Dr. Andy Clump from the UPMC Hillman Cancer Center explains how radiation could be used in your cancer care as well as new advances in the treatment of patients with head and neck cancers.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinician should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. The role of radiation in your cancer care. Welcome to the UPMC HealthBeat podcast. I’m Tonia Caruso, and joining us right now is Dr. Andy Clump from the UPMC Hillman Cancer Center. Doctor, thanks for joining us.
– Hi, thanks for having me.
– So you are a radiation oncologist, and let’s give folks a sense of the areas in which you specialize.
– All right. So, I’m a radiation oncologist at UPMC Shadyside, which is adjacent to UPMC Hillman, and I specialize in treatment of aerodigestive malignancies, which are predominantly head and neck cancers, as well as cancers of the lung.
– And so, no matter what a patient’s diagnosis, let’s talk about the process of when someone is diagnosed. What determines the path of treatment, whether it’s radiation, chemotherapy, surgery, combination of all three?
– Sure. So, when a patient is newly diagnosed, there’s a series of steps that go into making that diagnosis, which really requires a multidisciplinary team that’s made up of not only your surgeons, your radiation oncologist, and your medical oncologist, but often individuals that you think less often of. That includes pathologists, so those that actually tell us the cell type or what can help guide our treatments. There are those that include radiologists, so they give us an idea of the staging, so whether the disease has spread. And that’s really the two key components up front is not only determining the type of cancer, but also if it has spread to other sites, which allows us to determine the staging. So once we have a diagnosis and a stage, we then usually proceed in a multidisciplinary fashion, where our groups get together at this point. We’re getting together virtually, utilizing Teams, where we can share that information, whether it’s a pathology slide and imaging slide. And then we discuss the best treatment approach and really try to develop a treatment plan that’s specific for that individual.
– And when comes to radiation, let’s give folks a sense of what exactly radiation does. When is it most often used?
– So radiation therapy is utilizing ionizing radiation, which is in general x-rays, and it’s using x-rays that are powerful enough to be able to treat tumors that are deep-seated within the body. The radiation is a local therapy, so it delivers such treatment similar to a surgical approach. The surgeries remove that tissue, and individuals that have an operable disease or in diseases where surgeries are not indicated,
radiation serves as the main local therapy. And then in instances where it’s been resected, but there are high-risk features afterwards, it’s utilized as a therapy to reduce the risks of local recurrence.
– And so, then, depending upon the type of cancer, what all goes into the length of time that a patient may receive radiation or how often they receive radiation?
– Right. So, the duration of treatment really depends upon the diagnosis. So, in the instance of head and neck cancer, our treatments are usually ranging between five and seven weeks. Seven weeks is often the standard treatment approach when surgery has not been utilized. So for utilizing radiation and the curative management of a patient, let’s say, with a laryngeal cancer or tumor in and around the voice box, we would deliver 35 treatments over seven weeks. And many times we integrate chemotherapy, so our medical oncology colleagues are giving systemic therapy that’s given to improve the outcomes. And usually that’s an improvement in overall survival. In contrast, if surgical resection has been performed, we’re making a judgment call based upon risk factors that they tell us at the time of surgery and our pathologists give us in the ensuing days. So in that instance, treatments will range anywhere from five to six weeks after surgery.
– So the timing of treatments and the length of treatments are important, and that’s why it’s important that people continue their care in the middle of COVID-19.
– Right. Head and neck cancer is one of the diagnoses, which timing is extremely important. So even when we’re faced with competing viruses such as COVID-19, we really have to work through that process so that we can complete patients’ treatment within the appropriate time frame. We have a couple examples. So, in the patients that have had surgical resection, timing within the completion of surgery to the time they complete with radiation, we like to have that within a package time of 100 days. That’s where we know outcomes are most improved. In those individuals that are getting definitive treatment with radiation where their treatment courses are delivered over seven weeks, side effects often will begin around the third or fourth week into treatment, and it’s at that point that interruptions lead to subsequent declines and outcome. Usually for every day missed, there’s a decrease in outcome of around 1 percent. So it’s there that we manage patients proactively, we address their symptoms early, and we surround them with a team of health care providers that are truly devoted to maintaining their treatments and keeping that treatment time on course.
– Right. And so, what do you want to say to people about why it is so important that they keep coming in and the safety precautions that are taken in the Hillman Cancer Center and all of the hospitals?
– So, we’ve taken extra measures. So, early in the course of this, we really went and decided as a team to look at every cancer diagnosis and every patient that was diagnosed individually, and when appropriate,
we made steps to time their treatment so that we can complete their treatments without a decline in their overall outcomes. We’ve surrounded the patients now with proper distancing. We’ve been able to screen at our entrances. That includes both temperature taking, as well as a series of questions that look at risk factors. And we ask that question not only to the patient, but also their care provider. So we have now opened our doors not only for our patients, but they can provide one support person with them. Which I think is really a key part in all of this, is that as we’re able to surround our patients with their families, we know that that support that they provide, that leads to overall outcome improvements.
– And that’s so important. And there are always advancements across the medical front, and even in the field and especially in the field, of radiation. And let’s talk about some of the things that you are excited about and pleased about, looking toward the future.
– Right, so one of the things that we’ve made improvements in terms of management of head and neck malignancies is really the distinguishing between those that have virus-related disease versus those that have virus negative disease. The setting of HPV-positive patients and its prevalence within our treatment centers at this point really allows us and affords an opportunity to customize treatments. We can take every patient individually, and we can determine based upon where that disease is located whether or not surgery would be appropriate in terms of overall reducing the side effects of their outcome on maintaining cure rates that are really quite excellent. And so in instances where we utilize surgery, we’re often reducing the dose of radiation that’s delivered afterwards. There’s new clinical trials supporting that, many of which were led by our group here. In contrast, there are those individuals that would really suffer the side effects of all three modalities if they underwent surgery, radiation, and chemotherapy. There, we try to simplify those treatments and maintain a cure regimen of radiation and chemotherapy to give those excellent outcomes that we’re seeing without an increased toxicity profile.
– And as you’re always looking to make care better for patients and to make patients feel more comfortable and have better results, there’s now an enhanced clinical care team in place as well.
– Right. So we now have a team of dentists, speech and swallow experts, nurses that are all devoted to the care of our head and neck cancer patients, and where those patients that are being treated at Hillman, are surrounded by this team and with the goals of keeping them on therapy without those interruptions, again, to improve upon overall outcomes.
– Well, doctor, such great information. Dr. Andy Clump, we thank you so much for spending time with us today. We appreciate it.
– Thank you.
– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.
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The UPMC Hillman Cancer Center provides world-class cancer care, from diagnosis to treatment, to help you in your cancer battle. We are the only comprehensive cancer center in our region, as designated by the National Cancer Institute. We have more than 60 locations throughout western Pennsylvania and Ohio, with more than 200 oncologists. Our internationally renowned research team is striving to find new advances in prevention, detection, and treatment.