Navigating Radiation Treatments for Cancer Patients
Featuring: Chandra Kota, PhD
In short
Medical physicist Chandra Kota, PhD, walks through how modern radiation therapy works, what has changed in recent decades, and how patients can think through their options. He covers the main types of radiation (photons, electrons, protons, radioligands), newer guidance technologies that protect healthy tissue, and specific advances in prostate cancer treatment — including how multiparametric MRI now allows higher doses to be aimed at the exact areas of disease.
- •Ask your care team whether proton therapy is right for your cancer type — it can deliver better dose distribution and cause less damage to surrounding healthy tissue than other forms of radiation.
- •Find out if real-time guidance technology or biologically-guided radiation therapy is available at your center, since these newer approaches can reduce the radiation zone and improve accuracy even if you move during treatment.
- •If you have prostate cancer, ask whether multiparametric MRI is being used in your radiation planning so higher doses can be directed precisely at the disease areas.
- •If you have had prior radiation, tell every new provider — cumulative exposure limits on nearby tissue can affect whether and how re-irradiation is safe.
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“We used to treat the whole prostate with a uniform dose. But now with multiparametric MRI, we can see the areas of disease more clearly. We incorporate that into radiation planning. ” – Chandra Kota, PhD “We could use more patient advocates.
Meeting Summary
Surgery or various kinds of radiation can often serve as the first line of treatment to kill solid tumors and provide reasonably durable local control for cancer patients. Radiation therapy can be delivered from outside the body ( external beam), with implanted radioactive sources near the tumor (brachytherapy), and more recently with radioactive molecules that bind to targets on the tumor cells (radioligand).
Most doctors believe that surgery and radiation are equally effective. Surgery may offer a slightly higher long-term cure rate than radiation. Radiation usually doesn't require a stay in the hospital, and you may be able to carry on with your daily life. The disadvantages of surgery include the inability to kill microscopic disease around the edges of the tumor, and difficulty in tolerating the surgery and anesthesia.
Disadvantages of radiation therapies include a cumulative tolerance limit of various tissues which can limit re-irradiation. Radiation can be delivered at different dosages depending on modality and clinical goals. Understanding and navigating the radiation process can be challenging since it is complex and often involves your active participation.
Technical and clinical advances in the past few decades have created new opportunities for radiation therapies that offer better outcomes. Chandra Kota, PhD, Senior Medical Physicist at ChristianaCare, has first hand experience with many radiation therapy techniques and is uniquely qualified to describe the various radiation processes to help you better understand and navigate this complex treatment modality.
What should you know about getting radiation therapy?
•There are different radiation therapies (photons, electrons, and protons). Different types of radiation deposit energy differently, leading to varying biological effects. You need to have a personalized approach to your radiation therapy.
•The benefits of proton therapy (over other radiation options) include better dose distributions and reduced damage to healthy tissues. What is new in radiation therapy?
•Real-time guidance technology for radiation (combining a scanner with the radiation delivery) can decrease margins and spare surrounding tissues.
•“Biologically-guided radiation therapy” uses an injected radiotracer which lights up solid tumors to guide the radiotherapy beam during delivery of radiation, increasing accuracy even if you move.
•New radiation technologies (such as volumetric radiation) are much faster than the older technology. You may lay there for five minutes instead of the twenty minutes that you had to earlier.
•Radiosensitizers, techniques to sensitize cancer cells to radiation, are in research, but none are demonstrating major effects yet.
•With radioligands (e.g., leutetium), a gap in delivery, instead of a straight course, yields better patient survival. What can you do to see if radiation therapy is right for you?
•Review our discussion with Carl Rossi of California Protons for more details on proton beam therapy and how it compares to other radiation options and surgery.
•Read about ongoing research in radiation.
•Explore ways to optimize your radiation treatment to better spare nearby critical structures, like your urethra for prostate cancer patients. The information and opinions expressed on this website or platform, or during discussions and presentations (both verbal and written) are not intended as health care recommendations or medical advice by Cancer Patient Lab, its principals, presenters, participants, or representatives for any medical treatment, product, or course of action. You should always consult a doctor about your specific situation before pursuing any health care program, treatment, product or other course of action that might affect your health. Meeting Notes KEYWORDS radiation, patient, treatment, protons, beams, dose, prostate, radiation oncologist, field, tumor, target, proton beam, called, radiation treatment, therapy, machine, treat, photons, deliver, people SPEAKERS Chandra Kota (70%) , Allen Morris (11%) , Brad Power (9%), Rob Weker (7%), Richard Anders (3%) SUMMARY Chandra Kota discussed the latest developments in radiation oncology, highlighting the importance of interdisciplinary collaboration, technological advancements, and personalized treatments. He discussed the evolution of radiation therapy technology, with a focus on improving treatment times and reducing off-target toxicity. He also discussed the latest developments in radiation therapy for prostate cancer, including improved dose distribution and emerging technologies. The conversation also touched on the potential of rad radiosensitizers in cancer treatment and the need for more patient advocates to bridge the gap between radiation oncology and laboratory medicine. OUTLINE Radiation therapy for cancer treatment.
•Chandra Kota discusses radiation treatment for cancer, providing insights as a medical physicist.
•He explains the complexity of oncology, mentioning various specialists and outside organizations working to improve patient care.
•He highlights the challenge of keeping staff and physicians educated in the face of rapidly changing knowledge and clinical pathways. Radiation oncology, jargon, and treatments.
•In the radiation treatment process, the patient consults with a doctor, undergoes simulation to develop a treatment plan, and receives targeted radiation treatment for localized cancer.
•Medical doctors, physicists, therapists, and nurses collaborate to provide radiation oncology treatment.
•Technical staff (biomed engineers, biomedical technicians) maintain and repair radiation machines during treatment.
•Dr. Kota explains the history and advancements in radiation therapy, including multileaf collimator (a beam targeting device) and volumetric arc therapy.
•He demonstrates how these advancements improve targeted radiation dose delivery. Radiation types and their effects on cancer treatment.
•Dr. Kota explains differences in radiation therapy types (photons, electrons, protons) and their applications.
•He highlights the benefits of proton therapy, including better dose distributions and reduced damage to healthy tissues.
•Different types of radiation deposit energy differently, leading to varying biological effects, and patient selection is crucial for optimal treatment.
•He discusses different dose ranges for radiation therapy, including partial killing of tumor cells and ablative lesions. Radiation therapy for prostate cancer, including dosage, delivery methods, and side effects.
•Radiation therapy can treat non-cancerous conditions like trigeminal neuralgia and osteoarthritis, and modulate inflammation at lower doses.
•Dr. Kota discusses challenges in radiation therapy for prostate cancer, including margin reduction and bladder filling.
•He discusses guidance technology for prostate cancer treatment, highlighting its ability to decrease margins and spare surrounding tissues.
•He also mentions biologically-guided radiation therapy using PET imaging agents, which can localize solid tumors for treatment. Advancements in prostate cancer radiation therapy.
•Dr. Kota discusses radiopharmaceutical therapy for prostate cancer, including different types of emitters and their effects on cells.
•Investigators explore novel techniques for personalized radiation therapy, including targeted biopsies and multi-parametric MRI.
•He discusses challenges in the radiation therapy field, including lack of policy support, reimbursement issues, and limited funding for research and education. Radioligands and their potential for cancer treatment, with mentions of investment and innovation.
•Pharmaceutical companies are investing heavily in radioligand therapy. Proton beam therapy for cancer treatment, reimbursement challenges, and new technologies.
•Rob Weker shares his experience with proton beam radiation therapy for pancreatic cancer, highlighting the challenge of reimbursement.
•Dr. Kota discusses the challenges of treating cancer with radiation, including the need for more targeted treatments and the potential for unintended side effects.
•Rob Weker expresses suspicion that his initial radiation treatment for testicular cancer may have contributed to the development of pancreatic cancer 20 years later.
•He mentions proton therapy centers in Philadelphia and UPenn.
•Dr. Kota discusses older proton technology and its limitations. Radiation therapy techniques and their differences.
•Allen Morris questions Dr. Kota about medical physics, specifically the differences between historic conformal radiation therapy and newer techniques like IMRT and volumetric arc therapy.
•Dr. Kota describes advancements in radiation therapy technology, including multileaf collimators and volumetric arc therapy. Optimizing radiation therapy with proton beams.
•Allen Morris explains that using more beams in radiation therapy is a medical radiation physics concept, and only tangentially the purview of radiation oncologists. That the number of beam angles are a physical (physics) way to reduce off-target effects.
•Dr. Kota mentions that optimizing the timing of proton beam delivery can help reduce the entrance bath and improve treatment outcomes, but this may require faster machine capabilities and more complex math.
•Richard Anders wonders about theoretical minimum radiation delivery to normal tissues, resulting in limiting off-target toxicity, given an infinite number of beams.
•Dr. Kota explains that with photons, there is no theoretical minimum, but with protons, it depends on collimation and beam overlap. Radiosensitizers for cancer treatment, with a focus on boron neutron capture therapy and hyperbaric oxygen.
•Dr. Kota mentions boron neutron capture therapy as a potential radiosensitizer, but notes that it has limitations.
•He explains the role of medical physicists in radiation oncology, including planning and overseeing treatments.
•Medical physicists work with radiation oncologists to ensure quality and accuracy in radiation therapy. Radiation oncology, medical physics, and patient advocacy.
•Allen Morris discusses that radiation oncology and pathology/laboratory medicine are complex fields involving many types of professionals within each. And that if you have an understanding of the differences in the educational backgrounds of those expert types, you can better direct the “conversation”.
•He points out that ADT treatment combined with Radiation therapy is established as a synergistic combination and the combination continues to mature by answering corollary questions such as what duration is optimal for various patient contexts.
•Dr. Kota encourages more patient advocacy to address radiation fears and promote its role in cancer care.
Full transcript
Brad Power This is the Cancer Patient Lab. Today we're honored to have Chandra Kota with us. He's going to give us some background and information about how to think about radiation treatment for cancer. Chandra is a longtime friend. He's been involved with our activities for many years. He's currently based in Delaware. When I got to know him, he was doing something at Yale. He's a medical physicist. He works with radiation oncologists.
Early on, I had to learn that there's a difference between the radiation that's used for diagnosis, and the radiation that's used for treatment, and Chandra had to keep correcting me on those distinctions. This is for information purposes only, and is not medical advice. Please consult your doctor. We're trying to give you information that will help you in conversations with your medical team. We're a patient-led organization. We are volunteers.
We depend on the kindness of members to make donations. Please donate if you're so inspired. Chandra Kota 1:48 I want to share some thoughts about radiation and its place in treatment for cancer. I am what's called a “medical physicist”. It's a very niche field. We are more of experts on the technology side to deal with radiation, both in radiation therapy as well as in diagnostic imaging.
We help the radiation oncologist and the medical doctors in designing the treatment plans and overseeing the delivery of treatments, and quality control and quality assurance. You could think of it like a pharmacist, but also doing other things beyond just what pharmacists might do on the medical oncology side. Chandra Kota 2:58 Thinking outside the box of my day job, I like to think of this whole universe of oncology as the “oncoverse”.
It's very complicated. As we get older, most of us are likely to get some kind of cancer. That's just the body's natural aging mechanism. Then you go through the diagnosis and then you meet a bunch of specialists who are going to try to make things better for us, like a surgical oncologist, medical oncologist, radiation oncologist.
Then there are all these other people on the outside that are also working diligently trying to make things better for everybody. Like there is pharma. There's devices. There's insurance people. There's private equity, trying to invest money and support innovation. And the support organizations, a lot of them are just volunteers, like the one that Brad runs, which is more focused towards trying to find treatments outside the standard of care.
There are other support organizations that are there. So if patients need somebody to talk to or, or go visit and get some help, they're there. For example, I volunteer at one, Cancer Support Community for Greater Philadelphia. It's a great place. And there are others. The problem is, since about 30 years ago, everything's changing so fast.
There's new understanding of disease, and there's new technologies and new clinical pathways, and there's just an explosion of knowledge. I'm from the provider side, so we take care of patients right in the hospital setting. I just see so much new knowledge coming out. It's a challenge to keep the staff educated, the physicians educated.
How do you disseminate all this knowledge, and all these pathways so they can get down to the clinical level so that patients can benefit from it? Within radiation oncology, we can think of the field like this. As a patient, you would come in and consult with a doctor. The doctor might order more scans and come up with a clinical treatment plan. There's a bunch of jargon that's used.
You will move on to the next step, which is called a “simulation”. That's usually done with a CAT scan. We plan the radiation, how the radiation beams will be directed at the tumor, based on the CAT scan. Radiation treatment is a very targeted treatment. We treat well defined, localized disease. We cannot treat diffuse disease.
Once it's well defined and localized, we target it using radiation planning, and then we do a lot of quality assurance to make sure that whatever has been planned is the radiation that's going to be delivered through the treatment to the patient. Then there's the treatment itself.
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