I am Doctor Nitika Paudel,
I am a Radiation Oncologist at MedStar Georgetown University Hospital.
I see and treat patients with different kinds of cancer,
but my primary focus is in thoracic malignancies.
These are cancers that arise in the chest, such as lung cancer and breast cancer.
My treatment philosophy has two parts.
one part is the actual radiation treatment, and I believe that
treatment recommendations have to be based on clinical evidence.
They have to be in line with national guidelines.
We have to discuss patient cases in a multidisciplinary setting
where we get input from different experts in the field so that we can come up
with the best, most optimal treatment plan for our patients.
And the second aspect is more personal.
I had a personal experience with a very close family member
who was diagnosed with an aggressive type of cancer,
and from interacting with our patients and their families,
I know what they go through once they are diagnosed with cancer.
So, when I first meet with a patient, I really like to take my time
and go over their diagnosis, their staging, review their imaging
and also talk about how to navigate this system
and help them in any way I can.
This is a very exciting time
to be in medicine and very exciting time to be in oncology.
There are so many different therapies that are available to our patients
now that were not available even a few years ago.
We are learning so much about the cancer in the molecular level, and we're really
bringing the therapies that were developed in the lab to clinical practice.
So, it's really exciting from a provider perspective, knowing that our patients
have a lot more treatment options now than they had before.
I love my job. It's a great privilege to come to a place like this
and be able to work with amazing staff, brilliant colleagues,
and together we get to serve our patients
to help them in the most difficult part of their lives.
We get to team up and help cure their cancer
or help alleviate the symptoms they're having from cancer.
I derive a lot of inspiration
and perspective from our patients, so this is a very rewarding job.
I believe patients should come to MedStar Georgetown University
Hospital for comprehensive, specialized and state of the art care.
And hopefully, once you come here, you'll realize that people who work
here are warm there are invested in your health and well-being.
The goal with proton therapy and radiation therapy in general depends
on the stage of cancer, when the lung cancer is early stage
or locally advanced, which means that it has spread to the lymph nodes .
The goal of treatment is still curative
when the cancer has spread outside of the chest to other organs.
Radiation can be used in a palliative setting to alleviate
any symptoms related to cancer.
Our lungs are sensitive to the effects of radiation.
We also have heart in the chest.
Using proton therapy to treat lung cancer.
We are able to minimize radiation going to the uninvolved lung
as well as the heart, thereby minimizing side
effects of treatment.
On average, a typical treatment with proton therapy for lung cancer
will take about 20 to 30 minutes.
A radiation course for lung cancer
treatment also depends on the stage
of disease, early stage lung cancers
can be treated within one to 15 sessions.
Locally advanced lung cancers, which are cancers
that have spread to the lymph nodes,
typically need about 30 treatment
sessions, so about six weeks of treatment.
When we meet with patients,
we evaluate them to see which treatment
technique would be most beneficial.
For proton therapy, if a patient has certain conditions.
For example, if they have a significant
history of cardiopulmonary disease, if they have certain connective
tissue disorders, if they have a history of previous radiation to the chest,
young patients or patients who have diseases
that have long natural history may benefit from proton therapy.
So, this evaluation takes place upfront
to identify patients who are candidates for proton therapy.
Proton can be used to treat different cancer types in all stages,
but it really depends on the tumor,
the location, the motion within the tumor,
the normal organ surrounding the tumor and ultimately the goal of treatment.
Patients with lung cancer undergoing radiation
therapy can develop fatigue, feeling tired.
They can develop skin reaction like a sunburn and depending on the
proximity of their tumor to the esophagus, they can also develop sore throat.
In my experience,
patients undergoing treatment with protons
experience less acute side effects, and the side effects are less
intense compared to treatment with standard radiation.
When we use radiation to treat locally advanced lung cancer,
there will be some amount of radiation that goes into the heart.
This is because of the proximity of the heart to the lungs.
From clinical trials,
we know that radiation to the heart
increases risk of developing cardiovascular disease,
it increases the risk of developing cardiac events.
When we use proton therapy,
there is less radiation, particularly low
to intermediate dose of radiation that goes into the heart.
So, by reducing the radiation exposure,
your risk of developing cardiovascular
disease is decreased.
Multidisciplinary team
approach has several advantages for our patients.
It improves communication, it improves coordination of care.
It can actually lead to better cancer outcomes.
The Lung Cancer Treatment Group here at MedStar Georgetown University
Hospital meets once a week to discuss different patient cases.
We also see patients together in our multidisciplinary clinic.
This is great for patients because it
improves communication, it improves coordination of care,
and ultimately it improves cancer outcomes.
Proton Center at MedStar Georgetown
University Hospital opened in 2018.
This was the first proton center in the D.C.
area, so our department has the expertise as well as the experience.
And the best thing about our proton center is that it is located
within the Lombardi Cancer Center, which makes
coordinating care easier with other specialist.
You could get chemotherapy and walk
across the hall and come get your radiation treatment.