50 Years of Cancer Progress: Radiation Oncology

Name: 50 Years of Cancer Progress: Radiation Oncology
Uploaded: 2025-02-10T14:29:25.93Z
Duration: 29 min

February 10, 2025

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00:00Funding for Yale Cancer Answers
00:02is provided by Smilow Cancer
00:04Hospital.
00:06Welcome to Yale Cancer Answers
00:08with the director of the
00:09Yale Cancer Center, doctor Eric
00:11Winer.
00:12Yale Cancer Answers features conversations
00:14with oncologists and specialists
00:16who are on the forefront
00:17of the battle to fight
00:18cancer.
00:19This week, it's a conversation
00:20about radiation oncology with doctor
00:23Peter Glazer.
00:24Doctor Glazer is the Robert
00:25E. Hunter Professor of Therapeutic
00:27Radiology
00:28and Professor of Genetics and
00:30chair of the department of
00:31therapeutic radiology at the Yale
00:33School of Medicine.
00:35Here's doctor Winer.
00:37Can you just tell us
00:38a little bit about yourself?
00:40How is it
00:42that you came to be
00:43a radiation oncologist?
00:45I'm a
00:47physician scientist with an MD
00:49and a PhD in genetics,
00:51and as you mentioned,
00:52my medical specialty is in
00:53radiation oncology.
00:56And my research focuses on fundamental
00:58cancer biology and
01:01development of translational
01:02research opportunities.
01:05I got started in the
01:07field because of a strong
01:08clinical interest in oncology,
01:11and in taking care of
01:12cancer patients, and that was
01:13coupled with a growing research
01:15interest in the field of
01:17DNA repair, which is how
01:18cells fix their DNA.
01:21And that's an important topic
01:22in the field of radiation
01:23oncology.
01:25Can you just
01:27tell us a little bit
01:29about
01:30radiation as a treatment,
01:33both in terms of how
01:34it's delivered, or
01:37I should say the different
01:39ways in which it can
01:40be delivered.
01:42And then we'll explore
01:44some other aspects of radiation.
01:46Sure. Radiation
01:47oncology is the medical specialty
01:50that uses focused x rays
01:51to treat cancer
01:53because of their ability to
01:54kill cancer cells.
01:56And early medical applications of
01:58radiation were based on radioactive
02:00materials like radium
02:01that were discovered by
02:03Marie Curie, because early on
02:05it was found that radiation
02:06causes tumors to shrink.
02:09Later on, other isotopes like
02:10cobalt, iridium,
02:12and others were identified and
02:14developed,
02:15and some are used for
02:16a type of treatment called
02:17brachytherapy, which involves placement of
02:19radioactive
02:20sources
02:22in close proximity to a
02:23tumor as is frequently done
02:25for cancers of
02:28the gynecologic
02:30tract in women.
02:31So a device is actually
02:33put in and it gives
02:34off radiation
02:35while it sits
02:37essentially near or within somebody.
02:39It dwells next to the tumor.
02:45It's put in a
02:46surgical procedure, and then it's
02:48removed after a specified time.
02:51And in some other
02:53approaches, isotopes are
02:55injected systemically for special applications
02:58usually linked to a carrier
02:59like an antibody.
03:02When X rays were first
03:04developed, it was known that
03:05they could be generated by
03:06cathode ray tubes, but
03:08that was low energy and
03:09had drawbacks. So after World
03:11War II, a major advance
03:12was the development of technology
03:14to
03:15accelerate electrons
03:18at high voltage into a
03:19medical target to
03:21generate high energy x rays
03:22or photons.
03:23And that was the birth
03:24of the linear accelerator or
03:26LINAC.
03:28And this allowed for treatment
03:29of deep seated tumors in
03:30the body with sparing of
03:32superficial
03:33tissues.
03:35And it seems to me that
03:36it was the case many
03:37years ago
03:39that radiation oncologists would take
03:41an x-ray,
03:43just a standard x-ray that
03:45might show, for example, in
03:46the chest
03:47a lung cancer.
03:49And
03:50in what now seems like
03:52a pretty crude manner,
03:54they would just draw around
03:56that tumor and then aim
03:58the beam
04:00at the tumor. Is that
04:02basically right?
04:04Yes, early on
04:05the treatment machines were
04:08were limited in
04:10their ability to move and
04:11to deliver shaped beams. So
04:14most of the treatments were
04:15from the front or the
04:16back of the patient in
04:17a simple
04:18way.
04:20And so we were guided
04:21by what we kind of
04:22refer to as two dimensional
04:24imaging, which is those plain
04:25film x rays.
04:27But, one of
04:28the major advances
04:30in field has
04:32been the use of advanced
04:33imaging like CT scans, MRI
04:35scans, or now even PET
04:37scanning
04:38to create three-dimensional images
04:40of the tumor target.
04:41And that's coupled with
04:43many technological
04:45advances in the linear accelerators
04:47that allow
04:48the delivery of very complex,
04:51beam arrangements that really shape
04:53the dose distribution in a
04:55three-dimensional manner.
04:57And my sense is that
04:58by using those three-dimensional images
05:00like CT scans and with
05:02the changes in some of
05:04your,
05:05equipment that delivers radiation,
05:08two things have happened.
05:09The treatment is far more
05:11effective,
05:12and at the same time,
05:13you can spare patients a
05:15lot of the side effects
05:16that used to be pretty
05:17commonplace.
05:19That's right. Because now we
05:20can shape the dose distribution
05:22a lot more conformally
05:24to the tumor itself
05:26and substantially reduce the dose
05:27to surrounding tissues.
05:30That's allowed us to deliver
05:32the treatments
05:33much more safely with less
05:35side effects.
05:37And in some cases, we
05:38can give a higher dose
05:40each day and reduce
05:42the number of
05:43days of treatment and that's
05:45also a
05:46benefit to patients.
05:48Before we get into some
05:49additional advances,
05:51maybe you could just comment
05:53on some of the myths
05:55that people still carry around
05:57about radiation.
05:59You know, in
06:01not such a different way
06:02than with chemotherapy,
06:03there are a lot of
06:04patients who come see us
06:06and have preconceived notions about
06:09what these treatments are like
06:10and will come in saying,
06:11well, I'm never doing that
06:13because
06:14you know, my great aunt received
06:16that and had some terrible
06:18problems.
06:20What are the specific
06:22misunderstandings
06:23about radiation?
06:25Well, I think that
06:27one is,
06:28what we're alluding to before
06:30is, you know,
06:31historically, some people may remember
06:33that
06:34people treated with sort of
06:36the older fashioned ways of
06:37giving radiation developed
06:39skin burns
06:41that
06:43were very challenging to treat
06:45and to heal. But
06:47the advances that we just
06:48talked about in
06:50delivery of radiation more deeply
06:53into the body and sparing
06:54the skin with shape beams,
06:57has allowed us to substantially
06:59avoid
07:01the skin damage
07:02and also
07:03side effects to other
07:05tissues.
07:08And I'm not saying that doesn't sometimes
07:10happen. There
07:12can be some
07:13side effects to the skin,
07:14but it's much much
07:16less than it used to be for
07:18the skin and for
07:19that matter, other organs too.
07:23There is some
07:25effect of radiation as it
07:27passes through healthy tissue, and
07:29sometimes that can lead to
07:30some fatigue and temporary loss
07:32of energy.
07:34Sometimes, if patients are treated
07:36in the area of the
07:37head and neck, they may
07:38develop dry mouth,
07:41or if they're treated in
07:42the GI tract, they may
07:43have some symptoms
07:45associated with that. But, usually
07:47these symptoms fade over time.
07:49What are some of the
07:50most common uses of radiation?
07:52About sixty percent of all
07:53cancer patients
07:55are treated with radiation and
07:58many different types of tumors
07:59are treated.
08:04One very common treatment is for
08:05cancers of the head and
08:06neck where radiation is considered
08:09a curative treatment often in
08:11combination with chemotherapy.
08:13We do a lot of
08:14radiation treatments for breast cancer,
08:16prostate cancer,
08:18brain tumors,
08:20and, tumors of the GI
08:22tract. I mentioned
08:25gynecologic
08:25malignancies
08:26where radiation is very effective
08:30and routinely achieves
08:32curative effect in many of
08:33those scenarios.
08:35And in some cases, these are
08:37a substitute for
08:39surgery, and in some cases,
08:41it's done in conjunction with
08:43surgery.
08:44Radiation
08:46is particularly effective for localized
08:48disease
08:49and can be an alternative
08:51to surgery in some cases,
08:53either because the individual is
08:55not medically able to undergo an
08:59operation,
09:00or because the
09:03morbidity or side effects
09:05of getting radiation may actually be
09:08more favorable than a surgical
09:10intervention.
09:11Not so many years ago
09:12when someone would have cancer
09:14that unfortunately would spread to
09:16their brain,
09:18they very commonly would
09:20get radiation
09:22to the entire brain, to
09:24the whole head essentially.
09:26And increasingly
09:28over the years, it seems
09:30that that's not the case,
09:31and treatments that are
09:33referred to as either
09:34stereotactic
09:36radiosurgery
09:37or gamma knife
09:39have been used and have
09:41been very effective.
09:42Can you tell us a
09:43little bit about those treatments?
09:45Yes, you're absolutely
09:47right that
09:48years ago for
09:50metastases in the brain,
09:53treatment would be given to
09:54what we call the whole
09:55brain, which is basically the
09:56upper
09:57part of the head through
09:59and through. But the advances
10:01that I was alluding to
10:02in terms
10:04of the technology, the treatment
10:05machines, and also specialized devices
10:07like the gamma knife,
10:09allows very focused treatment of
10:12individual metastatic lesions,
10:15with really exquisite precision that
10:17allow
10:18a good deal of sparing
10:20of the surrounding healthy brain.
10:23So now it's pretty much
10:24standard of care to
10:26treat
10:27the metastatic lesions fairly aggressively,
10:30but with highly focused treatment.
10:32And the Gamma Knife actually
10:33is one of the best
10:34devices to do that for
10:35brain lesions because of its
10:37high precision.
10:39I mean, this has really
10:41transformed
10:42in many ways the treatment
10:44of cancer that has spread
10:45to the brain
10:46and has allowed people to
10:49live longer and at the
10:50same time live much better.
10:54And it's become especially important as systemic
10:56therapies have improved.
10:59So now we are taking
11:02a more aggressive
11:03approach to trying to
11:06treat lesions in the brain
11:08when the systemic disease can
11:10be controlled by other approaches.
11:12It seems that there are
11:14even newer approaches, and you
11:17have a new machine
11:18that gives
11:20guided radiation.
11:21And maybe you can tell
11:23us a little bit about
11:24that, and what
11:26kind of guidance is used?
11:29This is along the lines of what
11:31we call image guided therapy,
11:33in which the linear
11:34accelerators have an onboard imaging
11:36device to help
11:39us evaluate
11:41and modify the treatment
11:43at the time
11:44the patient
11:46is in the machine and
11:48in some cases almost in
11:49real time.
11:51This approach started with CT
11:53scan and MR scan,
11:56included in Lenox, but this
11:58new biologically guided therapy incorporates
12:01a PET scanner or PET
12:02imager in the device. NOTE Confidence: 0.9444651
12:04A PET scanner image
12:07positron emissions from radioactive tracers
12:10that
12:11accumulate in the tumor when
12:13certain
12:14compounds are given to the
12:15patient ahead of time. And
12:17that allows us to account
12:19for the localization of the
12:21tumor,
12:22and also its motion within
12:24the patient, and in some
12:26cases depending on the tracer
12:28we use on its biological
12:29properties.
12:30And then we can modify
12:33the treatment, beamlets,
12:35in real time based on
12:36the positron emission pattern.
12:39How much experience have
12:41you had with this so far?
12:42We've had it going
12:44for about a year, and
12:46actually, I think we have
12:48one of the largest experiences
12:49in the country with this.
12:50So we're getting more familiar
12:52with how to best
12:54incorporate this technology into
12:57our treatment of patients.
12:59So it's really
13:01taking the treatment even
13:03a step further than you
13:05would with just a CT
13:06scan alone
13:08because with
13:09the PET part of that
13:10imaging, you can tell much
13:12more about what's going on
13:13in the tumor.
13:14It has a new dimension.
13:15Right now, it's primarily
13:17valuable for accounting for
13:19motion, especially lesions in the
13:21lung where you have breathing,
13:24the breathing cycle that
13:25causes motion.
13:27But we think that down
13:29the road, we will have
13:30many other applications of the
13:31technology.
13:33Well, this is great. We're
13:34gonna take a break for
13:35just a minute. And when
13:37we come back, we're gonna
13:38talk a little more about
13:40how radiation works, and then
13:41we're gonna get into some
13:43of the research you've done
13:44related to that.
13:46Support for Yale Cancer Answers
13:48comes from Smilow Cancer Hospital,
13:50where all patients have access
13:52to cutting edge clinical trials
13:53at several convenient locations throughout
13:55the region.
13:56To learn more, visit smilowcancer
13:58hospital dot org.
14:02The American Cancer Society estimates
14:04that nearly one hundred and
14:05fifty thousand people in the
14:07U. S. will be diagnosed
14:08with colorectal cancer this year
14:10alone.
14:11When detected early, colorectal cancer
14:13is easily treated and highly
14:15curable,
14:16and men and women over
14:17the age of forty five
14:18should have regular colonoscopies
14:20to screen for the disease.
14:22Patients with colorectal cancer have
14:24more hope than ever before,
14:25thanks to increased access to
14:27advanced therapies and specialized care.
14:30Clinical trials are currently underway
14:32at federally designated comprehensive cancer
14:34centers, such as Yale Cancer
14:36Center and Smilow Cancer
14:38Hospital,
14:39to test innovative new treatments
14:40for colorectal cancer.
14:42Tumor gene analysis has helped
14:44improve management of colorectal cancer
14:47by identifying the patients most
14:49likely to benefit from chemotherapy
14:51and newer targeted agents resulting
14:54in more patient specific treatment.
14:56More information is available at
14:58yale cancer center dot org.
15:00You're listening to Connecticut Public
15:02Radio.
15:03Good evening again. This is
15:04Eric Winer with Yale Cancer
15:06Answers, and I'm here tonight
15:09with my guest,
15:11doctor Peter Glazer,
15:13who is a professor of
15:16therapeutic radiology and a professor
15:18of genetics here at Yale
15:19School of Medicine and chair
15:22of therapeutic radiology.
15:24Can you tell us a
15:25little bit
15:26about
15:27how it is that radiation
15:29on a cellular
15:31level
15:32kills cancer cells? What does
15:34it do that makes
15:36them die?
15:38The radiation
15:39that we use
15:41clinically to treat cancer is
15:42sometimes
15:43classified
15:44as ionizing radiation
15:46to differentiate it from other
15:48forms of
15:51radiation including photons, which is
15:53visible light.
15:56And what that means is
15:57that the radiation, x-ray radiation
15:59goes into cancer cells
16:02and causes ionization of the
16:04molecules
16:05inside the cell, and that
16:07leads to a lot of
16:08chemical reactions that damage the
16:09DNA.
16:11So fundamentally,
16:12radiation causes DNA damage in
16:14cancer cells
16:15and if we can provide
16:17sufficient damage, the cells cannot
16:20fix themselves well enough to
16:22recover
16:23and that leads to a
16:24destruction of the tumor and
16:26tumor regression.
16:28And the DNA is essentially
16:30the brain of the cancer cell?
16:32Yes, DNA
16:33as in all cells, has
16:35the blueprint for how a
16:37cell functions,
16:38and DNA
16:40leads to the production of
16:42downstream molecules like RNA and
16:44proteins. So if you get
16:45the DNA, then you basically
16:47block all cellular functions
16:49and the ability of the
16:50cell to survive.
16:51Now one of the things
16:53that
16:54one hears as a doctor
16:56from patients is the question,
16:58well, doesn't radiation
16:59cause cancer?
17:01And I think people are
17:03often thinking about
17:05the fact that, you know,
17:07repeated,
17:09imaging studies are associated with
17:11a very small increased risk
17:13in cancer in certain circumstances.
17:16Is that a question that
17:17that all of you get
17:19asked a fair amount?
17:20Yes. We sometimes talk about
17:22that with patients. I
17:23I think that it, you
17:25know, it is known that
17:27there is a link between
17:28radiation exposure and
17:31developing malignancies.
17:32I think this is one
17:33of the
17:35key reasons that we've worked
17:36so hard to develop technologies
17:38that focus the radiation
17:40intensively on the tumor and
17:43work to spare the healthy
17:44tissue
17:45as much as we can.
17:48And, you know, we've studied
17:49this a lot in the
17:50field, and the risk of
17:54secondary malignancies
17:55is not zero, but it's
17:56very low, especially for most
17:58adult patients.
17:59We worry a little bit
18:00more about children, which is
18:02one of the reasons that
18:03we spend a lot
18:05of time in developing treatment
18:07approaches for children that are
18:09very highly focused. And
18:11one of the more recent,
18:13two elements along those lines
18:14is the use of proton
18:16beam therapy,
18:17which is
18:19especially valuable for treating
18:21children.
18:22And,
18:23there's gonna be a proton
18:25beam facility
18:26in Connecticut
18:27in the not distant future
18:29that we've been involved with.
18:31Protons
18:34are a type of ionizing
18:35radiation, but instead of x
18:37rays, they use
18:38protons, which are a subatomic
18:40particle,
18:42which a machine
18:44called a cyclotron will accelerate.
18:46And the protons
18:47also enter into the tissue,
18:49but they have a special
18:51property because
18:52they're a particle with mass
18:54that they enter tissue and
18:55they stop suddenly to deposit
18:57their dose.
18:59And that lets us tailor the
19:03delivery of the ionizing radiation
19:05even better.
19:07And,
19:08we think that it has
19:09some advantages.
19:11But developing proton beam facilities
19:13is not a simple endeavor.
19:15It's much more expensive and
19:16involved than
19:18installing a regular LINAC.
19:20And so there are not
19:22many in the country,
19:24and there is
19:25not one in Connecticut right
19:26now, but Yale New Haven
19:28Health System and Hartford HealthCare
19:30have partnered,
19:32and we recently did the
19:33groundbreaking to
19:36advance a new proton beam
19:37facility,
19:39in the center of the
19:40state that'll be
19:42a resource for all of
19:43the people in the region.
19:44And the price tag for
19:46these kinds of facilities is
19:48in the
19:49tens of millions of dollars.
19:52You know, this one is
19:53somewhere in the range of
19:54seventy million all in with
19:56all the construction and
19:58equipment.
20:01Can you
20:02talk about some of your
20:04research?
20:05And
20:06I know some of the
20:07recent research has
20:09related to the treatment of
20:13what is
20:15often thought of as
20:17inherited breast cancer and other
20:19cancers that
20:20arise in the setting of
20:22of BRCA
20:23mutations.
20:25But I know that your
20:27research career stretches
20:29pretty far back. And
20:31what are some of the
20:32things you've worked on over
20:33the years? And then maybe
20:34we can talk more about
20:36BRCA.
20:37Yes, I've
20:39been interested in how
20:41DNA repair pathways can influence
20:43the development of cancer and
20:45how they can be exploited
20:46for treatment.
20:47And you mentioned
20:49the BRCA1
20:50and BRCA2
20:52genes which are linked
20:56to a large extent to
20:57breast and ovarian cancers.
21:00And defects in those genes
21:01lead to a deficiency in
21:04a pathway of DNA repair
21:06called homologous recombination.
21:08We recently discovered that some
21:10other genes that are seen
21:12mutated in cancers
21:14that are linked to abnormal
21:16metabolism
21:18also cause a defect in
21:19the same DNA repair pathway
21:22and we found unexpectedly
21:24that they can be exploited
21:26with
21:27molecularly
21:28targeted agents that
21:31exploit related
21:32DNA repair pathways.
21:35And similar to the situation
21:36with BRCA1 and BRCA2,
21:38these genes include
21:41genes with the names IDH1
21:42and two, SDH and FH
21:45and they're linked to
21:47brain tumors, sarcomas, kidney cancers
21:49and others.
21:51Some of the strategy that
21:52we and others have worked
21:54on, you can think of
21:55it like a traffic pattern
21:56since you and I live
21:57in Southern Connecticut.
21:59If there's a big
22:00crash on I-95
22:02and you can't get where
22:03you're going, you might think
22:04of going to the Merritt
22:05Parkway,
22:06but we're using an agent
22:08that blocks the Merritt Parkway,
22:09so then you have nowhere
22:10to go.
22:11And so, we're taking that
22:13kind of approach for these
22:15genetically linked cancers.
22:17And this is by developing
22:19drugs?
22:20Yeah. Drugs that target other
22:22DNA repair pathways. So there's
22:24a well known class of
22:25drugs called PARP inhibitors.
22:27We did not develop them,
22:28but we're trying to find
22:30new uses for them.
22:32Another thing that we did
22:33was, we found that agents
22:35that inhibit
22:37angiogenesis,
22:38which means the development of
22:40new blood vessels,
22:42these can lead to reduced
22:44oxygen in tumors, a situation
22:46known as hypoxia.
22:47And that,
22:49we found, causes decreased DNA
22:51repair,
22:51and we can then exploit
22:53that situation with some of
22:54the agents I just talked
22:56about.
22:57And is there a role
22:58for using radiation
23:00in combination with some of
23:01these therapies?
23:03Yes, for sure.
23:04Some of these DNA repair
23:05inhibitors like PARP inhibitors,
23:08and others that are in
23:09clinical development, there's a number
23:10of targeted agents,
23:12that we and others are
23:14working on to
23:15inhibit repair pathways that are
23:17important
23:19to how the cancer cell
23:20tries to fix
23:22the type of DNA damage
23:23the radiation causes.
23:25And if I can just
23:26explore one other combination that's
23:29been talked about recently. So
23:31immunotherapy,
23:32of course, has become,
23:35the treatment of the past
23:37decade. It's used in
23:40well over a dozen different
23:42tumor types and can be
23:44highly effective.
23:45But there's some suggestion that
23:47radiation could also augment the
23:50effect of immunotherapy.
23:52Yes. I think there's
23:54a lot of intense study,
23:56both basic science and in
23:57the clinic, on how to
23:58best combine radiation and immunotherapy.
24:02Radiation can
24:04elicit an inflamed response in
24:06tumors that
24:09synergizes
24:10with the type of immune
24:11response that
24:12these immune checkpoint inhibitors will
24:14provoke.
24:16It is also thought
24:17that radiation can cause the
24:19release of tumor antigens and
24:22sort of create an in
24:23situ tumor vaccine, if you
24:25will.
24:27So, you know, in general,
24:29it's thought that
24:30radiation can enhance the effectiveness
24:33of tumor
24:34immune therapy and vice versa,
24:36that immune therapy or immune
24:38response will enhance the effect
24:39of radiation.
24:42Have you seen a
24:43change in the
24:45type of
24:47medical student who goes into
24:50radiation oncology today versus
24:52twenty or thirty years ago?
24:54It would seem to me
24:55that a lot of these
24:56people must be people who
24:57are
24:59interested in physics and interested
25:01in science and
25:04perhaps interested
25:05in pursuing careers in research.
25:08Yes. I think it's always
25:09been a research friendly
25:12specialty because there's a lot
25:13of basic science, and cellular
25:16biology to explore as well
25:17as the physics and the
25:18more technological
25:21aspects.
25:21I think that, you know,
25:23years ago, it
25:25was felt, well, maybe people
25:26who had a little bit
25:27more proclivity for physics might
25:29go into the field. But
25:30actually, I think the field
25:31now
25:33attracts,
25:34people that like
25:36advanced technology that we can
25:38bring to bear, the image
25:39guidance, the
25:41treatment planning that, you know,
25:42is very computerized and visual,
25:47so I think it's expanded
25:49the reach of people that
25:50are
25:51interested in the field. And
25:52the other thing is I
25:53think people have come to
25:54know that
25:55we're a very patient oriented
25:57specialty,
25:59just like your specialty medical
26:01oncology. We're very patient facing,
26:03and, we have longitudinal
26:05relationships with our patients, and
26:07I think that that attracts
26:09the medical students as well.
26:11Longitude and relationships with your
26:12patients
26:14and, of course, close relationships
26:16with your colleagues since
26:18in the care of patients
26:19with cancer we
26:22all work together since it
26:24takes
26:25far more than any one
26:27discipline.
26:28And as we
26:30wrap up,
26:32can you
26:33speculate about where radiation
26:36oncology
26:37is going over the course
26:38of the next
26:40ten or twenty years?
26:43What should we be looking for?
26:44Well, I think that we're
26:45gonna see a greater
26:47ability to
26:48achieve real time adjustments in
26:50the treatment,
26:51using some of these onboard
26:52imaging technologies. And as the
26:55software
26:56and hardware improves
26:58and we can incorporate things
27:00like artificial intelligence to identify
27:03the tumor targets, track how
27:04they move and adjust radiation
27:07treatments.
27:08That's going to allow even
27:09more precise
27:10and tailored
27:12radiation therapy for patients.
27:14I think also we're going
27:15to see more individualized
27:16patient treatments based on clinical
27:18and genetic characteristics
27:20And, like we were alluding
27:22to before,
27:23I see the next five
27:24or ten years,
27:26that we will be able
27:27to deploy new targeted biological
27:29agents that sensitize tumors to
27:31radiation
27:32without
27:34sensitizing healthy tissues. And,
27:36for example, we're
27:37working in the lab to
27:38develop a class of peptide
27:40drug conjugates that does just
27:42that.
27:43And the preclinical models look
27:45encouraging, so hopefully that will
27:47eventually make its way to
27:48the clinic.
27:50And not to set up a
27:51competition with surgery, but do
27:53you think these changes
27:54will lead to fewer surgical
27:56procedures
27:57and more radiation?
27:59Well, I think it
28:00may change the balance for
28:02certain tumors. I think I've
28:04seen that the pendulum has
28:06swung back and forth,
28:08for different, types of tumors
28:10where,
28:12you know, radiation approaches,
28:14are more favored and then
28:16surgical. It really
28:17depends. I mean, the surgeons
28:19have been very good to
28:20advance their technology to robotic
28:22surgeries and minimally invasive surgeries.
28:24So I think it's all
28:25to the good for the
28:26patients, and we'll just have
28:28more choices for figuring out
28:30the best treatments.
28:31Doctor Peter Glazer is the
28:33Robert E Hunter Professor of
28:34Therapeutic Radiology and Professor of
28:36Genetics and Chair of the
28:38Department of Therapeutic Radiology at
28:40the Yale School of Medicine.
28:42If you have questions, the
28:43address is canceranswers
28:44at yale dot edu, and
28:46past editions of the program
28:47are available in audio and
28:49written form at yalecancercenter
28:51dot org. We hope you'll
28:52join us next time to
28:53learn more about the fight
28:54against cancer.
28:55Funding for Yale Cancer Answers
28:57is provided by Smilow Cancer
28:59Hospital.