we give radiation
to help get rid of that, patients may half fatigue and
tiredness during treatment. They may have some scar tissue
that forms in the lung around the area we treat. But most patients will
not feel more winded or short of breath after treatment. In patients with more advanced
tumors where the tumor has spread to lymph nodes in
the middle of the chest, we’re also targeting those
lymph nodes which sit close to the esophagus. Treating close to the esophagus
can cause some irritation with swallowing
during treatment, but that usually gets better
after treatment is over. [MUSIC] Lung cancer treatment
is complex. It involves multiple experts and specialists coming together to
make a coordinated decision to help optimize a patient’s
path through cancer care. What this means is that a
thoracic surgeon, a chemotherapy doctor, a radiation doctor,
and many other specialists have to work together for
the benefit of the patient. In our multidisciplinary team,
patients are able to come in and see a thoracic surgeon,
chemotherapy doctor, and a radiation doctor all in
one coordinated visit. While this visit occupies
the better part of a day, patients are able to come in and
see all the doctors and other specialists that
they’ll need to to have a successful plan put into
place to manage their cancer. [MUSIC] When a patient’s
diagnosed with cancer, it can feel like the carpet’s
been pulled out from under them. And having clarity as to
the path forward is critical. There are three unique things
that we bring to the table for our patients here
at Johns Hopkins. The first is expert based care. Our team is full of dedicated
thoracic oncology experts. What this means is that these
are doctors who focus on treating lung cancer. What that means is that
a group of experts will be wholly focused on
that patient’s care. The second thing we bring
is this multi-disciplinary approach. It’s critical that all
the doctors caring for the patient are rubbing
shoulders and in constant communication
about the patient. The third thing we offer is
innovation and discovery. We stand on the shoulders of
patients from years before. And the technologies that allow
us to deliver the therapy we do today come from discovery
that happened yesterday. Our mission is to be on the
forefront of that to constantly bring something better for
our patients. And we do that through
innovation and research, which is
a part of our mission. [MUSIC]