DiversityNursing Blog

5 Reasons Radiation Treatment has Never Been Safer (Op-Ed)

Posted by Erica Bettencourt

Mon, Mar 30, 2015 @ 01:40 PM

Dr. Edward Soffen

Source: www.livescience.com

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Dr. Edward Soffen is a board-certified radiation oncologist and medical director of the Radiation Oncology Department at CentraState Medical Center's Statesir Cancer Center in Freehold, New Jersey. He contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

As a radiation oncologist, my goal is to use radiation as an extremely powerful and potent tool to eradicate cancer tumors in the body: These techniques save and extend patients' lives every day. 

Historically, radiation treatments have been challenged by the damage they cause healthy tissue surrounding a tumor, but new technologies are now slashing those risks.

How radiation therapies work

High-energy radiation kills cancer cells by damaging DNA so severely that the diseased cells die. Radiation treatments may come from a machine (x-ray or proton beam), radioactive material placed in the body near tumor cells, or from a fluid injected into the bloodstream. A patient may receive radiation therapy before or after surgery and/or chemotherapy, depending on the type, location and stage of the cancer. 

Today's treatment options target radiation more directly to a tumor — quickly, and less invasively — shortening overall radiation treatment times. And using new Internet-enabled tools, physicians across the country can collaborate by sharing millions of calculations and detailed algorithms for customizing the best treatment protocols for each patient. With just a few computer key strokes, complicated treatment plans can be anonymously shared with other physicians at remote sites who have expertise in a particular oncologic area. Through this collaboration, doctors offer their input and suggestions for optimizing treatment. In turn, the patient benefits from a wide community of physicians who share expertise based upon their research, clinical expertise and first-hand experience. 

The result is safer, more effective treatments. Here are five of the most exciting examples:

1. Turning breast cancer upside down

When the breast is treated while the patient is lying face down, with radiation away from the heart and lungs, a recent study found an 86 percent reduction in the amount of lung tissue irradiated in the right breast and a 91 percent reduction in the left breast. Additionally, administering prone-position radiation therapy in this fashion does not inhibit the effectiveness of the treatment in any way.

2. Spacer gel for prostate cancer

Prostate cancer treatment involves delivering a dose of radiation to the prostate that will destroy the tumor cells, but not adversely affect the patient. A new hydrogel, a semi-solid natural substance, will soon be used to decrease toxicity from radiation beams to the nearby rectum. The absorbable gel is injected by a syringe between the prostate and the rectum which pushes the rectum out of the way while treating the prostate. As a result, there is much less radiation inadvertently administered to the rectum through collateral damage. This can significantly improve a patient's daily quality of life — bowel function is much less likely to be affected by scar tissue or ulceration. [Facts About Prostate Cancer (Infographic )]

3. Continual imaging improves precision

Image-Guided Radiation Therapy (IGRT) uses specialized computer software to take continual images of a tumor before and during radiation treatment, which improves the precision and accuracy of the therapy. A tumor can move day by day or shrink during treatment. Tracking a tumor's position in the body each day allows for more accurate targeting and a narrower margin of error when focusing the beam. It is particularly beneficial in the treatment of tumors that are likely to move during treatment, such as those in the lung, and for breast, gastrointestinal, head and neck and prostate cancer. 

In fact, the prostate can move a few millimeters each day depending on the amount of fluid in the bladder and stool or gas in the rectum. Head and neck cancers can shrink significantly during treatment, allowing for the possibility of adaptive planning (changing the beams during treatment), again to minimize long term toxicity and side effects.

4. Lung, liver and spine cancers can now require fewer treatments 

Stereotactic Body Radiation Therapy (SBRT) offers a newer approach to difficult-to-treat cancers located in the lung, liver and spine. It is a concentrated, high-dose form of radiation that can be delivered very quickly with fewer sessions. Conventional treatment requires 30 radiation treatments daily for about six weeks, compared to SBRT which requires about three to five treatments over the course of only one week. The cancer is treated from a 3D perspective in multiple angles and planes, rather than a few points of contact, so the tumor receives a large dose of radiation, but normal tissue receives much less. By attacking the tumor from many different angles, the dose delivered to the normal tissue (in the path of any one beam) is quite minimal, but when added together from a multitude of beams coming from many different planes, all intersecting inside the tumor, the cancer can be annihilated. 

5. Better access to hard-to-reach tumors

Proton-beam therapy is a type of radiation treatment that uses protons rather than x-rays to treat cancer. Protons, however, can target the tumor with lower radiation doses to surrounding normal tissues, depending on the location of the tumor. It has been especially effective for replacing surgery in difficult-to-reach areas, treating tumors that don't respond to chemotherapy, or situations where photon-beam therapy will cause too much collateral damage to surrounding tissue. Simply put, the proton (unlike an x-ray) can stop right in the tumor target and give off all its energy without continuing through the rest of the body. One of the more common uses is to treat prostate cancer. Proton therapy is also a good choice for small tumors in areas which are difficult to pinpoint — like the base of the brain — without affecting critical nerves like those for vision or hearing. Perhaps the most exciting application for this treatment approach is with children. Since children are growing and their tissues are rapidly dividing, proton beam radiation has great potential to limit toxicity for those patients. Children who receive protons will be able to maintain more normal neurocognitive function, preserve lung function, cardiac function and fertility. 

While cancer will strike more than 1.6 million Americans in 2015, treatments like these are boosting survival rates. In January 2014, there were nearly 14.5 million American cancer survivors. By January 2024, that number is expected to increase to nearly 19 million

But make no mistake — radiation therapy, one of the most powerful resources used to defeat cancer, is not done yet. As we speak, treatment developments in molecular biology, imaging technology and newer delivery techniques are in the works, and will continue to provide cancer patients with even less invasive treatment down the road.

Source: www.livescience.com

Topics: surgery, physician, innovation, oncology, technology, health, healthcare, nurse, medical, cancer, patients, hospital, medicine, treatments, radiation, chemotherapy, doctor, certified oncologist, oncologist, x-ray

Wisconsin Mom and Daughter Diagnosed with Cancer 13 Days Apart

Posted by Erica Bettencourt

Fri, Mar 06, 2015 @ 11:14 AM

ELIZA MURPHY

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It’s a battle they never thought they’d face, let alone at the same time.

Missy and Brooke Shatley, a mother and daughter from Prairie Farm, Wisconsin, both have cancer. They were diagnosed only 13 days apart.

“It’s that unbelief,” Missy, 38, told ABC News of her reaction when they learned the devastating news. “You feel numb like this can’t really be happening. This is happening to somebody else, it could never be you.”

 

Missy was diagnosed with stage 2 cervical cancer on December 26, the day after Christmas.

“I went in for my annual physical and that was the result of it,” she explained.

Then on January 8, Brooke, Missy and her husband Jason’s oldest child, was diagnosed with stage 3 ovarian cancer.

“Why us? Why?,” Missy asked. “Is it something in our water? Is it genetic? Why both of us in such a short time frame? The doctor said it’s not the water, it’s not the environment, it’s just a freak act of nature.”

Before Missy’s diagnosis, Brooke, 14, had been experiencing severe abdominal pain that went undiagnosed for several weeks.

“The doctors told us she had a baseball-sized hemorrhagic disc and it would go away on its own and we should just wait,” Missy explained. “We waited for a few weeks and thought, ‘This is ridiculous,’ and we sought a second opinion.”

The Shatley’s then took Brooke to see the same specialist that had just diagnosed her mom days earlier. The devastating news was that Brooke’s tumor was larger than they originally suspected and needed to be operated on immediately.

“It was a four-and-a-half hour surgery,” Missy recalled. “It was a football-sized tumor. It had intertwined in her abdomen. You couldn’t tell by looking at her belly, but it was football-sized.”

The brave mother-daughter duo began undergoing intense treatments at the same time in Marshfield, Wisconsin, about two hours from their home--understandably weighing heavily on husband and father Jason, a dairy farmer, who was traveling back and forth to take care of them while also tending to their other two children and maintaining their farm.

“It’s hard,” Missy said. “Just to even think, ‘That’s my wife and daughter,’ how does anybody deal with that? Plus we have two other kids at home so he’s trying to be a husband, father, keep up with the farm, he’s being pulled in so many directions, how do you even begin?”

This week has been better for the family, however. Both Missy and Brooke are back home, resting and enjoying their time, although possibly brief, out of the hospital.

Missy just completed her final round of radiation and chemotherapy on March 2. She now must wait eight to 12 weeks before they can tell how effective the treatment was on her cancer.

Brooke still has one more round of chemo to complete, tentatively scheduled to begin on March 9.

Although their simultaneous diagnosis has been difficult, Missy says, in a way, it’s been nice to have that newfound bond with her daughter.

“You don’t want to experience it with anybody, but if you have to, doing it as a mother-daughter is helpful,” she said. “You’re bonding over raw emotions. It’s definitely a connection that you form.”

On March 28 their community is holding a benefit for the resilient pair, which Missy says is just one of the generous things they’ve done to help throughout this process.

“Not in a million years could I imagine the outreach we’ve had,” she said. “The surrounding communities have been phenomenal. We have a dairy farm so we’ve had people volunteer to do chores, saw wood, make meals, provide transportation for the other kids when we need it--anything and everything they’ve offered up.”

Most importantly, she added, “Prayers, lots of prayers.”

Source: http://abcnews.go.com

Topics: mother, chemo, health, nurse, nurses, doctors, health care, cancer, hospital, medicine, treatments, radiation, chemotherapy, daughter, cervical cancer

'Invisible Tattoos' Could Improve Body Confidence After Breast Cancer Radiotherapy

Posted by Erica Bettencourt

Mon, Nov 03, 2014 @ 11:16 AM

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Invisible tattoos could replace the permanent dark ink tattoos used to ensure that breast cancer patients having radiotherapy are treated in exactly the same spot during each session, according to results from a pilot study to be presented at the National Cancer Research Institute (NCRI) Cancer Conference.

Research suggests that the permanent pin prick marks made on the skin of women having radiotherapy reminds them of their diagnosis for years to come, reducing body confidence and self-esteem.

It's also more difficult to spot these tattoos in dark-skinned women, potentially leading to inconsistencies in the area being treated.

The NIHR-funded researchers, based at The Royal Marsden hospital in London, asked 42 breast cancer patients undergoing radiotherapy to rate how they felt about their body, before the treatment and one month later.

Half the women were offered fluorescent tattoos, only visible under UV light, while the other half had conventional dark ink tattoos.

The researchers found that 56 per cent of the women who had fluorescent tattoos felt better about their bodies one month after treatment, compared to only 14 per cent among those who received black ink tattoos.

Using fluorescent tattoos also made no difference to the accuracy of treatment and took only slightly longer to carry out, compared to conventional dark ink tattoos.

Steven Landeg, a senior radiographer from the Royal Marsden, who is presenting the data, said: "These findings suggest that offering fluorescent radiotherapy tattoos as an alternative to dark ink ones could help ameliorate the negative feelings some women feel towards their bodies after treatment. It's important to remember that body image is subjective and dark ink radiotherapy tattoos will affect patients differently, but we hope that these results will go some way towards making this a viable option for radiotherapy patients in the future."

Evelyn Weatherall, 62, Surrey, had six cycles of chemotherapy, followed by radiotherapy, after being diagnosed with breast cancer following routine mammography through the UK's breast screening programme.

She said: "I'd asked if I could be part of any kind of clinical trial during my treatment because I'd read about how successful they were proving to be. My doctors told me about the invisible tattoos they were pioneering at The Royal Marsden hospital and I was more than happy to take part. I had lost my hair during chemotherapy and felt that I didn't want another visible reminder of my cancer.

"I think I was one of the first to undergo this procedure and it really worked. There wasn't a mark on my skin after the radiotherapy planning. I was going to a wedding soon afterwards and knew I'd be able to wear an outfit that didn't make me feel self-conscious.

"It's wonderful to think that I may have been a part of something that could become standard in the future."

Professor Matt Seymour, NCRI's clinical research director said: "With more than half of all cancer patients now surviving 10 years and beyond, it's imperative that we do everything we can to reduce the long term impact of treatment on patients, including cosmetic changes."

The study was funded by the NIHR Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research (ICR).

Source: MNT

Topics: cancer, patients, breast cancer, radiation, chemotherapy, tattoos, radiology, self esteem, body confidence

Breakthrough Technique Images Breast Tumors in 3-D With Great Clarity, Reduced Radiation

Posted by Alycia Sullivan

Fri, Oct 26, 2012 @ 02:59 PM

ScienceDaily (Oct. 22, 2012) — Like cleaning the lenses of a foggy pair of glasses, scientists are now able to use a technique developed by UCLA researchers and their European colleagues to produce three-dimensional images of breast tissue that are two to three times sharper than those made using current CT scanners at hospitals. The technique also uses a lower dose of X-ray radiation than a mammogram.

These higher-quality images could allow breast tumors to be detected earlier and with much greater accuracy. One in eight women in the United States will be diagnosed with breast cancer during her lifetime.

The research is published the week of Oct. 22 in the early edition of the Proceedings of the National Academy of Sciences.

describe the imageThe most common breast cancer screening method used today is called dual-view digital mammography, but it isn't always successful in identifying tumors, said Jianwei (John) Miao, a UCLA professor of physics and astronomy and researcher with the California NanoSystems Institute at UCLA.

"While commonly used, the limitation is that it provides only two images of the breast tissue, which can explain why 10 to 20 percent of breast tumors are not detectable on mammograms," Miao said. "A three-dimensional view of the breast can be generated by a CT scan, but this is not frequently used clinically, as it requires a larger dose of radiation than a mammogram. It is very important to keep the dose low to prevent damage to this sensitive tissue during screening."

Recognizing these limitations, the scientists went in a new direction. In collaboration with the European Synchrotron Radiation Facility in France and Germany's Ludwig Maximilians University, Miao's international colleagues used a special detection method known as phase contrast tomography to X-ray a human breast from multiple angles.

They then applied equally sloped tomography, or EST -- a breakthrough computing algorithm developed by Miao's UCLA team that enables high-quality image-reconstruction -- to 512 of these images to produce 3-D images of the breast at a higher resolution than ever before. The process required less radiation than a mammogram.

In a blind evaluation, five independent radiologists from Ludwig Maximilians University ranked these images as having a higher sharpness, contrast and overall image quality than 3-D images of breast tissue created using other standard methods.

"Even small details of the breast tumor can be seen using this technique," said Maximilian Reiser, director of the radiology department at Ludwig Maximilians University, who contributed his medical expertise to the research.

The technology commonly used today for mammograms or imaging a patient's bones measures the difference in an X-ray's intensity before and after it passes through the body. But the phase contrast X-ray tomography used in this study measures the difference in the way an X-ray oscillates through normal tissue rather than through slightly denser tissue like a tumor or bone. While a very small breast tumor might not absorb many X-rays, the way it changes the oscillation of an X-ray can be quite large, Miao said. Phase contrast tomography captures this difference in oscillation, and each image made using this technique contributes to the overall 3-D picture.

The computational algorithm EST developed by Miao's UCLA team is a primary driver of this advance. Three-dimensional reconstructions, like the ones created in this research, are produced using sophisticated software and a powerful computer to combine many images into one 3-D image, much like various slices of an orange can be combined to form the whole. By rethinking the mathematic equations of the software in use today, Miao's group developed a more powerful algorithm that requires fewer "slices" to get a clearer overall 3-D picture.

"The technology used in mammogram screenings has been around for more than 100 years," said Paola Coan, a professor of X-ray imaging at Ludwig Maximilians University. "We want to see the difference between healthy tissue and the cancer using X-rays, and that difference can be very difficult to see, particularly in the breast, using standard techniques. The idea we used here was to combine phase contrast tomography with EST, and this combination is what gave us much higher quality 3-D images than ever before."

While this new technology is like a key in a lock, the door will only swing open -- bringing high-resolution 3-D imaging from the synchrotron facility to the clinic -- with further technological advances, said Alberto Bravin, managing physicist of the biomedical research laboratory at the European Synchrotron Radiation Facility. He added that the technology is still in the research phase and will not be available to patients for some time.

"A high-quality X-ray source is an absolute requirement for this technique," Bravin said. "While we can demonstrate the power of our technology, the X-ray source must come from a small enough device for it to become commonly used for breast cancer screening. Many research groups are actively working to develop this smaller X-ray source. Once this hurdle is cleared, our research is poised to make a big impact on society."

These results represent the collaborative efforts of senior authors Miao, Bravin and Coan. Significant contributions were provided by co-first authors Yunzhe Zhao, a recent UCLA doctoral graduate in Miao's laboratory, and Emmanuel Brun, a scientist working with Bravin and Coan. Other co-authors included Zhifeng Huang of UCLA and Aniko Sztrókay, Paul Claude Diemoz, Susanne Liebhardt, Alberto Mittone and Sergei Gasilov of Ludwig Maximilians University.

The research was funded by UC Discovery/Tomosoft Technologies; the National Institute of General Medical Sciences, a division of the National Institutes of Health; and the Deutsche Forschungsgemeinschaft-Cluster of Excellence Munich-Centre for Advanced Photonics.

Topics: technology, breast cancer, radiation, 3D, tumor

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