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Welcome to Live Well with UCI Health.

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I'm Lisa Foxx, with 104.3 MYfm

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and iHeartRadio.

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I'd like to introduce to you

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Doctor Megan E. Daly.

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She's a national leader

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in cancer radiation therapy

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who was recently recruited

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to lead radiation

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oncology services for UCI Health

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Chao Family Comprehensive Cancer Center,

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the only Orange County

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based comprehensive center

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designated by the National Cancer

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Institute.

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She also serves as chair

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of the UC Irvine School of Medicine’s

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Department of Radiation Oncology.

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Board certified

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in radiation oncology

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her clinical focus

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has been

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in the treatment

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of thoracic malignancies and lymphoma.

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You are a busy lady.

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That is a mouthful and a lot going

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on, so thanks so much

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for your time today.

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Thank you so much for having me on.

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I always like to start

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these questions before we have our chat.

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What why this area of medicine for you?

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You know,

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you have so many choices

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in the world of medicine.

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And when you're studying,

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why radiation therapy?

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You know,

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I discovered radiation

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oncology in medical school

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almost by chance.

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I had several friends

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that had spent some time

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in the department and really enjoyed it.

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I had an open elective

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and they suggested that I check it out,

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and I ended up

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just absolutely loving the field.

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I was already interested in oncology

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and taking care of cancer patients,

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but it's a very unique

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area of oncology

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where you get to think about anatomy

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and think

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spatially and play

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with a lot of high-tech equipment

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and fun technology.

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And so for me, it was just this neat

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mix of patient care and technology

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and constantly changing technology,

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and it gave me the opportunity

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to do occasional procedures

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to see patients in clinic

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and to

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spend time on images

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and with the technology

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behind the scenes.

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And a chance to help so many. Absolutely.

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A chance to help cancer patients

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in such a meaningful way.

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So how many years now has it been

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that you've been kind of

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focused on this area?

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Are coming up on close to 15. 15?

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Okay. Well, let's get into it.

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People who are newly diagnosed

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with cancer are understandably fearful.

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It's a crazy thing

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to be diagnosed of many,

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you know,

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I'm sure like you,

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friends and loved ones.

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And of course, they're gonna have

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a ton of questions and concerns

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about treatment options,

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even help with understanding

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what the options are.

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Is it surgery? Chemotherapy?

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Like what do all these things mean?

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All these new words

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become a part of their life.

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How would you describe

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what radiation therapy is?

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Radiation

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therapy is just using high-energy

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X-rays to kill tumors.

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And that can be done

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in all sorts of different ways.

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It can be done on its own

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as just a treatment by itself.

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It can be done after surgery

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to sort of mop up after the surgery.

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It can be done in combination

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with chemotherapy again

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to try and help cure patients.

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And sometimes it can also

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be done to relieve symptoms,

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which can be some of the most

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satisfying cases that we can do.

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I saw online

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that actually radiation

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therapy kind of began

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like in the late 1800s.

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And like,

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I mean, look

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how I'd like to say how far we've come.

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I mean, from

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I can just envision

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like a big clunky old machine

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to what we have now.

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Can you kind of touch on the evolution

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of radiation therapy?

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Radiation has been around for a long time

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and we have come a very long way.

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The earliest radiation

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treatments were fairly primitive.

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They didn't even use what

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we call linear accelerators.

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So they used actual cobalt sources

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that were a lot

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riskier and a lot harder to to aim

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carefully and precisely.

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That gave

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way to the modern linear accelerators

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that allow us to really aim

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radiation in a careful

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and focused way at a specific area,

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at a specific tumor.

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And then gradually

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over the last few decades,

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we've really had a lot of advancements

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in the technology

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where we're able

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to really sculpt radiation

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dose carefully around the tumor

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so we can avoid nearby

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structures like a spinal cord

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or a carotid gland.

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Yeah, yeah.

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Important things to avoid.

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Yes. We're able to account for motion.

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So we're able to turn a beam off

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and on while somebody's breathing

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or actually track

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a tumor while it's moving.

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Because you think about it, many organs

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in our body actually move.

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So there have been incredible

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advances, though,

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even if we go back many decades,

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radiation has been curing patients

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even since,

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you know, many decades

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ago, for example,

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some of the first cures

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for Hodgkin's disease in the 50s and 60s.

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I love hearing you talk about it.

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I feel like you get excited.

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Is it

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like it's like

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the mixture of science of it

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too, right? The science part of it.

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It's so exciting.

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The science is exciting,

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and the being able

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to apply that science to cure

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patients is just really,

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really rewarding in the field.

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What about, again, for

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not just people who are newly diagnosed,

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but also people who just hear the word

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radiation and get,

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you know, fearful of that word?

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And what does that word mean?

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How how safe is it for cancer care?

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I mean, you're kind of talking about,

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you know, these great stories

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I've also heard

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now I know we’re

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going to talk about some myths

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in a bit, but,

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you know,

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it can kill

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the it's supposed to kill the bad cells,

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but it can also kill

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some of the good cells.

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Well.

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That's where a lot of our recent

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technology is so important

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in allowing us to really minimize

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how much radiation actually goes to

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those good cells that are nearby.

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You can hone in, maybe better?

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You can hone in much better.

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And it is true

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that there are still some side

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effects to radiation.

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There are to just about any treatment,

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but the side effects in many cases

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are so much less than they used to be

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because of our ability to really shape

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the radiation and carefully

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focus it away

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from those important structures

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that we need to avoid.

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Can I ask what now,

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what does radiation therapy look like?

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Is it a machine?

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Or like my girlfriend who has metastatic

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breast cancer.

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She's got a port in her chest.

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Does it does it plug in for some people?

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Is it a machine for other people?

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So the majority of radiation

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treatments are what we call

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external beam radiation

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or external radiation.

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And they're delivered with a big machine

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called a linear accelerator.

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So for the patient,

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what that means

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is that they come into the clinic

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and they're brought into a big room,

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and they lay down on a table.

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And there's usually a couple of

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technicians that we call

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radiation therapists who helped

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set them up on that table.

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And then they step out of the room,

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but they carefully watch them on a camera

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and communicate back and forth with them

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while they're delivering the treatment,

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and a machine moves around them

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while they're being treated.

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They don't feel anything.

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It's kind of like having a CT

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scan or an X-ray done.

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In terms of... Okay, I was going to say, 

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is it MRI loud where it can be that...

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It's not, it’s not as

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loud... Thank God... as an MRI...

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Those can be tough

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It's also not as claustrophobia inducing.

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Thank you for that.

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Okay, doctor, let's touch

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on some of these myths, okay?

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Myth number

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one, treatment will make me radioactive,

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and I have to avoid my family,

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my friends, especially kids

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and pregnant women.

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This old radioactive myth.

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Talk about that.

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So, external radiation

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treatments that I was,

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was just describing a minute ago.

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Those do not make you radioactive

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in any way, shape or form.

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These X-rays just pass

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straight through you

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and you are immediately

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safe to be around anyone.

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You can hold a baby on your lap.

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You can be around a pregnant woman.

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You are not radioactive

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in any way, shape or form.

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The only type of radiation treatments

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where there is any concern

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for radioactivity

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is something called brachytherapy.

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So there are select procedures,

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for example, certain types

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of prostate cancer treatments

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where small radioactive

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seeds are actually placed

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into the prostate gland. Okay.

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And then there will be a brief

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period of time

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where patients who have those procedures

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need to be a little bit careful,

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for example, around pregnant women.

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And they would be given

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very careful instructions about that.

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Just like stay home,

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Tom, for a day or two, right?

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Just relax,

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let it do its job, let it, you know.

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Right.

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But just maybe take a break

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from everybody.

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Okay. But not for too long. Yeah.

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And similarly there's some

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some radioactive drugs

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that are occasionally given... Okay...

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where there are similar instructions,

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but the vast majority of radiation

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treatments are delivered

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with a big machine.

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The X-rays pass right through you,

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and there is absolutely no concern

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about being radioactive at all.

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See how far we've come.

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That sounds great.

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Okay. Myth.

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Another myth.

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I will lose all my hair.

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Much like people

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who go to chemotherapy do.

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Do you lose your hair with radiation?

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So the only way

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you will lose your hair with radiation

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is if we were aiming at your head.

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So there are some select treatments

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where we might need to do...

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Like brain tumors? Radiation treatment. Yes.

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Certain types of brain tumors.

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And a patient's doctor

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will talk to them about that

00:07:48:16 - 00:07:50:15
if hair loss is a risk.

00:07:50:15 - 00:07:51:17
Otherwise the vast

00:07:51:17 - 00:07:53:06
majority of radiation treatments,

00:07:53:06 - 00:07:54:11
anything elsewhere in the body.

00:07:54:11 - 00:07:56:04
There is not a risk of hair loss

00:07:56:04 - 00:07:56:22
other than that

00:07:56:22 - 00:07:58:11
specific part of the body.

00:07:58:11 - 00:08:00:08
So if you had a tumor on your leg

00:08:00:08 - 00:08:01:14
and we needed to radiate your leg,

00:08:01:14 - 00:08:02:16
we might cause a little bit of your leg

00:08:02:16 - 00:08:04:01
hair to fall out.

00:08:04:01 - 00:08:05:15
And and doctors

00:08:05:15 - 00:08:07:13
should be able to describe that very carefully 

00:08:07:13 - 00:08:09:09
to you ahead of time. Sure, sure.

00:08:09:09 - 00:08:10:15
But we do not cause

00:08:10:15 - 00:08:11:14
hair loss in the same way

00:08:11:14 - 00:08:12:18
that chemo does.

00:08:12:18 - 00:08:13:17
Radiation burns

00:08:13:17 - 00:08:15:09
the skin and can be very painful.

00:08:15:09 - 00:08:16:09
Myth? Yeah?

00:08:16:09 - 00:08:17:20
There are some select cases

00:08:17:20 - 00:08:19:13
where there can be some skin irritation.

00:08:19:13 - 00:08:20:18
And this is an area where

00:08:20:18 - 00:08:21:16
we've come a long way

00:08:21:16 - 00:08:23:05
in recent years as well.

00:08:23:05 - 00:08:24:11
Even when I was in training,

00:08:24:11 - 00:08:24:23
many women

00:08:24:23 - 00:08:25:09
going through

00:08:25:09 - 00:08:26:09
breast cancer treatment

00:08:26:09 - 00:08:28:11
did get some significant redness

00:08:28:11 - 00:08:29:17
or tanning of their breast,

00:08:29:17 - 00:08:32:22
and a lot of that is much less nowadays.

00:08:33:09 - 00:08:34:13
That being said, depending

00:08:34:13 - 00:08:35:13
on the part of the body

00:08:35:13 - 00:08:36:06
that we're treating,

00:08:36:06 - 00:08:37:14
if we need to treat close

00:08:37:14 - 00:08:38:22
to the surface of the skin,

00:08:38:22 - 00:08:39:22
there can be essentially

00:08:39:22 - 00:08:41:20
a sunburn type reaction.

00:08:41:20 - 00:08:43:02
Many other types of treatment,

00:08:43:02 - 00:08:45:00
there is no skin reaction at all.

00:08:45:00 - 00:08:45:11
For example,

00:08:45:11 - 00:08:46:21
I treat a lot of lung cancers,

00:08:46:21 - 00:08:48:00
and it's very rare that we ever see

00:08:48:00 - 00:08:51:00
any sort of skin irritation or redness

00:08:51:00 - 00:08:51:22
or even tanning

00:08:51:22 - 00:08:53:12
when we're treating a lung tumor,

00:08:53:12 - 00:08:54:18
because it's deep inside the body,

00:08:54:18 - 00:08:56:00
so we're aiming at something

00:08:56:00 - 00:08:56:22
deep inside the body,

00:08:56:22 - 00:08:58:06
and there's almost no radiation

00:08:58:06 - 00:09:00:00
dose to the skin in those cases.

00:09:00:00 - 00:09:00:15
It's so amazing.

00:09:00:15 - 00:09:01:17
Like, would you attribute that to

00:09:01:17 - 00:09:02:05
mostly like,

00:09:02:05 - 00:09:02:13
you know,

00:09:02:13 - 00:09:04:03
funding for new technology, right?

00:09:04:03 - 00:09:05:17
I mean, these machines are much better.

00:09:05:17 - 00:09:07:01
I mean, we've gotten so advanced

00:09:07:01 - 00:09:07:19
in technology

00:09:07:19 - 00:09:08:14
where there's just less

00:09:08:14 - 00:09:09:15
and less side effects.

00:09:09:15 - 00:09:11:05
I do think as our ability

00:09:11:05 - 00:09:12:05
to carefully target

00:09:12:05 - 00:09:13:20
radiation gets better,

00:09:13:20 - 00:09:15:02
it does reduce side

00:09:15:02 - 00:09:16:07
effects. Lung cancer

00:09:16:07 - 00:09:18:10
is such a good example of that.

00:09:18:10 - 00:09:19:08
If we think go back,

00:09:19:08 - 00:09:20:03
say 25,

00:09:20:03 - 00:09:21:11
30 years ago,

00:09:21:11 - 00:09:23:05
lung tumors were typically treated

00:09:23:05 - 00:09:24:18
with just a couple of beams

00:09:24:18 - 00:09:26:04
sort of passing through the chest

00:09:26:04 - 00:09:27:06
and aiming at the tumor.

00:09:27:06 - 00:09:28:04
And there ended up

00:09:28:04 - 00:09:29:21
being some radiation dose

00:09:29:21 - 00:09:31:10
going all the way out to the chest wall

00:09:31:10 - 00:09:32:23
and potentially causing,

00:09:32:23 - 00:09:33:05
you know,

00:09:33:05 - 00:09:34:22
the sunburn type reaction on the chest.

00:09:34:22 - 00:09:35:14
And nowadays

00:09:35:14 - 00:09:37:22
it's really sculpted and careful.

00:09:37:22 - 00:09:38:15
We have much better

00:09:38:15 - 00:09:39:20
imaging to tell us exactly

00:09:39:20 - 00:09:40:16
where that tumor is.

00:09:40:16 - 00:09:42:16
We're able to be much more focused.

00:09:42:16 - 00:09:44:05
And so we're not getting all of that

00:09:44:05 - 00:09:45:18
extra dose to surrounding

00:09:45:18 - 00:09:47:22
not only skin, but lung, lung

00:09:47:22 - 00:09:50:02
tissue, heart, esophagus... Not

00:09:50:02 - 00:09:51:09
causing extra problems.

00:09:51:09 - 00:09:52:10
All these extra organs.

00:09:52:10 - 00:09:53:00
Lung cancer,

00:09:53:00 - 00:09:54:11
is that your primary area of expertise?

00:09:54:11 - 00:09:56:03
That is the primary area

00:09:56:03 - 00:09:58:08
that I've done most of my research in.

00:09:58:08 - 00:09:59:09
And it's one of the areas

00:09:59:09 - 00:10:01:00
I see patients in clinically.

00:10:01:00 - 00:10:01:13
I also see

00:10:01:13 - 00:10:02:16
breast cancer patients

00:10:02:16 - 00:10:04:12
and lymphoma patients.

00:10:04:12 - 00:10:04:19
Okay.

00:10:04:19 - 00:10:05:23
Another myth here,

00:10:05:23 - 00:10:07:06
radiation is only used

00:10:07:06 - 00:10:09:19
as a last resort to treat cancer.

00:10:09:19 - 00:10:12:06
Now that that is definitely not true.

00:10:12:06 - 00:10:13:09
Radiation actually plays

00:10:13:09 - 00:10:15:09
a really pivotal role

00:10:15:09 - 00:10:17:17
in all stages of cancer.

00:10:17:17 - 00:10:19:10
It's oftentimes part of

00:10:19:10 - 00:10:20:03
or even the

00:10:20:03 - 00:10:23:03
sole part of a curative treatment.

00:10:23:12 - 00:10:25:14
Just thinking of a couple of examples,

00:10:26:15 - 00:10:27:08
early stage

00:10:27:08 - 00:10:28:18
lung cancer for patients

00:10:28:18 - 00:10:30:09
who cannot have surgery.

00:10:30:09 - 00:10:31:15
Radiation has high cure

00:10:31:15 - 00:10:32:22
rates in that setting.

00:10:32:22 - 00:10:34:13
Just radiation by itself,

00:10:34:13 - 00:10:35:18
usually somewhere between one

00:10:35:18 - 00:10:37:11
and five treatments total.

00:10:37:11 - 00:10:38:22
So literally there are cases where

00:10:38:22 - 00:10:39:17
someone could come in

00:10:39:17 - 00:10:41:19
for one single treatment

00:10:41:19 - 00:10:42:16
and have an early stage

00:10:42:16 - 00:10:44:20
lung cancer cured.

00:10:44:20 - 00:10:46:00
There are types of lymphoma

00:10:46:00 - 00:10:47:11
that can be cured

00:10:47:11 - 00:10:49:13
just with radiation on its own.

00:10:49:13 - 00:10:51:16
Certain types of low grade lymphomas.

00:10:51:16 - 00:10:52:09
Using the C word.

00:10:52:09 - 00:10:54:19
Be careful now, but that's promising.

00:10:54:19 - 00:10:56:09
That's promising to hear that. Yes.

00:10:56:09 - 00:10:57:14
And that's what you deal with in your office

00:10:57:14 - 00:10:58:01
every day.

00:10:58:01 - 00:10:59:08
It is... On a regular basis...

00:10:59:08 - 00:11:00:01
On a regular basis.

00:11:00:01 - 00:11:00:20
It is. Okay...

00:11:00:20 - 00:11:01:17
Another myth:

00:11:01:17 - 00:11:02:18
a radiation treatment

00:11:02:18 - 00:11:05:00
will cause another cancer later.

00:11:05:00 - 00:11:06:20
There is some kernel of truth to this,

00:11:06:20 - 00:11:07:09
this myth.

00:11:07:09 - 00:11:10:09
Radiation can cause other cancers.

00:11:10:13 - 00:11:11:19
It's one of the things we know

00:11:11:19 - 00:11:12:16
about radiation

00:11:12:16 - 00:11:15:18
in every setting, medical or otherwise.

00:11:15:23 - 00:11:17:03
Cancers caused by

00:11:18:02 - 00:11:19:04
after treatment

00:11:19:04 - 00:11:22:04
related radiation are quite rare,

00:11:22:05 - 00:11:24:03
and those are partly related

00:11:24:03 - 00:11:25:06
to how large an area

00:11:25:06 - 00:11:26:02
we have to treat

00:11:26:02 - 00:11:27:12
as well as the doses we use.

00:11:27:12 - 00:11:28:11
And they're typically something

00:11:28:11 - 00:11:30:00
that comes on many years later.

00:11:30:00 - 00:11:31:01
So the area where we

00:11:31:01 - 00:11:31:18
worry about this

00:11:31:18 - 00:11:34:18
most is using radiation in children,

00:11:34:19 - 00:11:35:18
because they oftentimes

00:11:35:18 - 00:11:38:11
have many decades to develop new cancers. Okay.

00:11:38:11 - 00:11:39:15
Although I don't personally

00:11:39:15 - 00:11:42:03
treat pediatric cancer patients,

00:11:42:03 - 00:11:43:16
that is an area where we try

00:11:43:16 - 00:11:44:22
and be very cautious

00:11:44:22 - 00:11:46:22
about the use of radiation. Sure.

00:11:46:22 - 00:11:48:04
in adults,

00:11:48:04 - 00:11:49:19
a cancer resulting

00:11:49:19 - 00:11:51:09
as a side effect of the treatment

00:11:51:09 - 00:11:52:15
many years later is rare,

00:11:52:15 - 00:11:54:03
but it's something that I always discuss

00:11:54:03 - 00:11:54:21
with my patients.

00:11:54:21 - 00:11:55:12
I was gonna say, like,

00:11:55:12 - 00:11:56:14
we're talking about all these,

00:11:56:14 - 00:11:57:01
you know,

00:11:57:01 - 00:11:57:22
when you talk about pros

00:11:57:22 - 00:11:59:03
and cons of radiation therapy,

00:11:59:03 - 00:12:00:06
it sounds like

00:12:00:06 - 00:12:01:22
you're definitely leaning on the pro side

00:12:01:22 - 00:12:02:23
based on what I'm hearing. Yeah.

00:12:02:23 - 00:12:04:01
But this is always

00:12:04:01 - 00:12:05:10
one of these things that we would discuss

00:12:05:10 - 00:12:06:00
with patients

00:12:06:00 - 00:12:07:10
as a potential risk, knowing

00:12:07:10 - 00:12:08:23
that every treatment does have

00:12:08:23 - 00:12:11:06
possible risks or side effects.

00:12:11:06 - 00:12:13:10
If a person who is recently diagnosed

00:12:13:10 - 00:12:16:01
do they need to stop taking supplements,

00:12:16:01 - 00:12:16:21
or is there anything they would

00:12:16:21 - 00:12:17:04
kind of

00:12:17:04 - 00:12:18:08
like interact with radiation

00:12:18:08 - 00:12:20:05
therapy in a bad way, or... There

00:12:20:05 - 00:12:21:09
are not too many things

00:12:21:09 - 00:12:23:10
that would interact badly with radiation.

00:12:23:10 - 00:12:25:04
I always recommend that patients

00:12:25:04 - 00:12:26:11
still let their doctors know

00:12:26:11 - 00:12:28:02
about any supplements they're on.

00:12:28:02 - 00:12:30:06
There are some very rare supplements

00:12:30:06 - 00:12:30:23
that would honestly be

00:12:30:23 - 00:12:31:23
pretty hard to track down

00:12:31:23 - 00:12:33:05
that can act as radiation

00:12:33:05 - 00:12:34:19
sensitizers or protectants,

00:12:34:19 - 00:12:36:21
but those are unusual.

00:12:36:21 - 00:12:37:21
I still ask my patients

00:12:37:21 - 00:12:39:05
for a list of their medications

00:12:39:05 - 00:12:40:16
just so we can review. Yeah. All the medications.

00:12:40:16 - 00:12:41:17
All the supplements. Yeah.

00:12:41:17 - 00:12:42:14
All this stuff. Yeah.

00:12:42:14 - 00:12:43:10
And they're more common

00:12:43:10 - 00:12:44:18
that they interact with the drugs

00:12:44:18 - 00:12:45:08
they might receive

00:12:45:08 - 00:12:46:18
as part of their treatment too.

00:12:46:18 - 00:12:47:09
Sure, sure.

00:12:47:09 - 00:12:49:05
Are there certain groups of people

00:12:49:05 - 00:12:50:14
that could benefit more so

00:12:50:14 - 00:12:52:00
or even like you mentioned, you’re,

00:12:52:00 - 00:12:53:21
you know, curing,

00:12:53:21 - 00:12:55:14
some folks being cured

00:12:55:14 - 00:12:57:08
per se by radiation therapy.

00:12:57:08 - 00:12:58:05
Are there any like,

00:12:58:05 - 00:12:59:13
certain types of people that may benefit

00:12:59:13 - 00:13:00:23
more from radiation therapy?

00:13:00:23 - 00:13:03:08
It's more specific

00:13:03:08 - 00:13:05:16
cancer stages... Types of cancer? And types

00:13:05:16 - 00:13:08:16
that that can specifically benefit.

00:13:09:01 - 00:13:10:01
Though honestly,

00:13:10:01 - 00:13:11:12
there's very few types of cancer

00:13:11:12 - 00:13:12:08
where radiation

00:13:12:08 - 00:13:15:08
is not used in some form or fashion,

00:13:15:08 - 00:13:16:14
but some of the areas

00:13:16:14 - 00:13:18:11
where it's used very prominently

00:13:18:11 - 00:13:19:18
and successfully.

00:13:19:18 - 00:13:21:18
Prostate cancer can absolutely

00:13:21:18 - 00:13:23:04
be cured with radiation.

00:13:24:05 - 00:13:24:22
It is...

00:13:24:22 - 00:13:26:00
Radiation is frequently

00:13:26:00 - 00:13:28:21
used for breast cancer after surgery.

00:13:28:21 - 00:13:30:15
Lymphomas are highly responsive

00:13:30:15 - 00:13:32:01
to radiation,

00:13:32:01 - 00:13:33:17
and it's used quite a bit

00:13:33:17 - 00:13:34:16
in that setting.

00:13:34:16 - 00:13:37:12
Lung cancer, my area, early

00:13:37:12 - 00:13:38:20
stage lung cancers, locally

00:13:38:20 - 00:13:40:12
advanced lung cancers.

00:13:40:12 - 00:13:41:18
There's a pretty major role

00:13:41:18 - 00:13:44:00
for radiation in the lung cancer space.

00:13:44:00 - 00:13:44:13
But again,

00:13:44:13 - 00:13:46:14
just about every type of cancer,

00:13:46:14 - 00:13:48:16
there is an important role for radiation

00:13:48:16 - 00:13:50:01
as one of the three

00:13:50:01 - 00:13:51:02
main modalities

00:13:51:02 - 00:13:52:04
that we use: surgery,

00:13:52:04 - 00:13:53:19
systemic therapy or drugs

00:13:53:19 - 00:13:55:07
and radiation treatment.

00:13:55:07 - 00:13:56:23
They're really all

00:13:56:23 - 00:13:57:21
working together

00:13:57:21 - 00:13:59:02
to try and do the best

00:13:59:02 - 00:14:00:12
we can for our patients.

00:14:00:12 - 00:14:01:14
I feel like what I'm hearing is

00:14:01:14 - 00:14:02:09
like in the past,

00:14:02:09 - 00:14:04:02
maybe some people have this,

00:14:04:02 - 00:14:04:20
doom and gloom

00:14:04:20 - 00:14:06:00
idea of

00:14:06:00 - 00:14:08:17
radiation could be just, like, awful.

00:14:08:17 - 00:14:10:18
And you make it sound so promising.

00:14:10:18 - 00:14:11:12
And again,

00:14:11:12 - 00:14:13:02
how far has come with the technology.

00:14:13:02 - 00:14:15:18
You love what it does for your patients

00:14:15:18 - 00:14:16:19
and for people in general

00:14:16:19 - 00:14:18:22
who are cancer affected. Absolutely.

00:14:18:22 - 00:14:20:03
There are so many settings

00:14:20:03 - 00:14:21:11
where it really

00:14:21:11 - 00:14:23:02
has very few side effects

00:14:23:02 - 00:14:25:08
and can have great outcomes.

00:14:25:08 - 00:14:26:05
And I've already talked

00:14:26:05 - 00:14:27:03
about some of the settings

00:14:27:03 - 00:14:29:20
where it can potentially cure people.

00:14:29:20 - 00:14:31:08
There's also a lot of settings for even

00:14:31:08 - 00:14:33:21
if it's not potentially curing somebody,

00:14:33:21 - 00:14:35:11
it can be incredibly helpful

00:14:35:11 - 00:14:38:11
in reducing symptoms from cancer too.

00:14:38:11 - 00:14:39:09
We use radiation

00:14:39:09 - 00:14:42:09
a lot to reduce or eliminate pain

00:14:42:12 - 00:14:44:01
or even to treat emergencies,

00:14:44:01 - 00:14:45:15
for example, an airway obstruction.

00:14:45:15 - 00:14:46:06
We can sometimes

00:14:46:06 - 00:14:48:17
use radiation emergently to

00:14:48:17 - 00:14:50:03
help open up somebody's airway.

00:14:50:03 - 00:14:51:22
There's there's really a,

00:14:51:22 - 00:14:52:05
you know,

00:14:52:05 - 00:14:53:18
a wide range of things that we can do

00:14:53:18 - 00:14:55:12
with radiation for our patients.

00:14:55:12 - 00:14:56:14
Look at that. Okay.

00:14:56:14 - 00:14:57:11
So as a national leader

00:14:57:11 - 00:14:59:16
in clinical trials for radiation therapy,

00:14:59:16 - 00:15:00:21
serving as co-chair

00:15:00:21 - 00:15:01:21
of the National

00:15:01:21 - 00:15:02:21
Cancer Institute’s

00:15:02:21 - 00:15:05:17
Thoracic Malignancy Steering Committee,

00:15:05:17 - 00:15:06:09
what exciting

00:15:06:09 - 00:15:07:13
clinical trials are underway

00:15:07:13 - 00:15:09:06
now or will be opening at UCI Health?

00:15:09:06 - 00:15:11:10
Clinical trials can be such a

00:15:11:10 - 00:15:13:11
such a game changer and a life saver.

00:15:13:11 - 00:15:14:23
So talk about that.

00:15:14:23 - 00:15:16:23
Yeah, we do have a nice portfolio

00:15:16:23 - 00:15:18:16
of clinical trials

00:15:18:16 - 00:15:20:08
in the radiation oncology department

00:15:20:08 - 00:15:21:06
and at the Chao Family

00:15:21:06 - 00:15:23:06
Comprehensive Cancer Center,

00:15:23:06 - 00:15:25:01
specifically in radiation oncology.

00:15:25:01 - 00:15:25:13
Right now

00:15:25:13 - 00:15:27:16
we have multiple trials open

00:15:27:16 - 00:15:28:15
that are part of big

00:15:28:15 - 00:15:30:01
national cooperative groups,

00:15:30:01 - 00:15:31:01
meaning large groups

00:15:31:01 - 00:15:32:21
from many institutions take part.

00:15:32:21 - 00:15:33:16
And these are really

00:15:33:16 - 00:15:35:17
where a lot of the trials that are

00:15:35:17 - 00:15:39:07
big randomized practice changing studies

00:15:39:07 - 00:15:40:08
that try and establish

00:15:40:08 - 00:15:41:11
new standards of care

00:15:41:11 - 00:15:43:13
where hundreds of patients take part.

00:15:43:13 - 00:15:45:05
So, for example,

00:15:45:05 - 00:15:46:06
we have a trial open

00:15:46:06 - 00:15:46:18
looking at

00:15:46:18 - 00:15:48:14
using higher doses of radiation

00:15:48:14 - 00:15:50:19
in unresectable pancreatic cancer.

00:15:50:19 - 00:15:51:20
We have a trial open

00:15:51:20 - 00:15:53:04
looking at incorporating

00:15:53:04 - 00:15:54:13
very focused radiation

00:15:54:13 - 00:15:56:08
for hepatocellular carcinoma,

00:15:56:08 - 00:15:57:14
meaning liver cancer.

00:15:57:14 - 00:15:58:14
We have a trial looking

00:15:58:14 - 00:15:59:21
at using radiation

00:15:59:21 - 00:16:02:21
in renal cell carcinoma

00:16:03:02 - 00:16:04:08
in place of surgery

00:16:04:08 - 00:16:06:14
in combination with a type of drug

00:16:06:14 - 00:16:07:23
called immunotherapy.

00:16:07:23 - 00:16:10:05
And these are all big trials where these

00:16:10:05 - 00:16:11:03
these studies are open

00:16:11:03 - 00:16:12:12
all over the country,

00:16:12:12 - 00:16:14:14
but specifically here at UC

00:16:14:14 - 00:16:15:18
Irvine Health as well.

00:16:15:18 - 00:16:16:17
And then we also try

00:16:16:17 - 00:16:17:00
and have

00:16:17:00 - 00:16:18:08
trials open in our department

00:16:18:08 - 00:16:19:01
that are

00:16:19:01 - 00:16:21:03
small studies looking at really novel,

00:16:21:03 - 00:16:23:00
novel things and trying to offer things

00:16:23:00 - 00:16:25:15
that patients may not have access to

00:16:25:15 - 00:16:27:03
most places.

00:16:27:03 - 00:16:28:03
And there's a couple of

00:16:28:03 - 00:16:28:21
interesting trials

00:16:28:21 - 00:16:30:06
that have been done recently

00:16:30:06 - 00:16:32:03
by some of my faculty,

00:16:32:03 - 00:16:33:17
for example, a trial

00:16:33:17 - 00:16:36:03
looking at incorporating radiation

00:16:36:03 - 00:16:36:21
in combination

00:16:36:21 - 00:16:39:21
with an ablative technology called PEF

00:16:40:00 - 00:16:41:04
for tumors in the lung

00:16:41:04 - 00:16:42:04
that are kind of hard to treat

00:16:42:04 - 00:16:43:10
with just one or the other.

00:16:43:10 - 00:16:44:16
So combining the two.

00:16:44:16 - 00:16:45:06
But that's what's great

00:16:45:06 - 00:16:46:04
about clinical trials, right?

00:16:46:04 - 00:16:46:20
I feel like clinical

00:16:46:20 - 00:16:48:05
trials are kind of like a,

00:16:48:05 - 00:16:49:20
you know, a few doctors get together.

00:16:49:20 - 00:16:50:18
I don't know, they're like,

00:16:50:18 - 00:16:52:17
hey, I got this idea,

00:16:52:17 - 00:16:54:02
let's give it a shot and see.

00:16:54:02 - 00:16:55:11
Don't tell the big guys at the top,

00:16:55:11 - 00:16:56:18
but want to just try it

00:16:56:18 - 00:16:58:14
and see if it's affective.

00:16:58:14 - 00:16:59:20
Because if you don't take a risk

00:16:59:20 - 00:17:00:12
on some of these things,

00:17:00:12 - 00:17:01:20
sometimes people don't have any,

00:17:01:20 - 00:17:02:18
any other options.

00:17:02:18 - 00:17:04:07
But I'm sure there's different stages

00:17:04:07 - 00:17:04:15
where you are

00:17:04:15 - 00:17:05:04
for clinical

00:17:05:04 - 00:17:06:02
trials, maybe early

00:17:06:02 - 00:17:09:01
on, or maybe if they have a stage four

00:17:09:01 - 00:17:10:19
and it's not looking good.

00:17:10:19 - 00:17:11:12
Yeah, there's

00:17:11:12 - 00:17:11:16
you know,

00:17:11:16 - 00:17:13:08
I would also stress that all trials

00:17:13:08 - 00:17:15:09
go through a very rigorous review

00:17:15:09 - 00:17:16:21
to make sure that they are

00:17:16:21 - 00:17:19:04
in the best interests of our patients,

00:17:19:04 - 00:17:21:04
so that we have layers of review

00:17:21:04 - 00:17:22:11
with scientific committees

00:17:22:11 - 00:17:23:07
and an IRB

00:17:23:07 - 00:17:23:17
to make

00:17:23:17 - 00:17:25:02
sure that everybody's in agreement

00:17:25:02 - 00:17:26:17
that these are appropriate

00:17:26:17 - 00:17:27:22
and as safe as possible

00:17:27:22 - 00:17:29:05
to be offering to our patients.

00:17:29:05 - 00:17:30:02
But yes, the types of

00:17:30:02 - 00:17:31:07
studies that we offer,

00:17:32:07 - 00:17:32:13
you know,

00:17:32:13 - 00:17:33:03
in a setting where

00:17:33:03 - 00:17:33:11
there's not

00:17:33:11 - 00:17:34:08
a lot of other options

00:17:34:08 - 00:17:35:00
are very different

00:17:35:00 - 00:17:36:06
than the types of trials

00:17:36:06 - 00:17:37:14
that we offer where we already have

00:17:37:14 - 00:17:38:23
excellent cure rates.

00:17:38:23 - 00:17:39:14
Yeah, I was going to say,

00:17:39:14 - 00:17:40:19
but you've probably seen some

00:17:40:19 - 00:17:41:14
great success stories

00:17:41:14 - 00:17:43:02
come out of these clinical trials, right?

00:17:43:02 - 00:17:44:00
Yeah, absolutely.

00:17:44:00 - 00:17:45:05
I've heard really great things.

00:17:45:05 - 00:17:46:12
What other potentially groundbreaking

00:17:46:12 - 00:17:47:17
research is underway

00:17:47:17 - 00:17:49:19
in the Department of Radiation Oncology?

00:17:49:19 - 00:17:50:21
You kind of just mentioned a bunch,

00:17:50:21 - 00:17:53:18
but... Any secrets we can know... Well, I

00:17:53:18 - 00:17:54:15
wouldn't say it's a secret,

00:17:54:15 - 00:17:56:11
but a couple of my faculty,

00:17:56:11 - 00:17:58:09
Charles Limoli and Peter Maxim, who are both

00:17:58:09 - 00:17:59:10
PhDs are

00:17:59:10 - 00:18:00:04
very active

00:18:00:04 - 00:18:03:03
in a space called flash radiotherapy,

00:18:03:05 - 00:18:04:11
which is looking at the idea

00:18:04:11 - 00:18:05:22
that when radiation is given

00:18:05:22 - 00:18:07:17
at very fast rates

00:18:07:17 - 00:18:09:03
rather than the slower rates

00:18:09:03 - 00:18:10:05
we tend to deliver it at

00:18:10:05 - 00:18:12:14
there may be an effect where you

00:18:12:14 - 00:18:14:04
would markedly reduce side

00:18:14:04 - 00:18:15:15
effects to normal tissues,

00:18:15:15 - 00:18:16:21
and this is still

00:18:16:21 - 00:18:18:05
in a pretty early phase.

00:18:18:05 - 00:18:19:17
This is still being looked at in animals,

00:18:19:17 - 00:18:21:10
but they are very excited

00:18:21:10 - 00:18:22:18
to potentially bring this

00:18:22:18 - 00:18:24:06
in early phase clinical trials

00:18:24:06 - 00:18:25:17
eventually to our patients.

00:18:25:17 - 00:18:26:03
And look,

00:18:26:03 - 00:18:27:03
and the goal really is like,

00:18:27:03 - 00:18:28:11
let's try anything that works,

00:18:28:11 - 00:18:29:10
anything that works, anything

00:18:29:10 - 00:18:30:05
and everything that works.

00:18:30:05 - 00:18:30:16
You know,

00:18:30:16 - 00:18:32:01
I feel like you guys spend

00:18:32:01 - 00:18:32:23
all day in these,

00:18:32:23 - 00:18:34:21
you know, scientists and researchers...

00:18:34:21 - 00:18:36:01
Their main goal is to see, like,

00:18:36:01 - 00:18:37:01
what can we do to break through

00:18:37:01 - 00:18:38:08
and make it go away,

00:18:38:08 - 00:18:39:12
you know, make the pain go away.

00:18:39:12 - 00:18:41:08
How has radiation therapy changed

00:18:41:08 - 00:18:43:07
since you first started in the field?

00:18:43:07 - 00:18:44:07
Well, it's a lot of the things

00:18:44:07 - 00:18:46:00
that I've already been describing to you.

00:18:46:00 - 00:18:46:22
Just finding

00:18:46:22 - 00:18:50:03
things are getting getting the technology

00:18:50:03 - 00:18:51:16
to be a little more precise.

00:18:51:16 - 00:18:52:22
The imaging is the better.

00:18:52:22 - 00:18:54:16
Our ability to shape our radiation

00:18:54:16 - 00:18:56:08
fields around tumors, our ability

00:18:56:08 - 00:18:57:08
to track tumors

00:18:57:08 - 00:18:59:07
that are moving in the lung

00:18:59:07 - 00:19:00:06
or in the abdomen.

00:19:00:06 - 00:19:02:18
Those have all definitely improved over the last

00:19:02:18 - 00:19:04:23
10 to 15 years quite a bit. I love it.

00:19:04:23 - 00:19:05:13
The other thing

00:19:05:13 - 00:19:07:07
that I think is a huge change over

00:19:07:07 - 00:19:08:01
that time frame

00:19:08:01 - 00:19:10:07
is because we're able to be more precise.

00:19:10:07 - 00:19:11:18
We we take shorter

00:19:11:18 - 00:19:13:22
courses to finish patients’ treatments,

00:19:13:22 - 00:19:15:15
which is a big convenience

00:19:15:15 - 00:19:17:01
factor for our patients. Sure, sure.

00:19:17:01 - 00:19:18:13
You know, even when I was in training,

00:19:18:13 - 00:19:19:02
a course

00:19:19:02 - 00:19:19:19
of breast cancer

00:19:19:19 - 00:19:20:16
was typically 25

00:19:20:16 - 00:19:22:22
to 30 sessions or five to six weeks.

00:19:22:22 - 00:19:25:05
Now it's it's five to 15 sessions

00:19:25:05 - 00:19:26:10
or one to three weeks.

00:19:26:10 - 00:19:27:11
So we've really shortened

00:19:27:11 - 00:19:28:16
that period down.

00:19:28:16 - 00:19:30:23
Oh that's very encouraging.

00:19:30:23 - 00:19:32:03
The UCI Health Chao

00:19:32:03 - 00:19:33:07
Family Comprehensive Cancer

00:19:33:07 - 00:19:34:15
Center has been expanding

00:19:34:15 - 00:19:36:03
radiation oncology services.

00:19:36:03 - 00:19:36:23
Where can patients now

00:19:36:23 - 00:19:37:18
receive this treatment

00:19:37:18 - 00:19:39:06
and what is the future hold?

00:19:39:06 - 00:19:40:23
Well... It means great access for our patients,

00:19:40:23 - 00:19:42:00
regardless of where they live

00:19:42:00 - 00:19:45:00
in Orange County, and also

00:19:45:00 - 00:19:46:16
good access in terms of being able

00:19:46:16 - 00:19:47:09
to hopefully get in

00:19:47:09 - 00:19:48:09
and see a doctor quickly.

00:19:48:09 - 00:19:49:07
So we have

00:19:49:07 - 00:19:51:03
a department in our main

00:19:51:03 - 00:19:52:05
campus at Orange.

00:19:52:05 - 00:19:53:11
We have a radiation

00:19:53:11 - 00:19:55:00
oncology department

00:19:55:00 - 00:19:57:08
in our new cancer center in Irvine.

00:19:57:08 - 00:20:00:02
We have a recently opened cancer center

00:20:00:02 - 00:20:01:15
in Fountain Valley

00:20:01:15 - 00:20:03:13
and a cancer center 

00:20:03:13 - 00:20:05:12
in Los Alamitos as well. Look at that.

00:20:05:12 - 00:20:06:20
And of course, we're always

00:20:06:20 - 00:20:08:18
looking for other opportunities

00:20:08:18 - 00:20:10:04
to serve Orange County as well.

00:20:10:04 - 00:20:10:22
So, you know,

00:20:10:22 - 00:20:11:10
God forbid

00:20:11:10 - 00:20:12:03
you get diagnosed

00:20:12:03 - 00:20:13:12
or know someone who has, you know,

00:20:13:12 - 00:20:14:06
you got the best care

00:20:14:06 - 00:20:15:17
to offer and more places

00:20:15:17 - 00:20:16:14
in more ways for them

00:20:16:14 - 00:20:17:10
to get the best help.

00:20:17:10 - 00:20:19:02
So, okay, wonderful.

00:20:19:02 - 00:20:19:16
And then

00:20:19:16 - 00:20:20:08
what excites

00:20:20:08 - 00:20:20:15
you most

00:20:20:15 - 00:20:21:22
about coming to UCI

00:20:21:22 - 00:20:23:13
Health and UCI Irvine?

00:20:23:13 - 00:20:24:01
What makes

00:20:24:01 - 00:20:25:05
I think I already know

00:20:25:05 - 00:20:25:20
helping people,

00:20:25:20 - 00:20:28:00
but I love like seeing you smile.

00:20:28:00 - 00:20:28:13
Talk about this

00:20:28:13 - 00:20:29:20
because I feel like you really

00:20:29:20 - 00:20:30:11
what you love about

00:20:30:11 - 00:20:32:00
your job is making a difference.

00:20:32:00 - 00:20:32:06
Well,

00:20:32:06 - 00:20:33:03
we have such a great

00:20:33:03 - 00:20:34:12
multidisciplinary team here,

00:20:34:12 - 00:20:36:06
so just having that team of people

00:20:36:06 - 00:20:36:23
to work with

00:20:36:23 - 00:20:38:10
for the betterment of our patients

00:20:38:10 - 00:20:39:12
is wonderful.

00:20:39:12 - 00:20:41:12
So the combination of the surgeons,

00:20:41:12 - 00:20:42:19
the medical oncologists,

00:20:42:19 - 00:20:45:11
the other radiation oncology faculty,

00:20:45:11 - 00:20:46:12
the other staff,

00:20:46:12 - 00:20:48:18
nurses, radiation therapists, etc.

00:20:48:18 - 00:20:50:06
that all work together.

00:20:50:06 - 00:20:51:17
It's just such a great team

00:20:51:17 - 00:20:52:19
to try and work together

00:20:52:19 - 00:20:54:15
to take care of our patients.

00:20:54:15 - 00:20:55:16
And I think we have

00:20:55:16 - 00:20:57:04
wonderful resources here to

00:20:57:04 - 00:20:58:22
to do that here at the Chao Family

00:20:58:22 - 00:21:00:05
Comprehensive Cancer Center.

00:21:00:05 - 00:21:01:02
Well, thank you so much for all that

00:21:01:02 - 00:21:01:21
you do,

00:21:01:21 - 00:21:03:16
doctor Megan E. Daly

00:21:03:16 - 00:21:04:10
a national leader

00:21:04:10 - 00:21:05:15
in cancer radiation therapy.

00:21:05:15 - 00:21:07:14
And she's here at UCI Health Chao

00:21:07:14 - 00:21:09:01
Family Comprehensive Cancer Center.

00:21:09:01 - 00:21:09:08
Thank you

00:21:09:08 - 00:21:10:12
for all that you do and helping people

00:21:10:12 - 00:21:11:23
and keep bringing those

00:21:11:23 - 00:21:13:19
those cures our way. Thank you.