Easing Radiation Side Effects -- In-Depth Doctor's Interview
Maitland DeLand, M.D., discusses a way to prevent the burning and pain that comes with breast cancer radiation.
Ivanhoe Broadcast News Interview with
Maitland DeLand, M.D., Radiation Oncologist,
OncoLogics, Lafayette, Louisiana,
TOPIC: Easing Radiation Side Effects
How common is breast cancer?
Dr. DeLand: One in seven women will be diagnosed with breast cancer, and there will be 212,000 diagnosed this year.
And your mother is one of them?
Dr. DeLand: Yes. It runs in my family, and my grandmother had breast cancer. My mother had breast cancer last year, actually.
And she was in your study?
Dr. DeLand: Yes, she was. She was the very first patient in my study, and she tolerated treatment extremely well. She is very fair. She always burns, so I was very concerned about her tolerating the radiation treatment and the skin dermatitis, but she did very well.
Great. How permanent is radiation treatment for breast cancer?
Dr. DeLand: I would say at least 60 percent of the women get radiation treatment. After lumpectomy, all women get radiation treatment, which is conservative treatment for breast cancer. I would approximately 90 percent of the women now are getting lumpectomies instead of mastectomies, and after you get a lumpectomy, you need to have radiation treatment afterwards; under most circumstances.
Are these are usually stage I and stage II patients?
Dr. DeLand: I use stage I and stage II patients really for lumpectomies. The patients are typically stage I and stage II; sometimes they go down stage III and do it. But for my study, I use stage I and stage II.
Let's talk about the side effects of breast cancer radiation.
Dr. DeLand: Typical side effects of radiation include primarily radiation dermatitis, and this is when the skin turns pink. It can be light pink or a brisk pink, reddish like a sunburn, and it hurts. Also, your skin can peel, which is called a moist disclamation and, of course, there is associated swelling of the soft tissue with that.
What is the danger or risk of that soft tissue swelling developing?
Dr. DeLand: Most of the women that I see have gone through what I call a horrible triathlon, which is surgery and then chemotherapy, and finally they get to radiation. They could have had several surgical procedures. They could have an infection. They could have had fluid that had to be drained, and then they have chemotherapy. And certain agents really cause you to have a more intense radiation reaction; they sort of sensitize the skin.
So by the time the patient gets to me, if she has a bad moist breakdown of her skin, it is going to be very hard to heal. It may delay her treatment, and really it affects her psychology, emotionally -- it makes simple tasks like taking a shower painful. I mean little things we take for granted like putting on a brassiere before you go to work or go to church. I had one lady tell me one time, "I need to wear my bra so I can go to church, but it hurts too much." So these little simple things that for us we take for granted become more difficult. You know, carrying your child -- if you have a bad reaction on your chest, it's hard.
It's a huge impact on women.
Dr. DeLand: Yes. Especially at this stage, because this is like the third phase of what they have been through. They probably have already lost their hair, they have been antibiotics, they have been through low blood counts, they are tired and many of them trying to work still and be OK for their families because the mother, you know, all the kids look to the mom for everything and she has to be strong.
And it's not something you hear very much about.
Dr. DeLand: No. Because it's more of an accepted toxicity. It is sort of like you know this is going to happen. You may hear, "Oh yes, my father got radiation or my mother got radiation, and they were burned." So I have people come in and they are leery to get the radiation.
In the current treatments before this, what was used to treat this and help the burn?
Dr. DeLand: Basically, you are just treating the symptoms after it happens. There has been nothing to prevent this toxicity, and you are talking about essentially Aquaphor, different kinds of creams, sort of like getting a sunburn and then going to get some Solarcaine or something to put on afterwards to soothe it. So they are just sort of soothing lotions and creams, nothing preventative.
What exactly is LED photo-modulation?
Dr. DeLand: LED is light-emitting diodes, and this is a series of low-energy lights at a certain wavelength, frequency and pulsation that basically stimulate the skin cells to repair themselves; it is completely non-thermal, so there are no side effects.
It is currently used in dermatology clinics around the country, right?
Dr. DeLand: Yes. It is currently used for photo aging. It is used for healing burns, and that is how I got the idea to use it for my patients. It is used for also inflammatory skin conditions such as rosacea or eczema.
It is sometimes used for wrinkles, right?
Dr. DeLand: Yes. That's the primary use, and it is a different schedule; it's twice a week for wrinkles. It basically decreases the wrinkles approximately 40 percent, smoothes out any sort of skin colorations that are different like from aging, and decreases your pores. It is completely no side effects, and there is no down time. That is the nice thing about photo modulation.
And how does it do that?
Dr. DeLand: On the cellular level it basically stimulates collagen to regenerate, but it also interferes with certain pathways like cellular pathways. It interferes with the production of collagenase; it also interferes with inflammatory pathways, which that is what makes your skin pink. That is what gets your cells to start breaking down.
Why do this with women who have breast cancer?
Dr. DeLand: Well, I guess I had noticed that women were so tired by the time they got to me and having to face another toxicity that nobody had really done anything about. Nobody had thought about preventing it, and I think it is wonderful to prevent something rather than have to take care of it later. So really LED provides a protective effect for the skin, and I just think anything that can help my patients, I'm going to support.
Great. And how is it given?
Dr. DeLand: My initial protocol called for it to be given immediately after treatment, and you have an LED light panel that shines on the breast -- same as the treatment. The patient just lays there, they have goggles on, and it lasts 30 seconds. The panel is right up close to the breast. My new protocol, I'm going to do it before and after radiation treatment to try to improve on my results.
Wow. How does it work in 30 seconds?
Dr. DeLand: Basically, dermatologists have had determined that there is a certain pulsating frequency and wavelength that stimulates the cells and you need to do it for this certain period of time. So that works for this.
What did your study show? What were the results?
Dr. DeLand: Fabulous results. Ninety-five percent of my patients that receive the LED photo-modulation with the radiation had no skin reaction or very mild arrhythmia. None of my patients got a moist reaction. I was just thrilled with that.
Wow. And no patients had to have their radiation treatment stopped?
Dr. DeLand: No, not at all.
In the past, what percent of patients needed change in treatment because of the burns?
Dr. DeLand: Typically, I would say a good 30 percent. You need to stop the treatment or change it some way to get off that skin that is peeling. Now some radiation oncologists will just say you have to continue or it gets worse and worse and worse, and that is miserable.
Had any of the patients had radiation without the LED and then had it again with the LED photo-modulation?
Dr. DeLand: I actually had one patient ... has metastatic breast cancer ... and she had a similar site treated before and she told me, “I can tell a big difference, it is so much less painful, you know.” She said, “This is nothing like last time; this is much better.”
Could this be used for other radiation anywhere?
Dr. DeLand: Pretty much, pretty much -- any area where you are getting a significant skin dose, which I think head and neck patients. I actually just got off the phone with a doctor who was interested in it for his head and neck patients. Any place where there is a skin fold, you know, where you are going to get more of a reaction. Any time you have chemotherapy at the same time as you have radiation, you are going to have more of skin reaction.
Do hospitals have this usually?
Dr. DeLand: No. This is primarily cosmetic. So some dermatologists will have this. I am the first radiation oncologist to do this.
When do you think that is going to start changing and radiation oncologists across the country will begin offering the treatment?
Dr. DeLand: I have been getting quite a few calls, and I am really pleased because typically my specialty, we are interested in cure rates and morbidity to some extent, but we are more interested the patient, you know, what is the outcome? Is the patient going to live longer? And we have to start looking at toxicities like they are with chemotherapy now.
How many people were in your study?
Dr. DeLand: I have 19 people in my original study.
And are you in a second phase?
Dr. DeLand: We are starting a second phase where I am going to be treating before and after.
Will there be about the same number of patients?
Dr. DeLand: Oh, I'm going to do more. I'm going to do more.
What inspires you? What keeps you going?
Dr. DeLand: I love what I do. I love making life better for these women who have to face cancer and had this sentence. You have to do this surgery. You have to do this chemo. You have to do this radiation, and I always tease them that they have a calendar like they are in prison and they are crossing off the days they have to have radiation. And so for me, if I can make it better for them, that is what motivates me.
How exciting is this for you to be part of something like this that is actually preventing a side effect that has just been a side effect for all these years?
Dr. DeLand: I'm not really one of those scientific doctors; I am more of a down-to-earth personal doctor, and so for me to be helping somebody on a clinical level curing their cancer, making them feel better, and having fewer side effects, that is so important.
Let's say there is a woman in New York [reading this]. Would it be an option for her though? Is it a real possibility for her to go into her doctor or radiation oncologist to talk about this?
Dr. DeLand: Absolutely. I think it is very important because our two specialties don't get together, you know, cosmetic dermatology and radiation oncology. So there has been no communication. Any doctor I will send the information to so they understand what it entails, and if they do not have the machine, probably one of their dermatology colleagues has one.
Does it have to be directly after the radiation or would someone, if they really wanted this to be done, be able to get the radiation and then go to a dermatologist and get it done?
Dr. DeLand: Yes, I think that would be fine. [But] I think it would be easier, frankly, for the person to be able to do both in one place, you know what I mean because they are kind of busy running around. It would be easier for them so they don't have to go to another office. And I don't think it's an expensive unit at all compared to the linear accelerators that we buy; it's way less expensive. And it's such a nice thing for people. It just is. I think any hospital could afford it.
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END OF INTERVIEW
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