ABOUT THIS EPISODE

What is radiation oncology, and how is it used for neuroendocrine cancer? UCSF radiation oncologists Dr. Will Chen and Dr. Alexandra Hotca-Cho describe external radiation therapy (SBRT) and how, when, and where it may be used for select patients with neuroendocrine cancers. They address common concerns about the planning process, safety concerns, and treatment sequencing.

TOP TEN QUESTIONS ABOUT EXTERNAL RADIATION THERAPY FOR NEUROENDOCRINE CANCERS:

1. What is radiation oncology? How does it work? How is it different from other types of radiation?
2. What are the types of radiation therapies used for neuroendocrine cancer? 
3. Which neuroendocrine cancers are they used for, and when are they used? How do you decide who is a good candidate and if it will be effective?

• Where in the body can SBRT be used? (bone, liver, pancreas, rectal?) Where can it not be used in the body, and when is SBRT NOT used?
• Is there a number or size limit of the tumor(s)?

4. For Bone: How do NETs affect the bones? Are they “on” or “in” the bone, and does the tumor tend to weaken it?

• If given to the bone, does SBRT weaken the bone? What are the chances of fracture with radiation to the bone? Does it matter which area of the bone/body is treated? What other factors influence fracture risk? (age, dose, number of treatments)? Should patients have a bone density scan before SBRT?
• If bone lesions are causing pain, how soon after treatment might a patient expect to have pain alleviated?
• How common is increased pain after treatment to the bone? What causes that?

5. Safety: 

• How much radiation is given with these procedures? Is there a concern about radiation safety following the procedures? (Do patients need to avoid others in the hours or days after the treatment?)
• Is there a lifetime limit to the amount of radiation one can receive, especially considering surveillance CT & PET scans?
• How often can these procedures be repeated? 
• Does it damage other tissues or organs? How common are secondary cancers? What types and how treatable are they?
• Is there a risk with fertility?
• What other risks are there?

6. How do these therapies compare to PRRT or radioembolization in terms of safety? If someone has had PRRT or radioembolization, can they also receive radiation therapy to the liver or bones? Is there increased risks if someone has had PRRT, radioembolization or CAPTEM or alkylating agents? 
7. Is there an optimal sequence for treatments? 
8. What is SBRT like for patients? What is the planning and preparation process? How do you determine how many treatments and what dose to give?
9. What does the patient experience during and after the procedure? Does it hurt? What are the side effects? How much time do I need to take off of work? 
10. How effective is SBRT in terms of managing symptoms? How effective is SBRT in controlling or destroying the tumor?  How do you know if the treatment “worked”?

Bonus: What is the future of radiation therapy in neuroendocrine cancer treatment?

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