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cover of episode #343 – The evolving role of radiation: advancements in cancer treatment, emerging low-dose treatments for arthritis, tendonitis, and injuries, and addressing misconceptions | Sanjay Mehta, M.D.

#343 – The evolving role of radiation: advancements in cancer treatment, emerging low-dose treatments for arthritis, tendonitis, and injuries, and addressing misconceptions | Sanjay Mehta, M.D.

2025/4/7
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Peter Attia: 我对放射肿瘤学很感兴趣,特别是低剂量辐射治疗炎症性疾病和运动损伤的应用。我想了解这个领域的历史、误解以及最新的进展。 Sanjay Mehta: 放射肿瘤学是一个年轻且快速发展的领域,技术在过去几十年里发生了巨大变化。放射疗法在现代肿瘤学中发挥着关键作用,它可以精确靶向肿瘤,同时最大限度地减少对周围健康组织的损伤,从而降低副作用。低剂量辐射疗法在治疗关节炎、肌腱炎等炎症性疾病方面也显示出显著疗效,但在美国尚未得到广泛应用。 放射恐惧症是阻碍低剂量辐射疗法在美国推广的主要因素之一,它与核事故、冷战以及对早期辐射应用的误解有关。然而,大量数据表明,低剂量辐射的益处远大于风险,甚至可能存在激素效应。 在乳腺癌治疗中,放疗技术已经取得了显著进展,从根治性乳房切除术转向了乳房保留手术联合放疗,这提高了患者的生活质量。现代放疗技术可以精确靶向肿瘤,并最大限度地减少对周围组织的损伤,从而降低副作用。 在治疗前列腺癌方面,放疗技术也取得了显著进展,其治愈率和精确度都有所提高。现在,几乎所有适合手术的患者也适合放疗。低剂量辐射疗法可以有效缓解前列腺癌患者的副作用,如尿失禁和阳痿。 在脑肿瘤治疗中,放疗技术已经从全脑放疗转向了更精确的立体定向放疗,以减少认知副作用。对于某些类型的脑肿瘤,如胶质母细胞瘤,放疗仍然是重要的治疗手段。 低剂量辐射疗法在治疗肌腱炎、关节炎、足底筋膜炎等炎症性疾病方面也显示出显著疗效,其疗效与皮质类固醇注射剂相似,但疗效更持久。这种疗法在美国的应用受到阻碍,这与医疗专业人员的认知不足和保险报销等因素有关。 低剂量辐射疗法在治疗其他炎症性疾病方面也显示出潜力,如腕管综合征、网球肘、高尔夫球肘等。这种疗法可以有效缓解疼痛,并提高患者的生活质量。 Peter Attia: 我对低剂量辐射治疗炎症性疾病和运动损伤的应用很感兴趣,特别是它在美国以外的广泛应用。我想了解这种疗法的疗效、安全性以及在美国推广的障碍。 Sanjay Mehta: 低剂量辐射疗法在欧洲得到了广泛应用,每年有数万名患者接受这种治疗。这种疗法可以有效缓解关节炎、肌腱炎等炎症性疾病的疼痛,其疗效与皮质类固醇注射剂相似,但疗效更持久。 低剂量辐射疗法的安全性很高,其辐射剂量非常低,对人体的影响微乎其微。这种疗法是非侵入性的,患者无需住院,治疗过程简单快捷。 低剂量辐射疗法在美国的推广受到阻碍,这与医疗专业人员的认知不足、保险报销等因素有关。此外,放射恐惧症也是一个重要的因素。 然而,随着越来越多的证据表明低剂量辐射疗法的疗效和安全性,这种疗法在美国的应用将会越来越广泛。

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This chapter defines radiation, differentiating between ionizing and non-ionizing radiation. It explains how radiation doses are measured using units like gray and sievert, providing real-world examples of radiation exposure from various sources and discussing the linear no-threshold model and hormesis.
  • Radiation is part of the electromagnetic spectrum, with ionizing radiation capable of damaging DNA.
  • Radiation doses are measured in grays (absorbed dose) and sieverts (exposure).
  • Common misconceptions about radiation exposure from sources like cell phones and microwaves are addressed.
  • The linear no-threshold model (LNT) is discussed, along with evidence suggesting a hormesis effect at low doses.

Shownotes Transcript

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Sanjay Mehta is a radiation oncologist with over 20 years of experience at St. Joseph's Medical Center in Houston, Texas. In this episode, Sanjay explores the rapidly evolving field of radiation oncology, addressing common misconceptions about radiation exposure. He delves into radiation's critical role in modern oncology, examining recent advancements that precisely target tumors while minimizing damage to surrounding healthy tissues and reducing side effects, with specific insights into breast, prostate, and brain cancers. Sanjay discusses fascinating international practices involving low-dose radiation therapy for inflammatory conditions such as arthritis, tendonitis, and sports injuries, highlighting its effectiveness and potential for wider adoption in the United States. Wrapping up on a lighter note, Peter and Sanjay discuss their mutual passion for cars and reveal how this shared interest first brought them together.

We discuss:

  • How radiation oncology became a distinct, rapidly evolving medical specialty [2:45];
  • Defining radiation, ionizing vs. non-ionizing, and common misconceptions about radiation exposure [5:30];
  • How radiation doses are measured, real-world examples of radiation exposure, and safety practices [9:00];
  • Radiation doses from common medical imaging tests, and why benefits of routine imaging outweigh risks [14:15];
  • Therapeutic radiation oncology: the evolution of breast cancer treatment toward less invasive surgery combined with targeted radiation [23:30];
  • Modern radiation oncology treatments for breast cancer—minimizing risks and maximizing patient comfort and outcomes [27:15];
  • How advances in radiation dosing, technology, and treatment precision have significantly reduced side effects [39:45];
  • How breast implants affect radiation treatment [44:45];
  • Radiation therapy for prostate cancer: advancements in precision, effectiveness, and patient selection criteria [48:00];
  • Radiation therapy options for inoperable prostate cancer or those seeking alternatives to surgery, and a remarkable patient case study [55:15];
  • How patients can effectively evaluate and select a high-quality radiation oncologist [1:05:45];
  • Radiation therapy for brain cancer: the shift toward precise, targeted techniques that minimize cognitive side effects, and remaining challenges [1:08:30];
  • The origins of radiophobia and how it influenced perceptions of radiation use in medicine [1:18:00];
  • Treating chronic inflammatory conditions such as tendinitis, arthritis, and more with very low-dose radiation [1:23:45];
  • Using low-dose radiation to treat spine injuries, scar tissue, fibrosis, keloids, and more [1:30:00];
  • The current barriers preventing widespread adoption of low-dose radiation therapy for inflammatory conditions [1:35:45];
  • The durability and versatility of low-dose radiation therapy in treating chronic inflammatory and arthritic conditions [1:40:45];
  • Sanjay’s talent as a drummer [1:44:45];
  • Peter and Sanjay’s shared passion for cars and racing [1:47:15]; and
  • More.

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