Benefits of the TrueBeam radiation therapy breath hold technology

We're talking wellness at MemorialCare health system. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): And welcome to the show I am Deborah Howell, and today we'll be talking about the extraordinary benefits of the TrueBeam Radiation Therapy Breath Hold Technology. Our guest is Dr. Linda Chan, a board-certified radiation oncologist at Saddleback Memorial Hospital. Welcome, Dr. Chan.

Linda Chan, MD: Thank you for having me.

Deborah Howell (Host): Oh, our pleasure. Let's get right into it. What is TrueBeam Radiation Therapy Technology and how does it work?

Linda Chan, MD: True Bean is essentially one of the most advanced new computerized radiation delivery systems out in the market today. And basically it's used to deliver image-guided radiation therapy and can also do something called stereotactic radiosurgery.

Deborah Howell (Host): Wow, that sounds very impressive. What are the benefits of using TrueBeam for radiation treatment?

Linda Chan, MD: Well, it delivers greater accuracy and higher precision for the actual radiation beam. The reason why that's important is because I can deliver a high dose of radiation therapy directly to the tumor tissue to try to maximize killing of the tumor, obviously, but also at the same time, it can try to minimize delivery of radiation therapy to surrounding normal tissue so that I can try to minimize any unexpected or obviously unwanted side effects.

Deborah Howell (Host): That is fabulous. Now, what is deep inspiration breath hold technology?

Linda Chan, MD: Ah, okay. So deep inspiration, obviously, I think everybody would understand that, but I'll just explain it a little bit more.

Deborah Howell (Host): Sure.

Linda Chan, MD: So when you take a deep inspiration, essentially you're taking a deep breath in, almost like you're about to... go into a pool or something. And with a deep breath, air fills all parts of your lung. When your lung fills like that, it basically lengthens and elongates your chest. So your diaphragm pushes down and your entire chest becomes... almost longer and skinnier in the body. And why that's helpful is because it will simultaneously push your heart down and back away from the chest wall. So for example, if I wanted to treat someone with breast cancer, especially a left-sided breast cancer where the left breast lies right on top of the heart, when I ask the patient to take a deep breath, it will physically push the heart away from the radiation field targeted at the breast. And this helps to protect the heart from any unexpected radiation dose and obviously therefore protects the patient.

Deborah Howell (Host): That is absolutely fascinating. Is this a brand new technology?

Linda Chan, MD: It's relatively new. It's not very prevalent, amazingly, in the market because unfortunately it does require additional expense. So we're very lucky at Saddleback to essentially have the only center with deep inspiration breath hold technology in all of Orange County, even in the greater L.A. area.

Deborah Howell (Host): Wow. So how does deep inspiration breath technology benefit the patient?

Linda Chan, MD: Okay. So let me explain a little bit more about how it works, and then I think it will clarify how it benefits the patient.

Deborah Howell (Host): Okay.

Linda Chan, MD: But essentially what happens is that during the radiation treatment, we'll ask the patient to take a deep breath and hold it for about 30 seconds. Then the computer in the TrueBeam technology will actually track the movement of the patient's lungs and the movement of the chest to determine how deeply the patient is breathing. Once we pass a certain threshold of the depth of the breathing, then the radiation beam will turn on and deliver a short burst of radiation during that deep breath. Then the radiation beam actually shuts off when the patient exhales. So when the patient takes a deep breath in, the radiation turns back on, and it's a continual cycle of turning on and off and on and off, while the patient takes a series of deep breaths. Now, the reason why this will then benefit the patient is that I can reduce dose to the heart, like I said, by physically pushing the heart away from the radiation beam, and simultaneously, because the lung is getting a little bit longer and skinnier in the body during the deep breath, I can also reduce radiation dose to the lung, so there have been clinical trials that looked to see if we reduce the dose to lung and heart, does that actually clinically benefit the patient? And it has. Some clinical studies have noticed almost, I would say, about a 50% reduction in the risk of side effects to the heart. So that might mean unexpected heart failure, or even something as disastrous as a heart attack. And clinical studies have shown that lung toxicity can be cut down by a third. And lung toxicity, what I mean by that, is that any unexpected or unwanted radiation dose to the lung can cause symptoms such as shortness of breath, difficulty taking a deep breath in, or pneumonia-type symptoms. So obviously, as a radiation oncologist, I want to try to minimize the risk of any of these disastrous side effects.

Deborah Howell (Host): Absolutely. Now, does the patient feel anything?

Linda Chan, MD: No, the patient doesn't feel anything at all.

Deborah Howell (Host): When the radiation is administered?

Linda Chan, MD: Nothing at all. It's like getting an x-ray. So you're just lying on a table. There's a machine that moves around you, but the beam is invisible. You cannot feel anything, see anything. You can't detect anything at all. So in fact, most of my patients take a nap because it's pretty soothing and we play any music of choice.

Deborah Howell (Host): This is just almost too good to be true. This is fabulous.

Linda Chan, MD: It is fabulous. Yes. And like I said, I think we're really lucky to have this technology because most of the centers that have this technology tend to be really big academic centers. For example, the Dana-Farber Cancer Institute in Boston that's associated with Harvard Medical School or MD Anderson in Texas. Because like I said, it is an additional expense to purchase this technology. But I think the clinical benefit to the patient is so fantastic. And that's why I feel very lucky that we have it here at Saddleback.

Deborah Howell (Host): Absolutely. Now, for which types of cancer is breath hold technology most impactful and why?

Linda Chan, MD: Well, it's most impactful for any cancers that are in the chest. So breast cancer patients, especially left breast patients, where the left breast is immediately overlying the heart, tends to be very impactful. Although, depending on the location of a patient's heart, it can also benefit a patient with right-sided breast cancer. It can also be used in the treatment of any tumor in the chest area as well. So obviously the lung is in the chest area, so many lung cancers could also benefit from this technology. And there are also some more uncommon or rare cancers, such as lymphomas, that might occur in the chest, or sarcoma, which is an unusual and rare cancer of muscle fibers or tendons, can also benefit from this technology.

Deborah Howell (Host): So who is a great candidate? I mean, you spoke to this a little bit. I want to really ask, is TrueBeam a good treatment option for all cancer patients or just some?

Linda Chan, MD: Well, TrueBeam is the underlying radiation technology that delivers the radiation beam. So that in itself is good for all cancer patients from head to toe. But the Deep Inspiration Breath Hold technology that we were speaking a little bit more in depth about, yes - that's generally for patients with tumors somewhere in the chest or thoracic area.

Deborah Howell (Host): Got it. What other radiation treatment options does the MemorialCare Cancer Institute at Saddleback Memorial offer?

Linda Chan, MD: We offer a really wide-ranging breadth of radiation technologies. So I'm proud to say that we also are a center that offers something called stereotactic radiosurgery. That even though the word “surgery” is in the name, there's actually no surgery involved. It's essentially a very focused, very precise beam of radiation therapy. You might imagine almost like a laser beam that delivers very accurate tiny beams of radiation therapy to essentially any tumor anywhere in the body. Now, it's used primarily for patients with lung cancer or brain tumors or tumors of the spine. It can also be used for patients with tumors in the gastrointestinal tract, such as the pancreas or liver. But the beauty of this technology is that we can, in real time, see the movement of the tumor and the surrounding normal tissues and continually adjust the radiation to try to match the movement of the tumor and the movement of the patient. So that again, we can be that much more precise with the delivery of the radiation to try to give the biggest bang for a buck. So again, the most radiation to the tumor and the least radiation to the surrounding normal tissue.

Deborah Howell (Host): I mean, seriously, what is not to love?

Linda Chan, MD: We also offer something called brachytherapy. Now, brachytherapy is something very different. It's actually internal radiations. So what that means is that there is a radiation device that is physically implanted into the patient. So that does mean a trip to the operating room, but there is a device that's physically implanted into the patient and radiation is delivered directly that way.

Deborah Howell (Host): Is this done robotically?

Linda Chan, MD: No, it's actually done the old-fashioned way with myself and sometimes with a surgeon assisting, and working with me. But this technology helps again for some types of cancers to deliver a much more precise, a much more targeted form of radiation therapy.

Deborah Howell (Host): Is it a time-release mechanism?

Linda Chan, MD: There are actually two kinds, so yes there's one kind of the time release mechanism, that's a great question. So there's one kind, for example, called radioactive seed implants that we use primarily in prostate cancer patients, where we implant radioactive iodine seeds. They're tiny, about the size of a grain of rice, and they deliver a low dose of radiation therapy on a time-release basis, directly to the prostate gland. But there's also another type of brachytherapy that we do that's a temporary brachytherapy almost, where we just temporarily place a radiation device into the patient. The radiation is delivered over the course of 15 or 30 minutes, and then the device is removed, and there's no radiation left in the patient, and everything is removed, and the patient's all done.

Deborah Howell (Host): Oh, my goodness. Dr. Chan, we could go on for hours. This is such positive, wonderful news for those who are suffering. And we can't thank you enough for being on the show today. We really appreciate it.

Linda Chan, MD: Oh, no. Thank you for having me. I really enjoyed it.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please go to MemorialCare.org. That's MemorialCare.org. That's all for this time. I am Deborah Howell. Thank you so much for listening and have yourself a wonderful day.