Ask a Radiation Oncologist: Dr Francis Chin from Icon Cancer Centre Singapore

Ask a Doctor ForumCategory: OncologyAsk a Radiation Oncologist: Dr Francis Chin from Icon Cancer Centre Singapore
Avatar photoDr Francis Chin asked 2 years ago
I am Dr Francis Chin, Radiation Oncologist practicing at Icon Cancer Centre- Singapore. Ask Me Anything! I am a Radiation Oncologist with experience across both medical and radiation oncology as well as palliative medicine. I am an ASEAN and Chevening scholar, receiving scholarships from the Singapore and British Government and participating in an EU sponsored MSc in radiation biology with distinction. I was the first student from Asia to attend this prestigious radiobiology course sponsored by the European Commission to produce experts in radiation biology and radiation oncology. Before joining Icon Cancer Centre, I worked for over 20 years with the National Cancer Center in Singapore and continue to be a visiting consultant at KK Women and Children’s Hospital. I am also on the steering committee of the Viva-KKH Paediatric Brain and Solid Tumour programme. I hold a number of positions across Singapore. I am Deputy Chair of the Institutional Research Boards in Oncology/ Haematology at SingHealth, with concurrent appointments with HSA/DSRB IRBs. I am also a member of the SingHealth Quality Assurance Committee who look into the Clinical Risk Management across SingHealth’s cluster hospitals. I am a member of the SingHealth NCCS Proton Therapy Implementation Committee and a lead Principal Investigator in a National Research Foundation 10 million SGD programme grant for proton therapy since 2017. I am passionate about the continual improvement of radiation oncology and lead several Quality Assurance Improvement projects teams, including the radiation proton development management team. I hold academic appointments as Adjunct Assistant Professor, SingHealth DUKE NUS Oncology Academic Oncology Clinical Programme (ACP) and Paediatrics ACP since 2015. My radiation oncology projects have been selected internationally by International Atomic Energy Agency (IAEA) as one of the highlights at IAEA’s technical experts meeting. I was the president-elect of the South East Asian Radiation Oncology Group (SEAROG) from 2017 to 2018; SEAROG comprises of the radiation oncology societies of South East Asian countries, including Indonesia, Philippines, Malaysia, Singapore, Cambodia, Myanmar and Vietnam. Since 2006 SEAROG has collaborated with ESTRO to organise local ESTRO school courses to improve the radiation expertise and training in this region. I am currently an editorial board member of the Royal College of Radiologist, UK and am also a recognised local and regional expert in radiation biology and a chapter author in the Oxford Textbook of Critical Care, (second edition) on radiation poisoning. I accept referrals for all cancer types and am experienced across a range of cancers with particular interest in paediatrics, soft tissue sarcoma, gynaecological condition and gastrointestinal cancers. Learn more about me here: I am excited to be here to share and discuss Radiation Therapy with everyone. I will be actively answering questions. If you have any questions about radiation therapy for treating cancers, in particular childhood cancers, soft tissue sarcoma, gynaecological cancers and gastrointestinal cancers, feel free to ask me! === Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
17 Answers
Jon answered 2 years ago

My father is undergoing chemotherapy for his non-small cell lung cancer. He seems to be fighting the side effects. He said the joint pain, fatigue, and diarrhea is killing him. Radiotherapy will be next for him. Would he be okay going for radiation therapy while the chemo side effects are such a big issue for him?

Dr Francis Chin replied 2 years ago

Treatment of lung cancer depends on the stage and type of histology. It used to be systemic chemotherapy being the mainstay of treatment for advance and metastatic small cell lung cancer. But now there is the era of individualised genomic medicine where if certain mutational target are found, the patient can also be candidates for undergoing targeted treatment and immunotherapy. In general, without knowing more details of your father’s specific case, radiation is also very useful treatment modality for lung cancer. Radiation are Xrays, which are also targeted locally and specifically to an area. The side effects are usually well tolerated and more so then chemotherapy which is a systemic treatment. Most patients with advanced lung cancers will find that radiotherapy is well tolerated and your doctor can specifically advise about expected side effects, but side effects are likely to be acceptable.

Richard answered 2 years ago

My brother’s melanoma came back after surgery. His doctor advised radiotherapy. Is this effective to permanently destroy the cancer cell?

Dr Francis Chin replied 2 years ago

Melanoma is an incredibly locally recurrent and aggressive tumor. Early disease can be treated with radiotherapy and can be moderately effective especially a high enough dose can be given. There are some new effective immunotherapy options available for melanoma also

Patricia Wang answered 2 years ago
I have breast cancer and have already undergone cancer treatment, including radiation therapy. I've been informed the cancer has spread to my bones and lungs. Is radiation therapy performed at the original site of cancer or will it need to be done near my bones and lungs?
Dr Francis Chin replied 2 years ago

It’s not possible to know definitely without more details of your treatment, but usually radiotherapy is only given once to site and if you had been given to the breast or chest wall in the past, its unlikely to have a second treatment there. So, it is likely that the radiation is going to be for palliative reasons and in this case radiotherapy will treat the bones and the lungs metastasis for pain control.

Joseph answered 2 years ago

I am having a skin rash that seems to be a side effect from my previous radiotherapy. Would the rash get severe if I continue the therapy before having it looked at? Have you experienced this rash in your patients?

Dr Francis Chin replied 2 years ago

Each person’s reaction to radiation is different. There are some persons who are more sensitive and may exhibit as skin redness or as a rash. Sometimes these rash are related to previous systemic chemotherapy in a recall reaction. There is a possibility that the rash will get worse before it gets better. Radiotherapy skin reactions are graded from 1 to 4 from mild redness, to more moderate redness with open wounds to ulcerations with infections. The doctor looking after you for radiotherapy will evaluate you weekly and be able to advise. These rash are common occurrences for patients receiving radiotherapy for the reasons above.

Chwen Sher answered 2 years ago

Is it normal for radiotherapy to cause more frequent urination? I am currently undergoing radiotherapy for prostate cancer. There are also times I cannot control my urine stream. Would this condition go away once I finish my radiotherapy?

Dr Francis Chin replied 2 years ago

If the radiotherapy is applied to the pelvis for prostate, rectal or gynaecology cancers, then frequent urination is one of the expected side effects, up to 10 to 15% but is mostly mild, but there are times when it could be more severe and leading to bladder irritation and even bladder infection. There are many reasons why one cannot completely control ones urine stream, there are tumor factors, factors relate to the patient as well as related to the treatment. Speak to your doctor to explain your specific problem. There are medications that maybe suitable if its related to bladder muscle instability or if there is an underlying urine tract infection that needs to be treated. There is a reasonable expectation that the bladder irritation related to the treatment will go away once the radiotherapy treatment ends.

Sheng Wei answered 2 years ago

My grandfather is fighting a metastatic brain tumor. He is 79 years old. Is radiotherapy still safe for a man his age? Is there any new development in the field that will bring about the most effective outcome with less side effects?

Dr Francis Chin replied 2 years ago

Radiotherapy is one of the modalities for treating metastatic brain tumor. Your doctor will be able to assess if your grandfather will be suitably treated based on tumor and patient factors. But in general, radiation therapy is well tolerated and suitable even when a patient is elderly and has a poor performance status. There are new drugs and genetic sequencing that can individualised the treatment for the specific tumor but they require a biopsy to get a sample of the tumor for testing. Your doctor can advise if its feasible and if there are any new protocol trials available to your grandfather.

Kenneth answered 2 years ago

I am currently in the midst of receiving radiotherapy for my cancer and my wife is pregnant. Is it safe for her to be around me?

Dr Francis Chin replied 2 years ago

The majority of radiation given is given daily via a linear accelerator, the radiation stops once the machines stops. And patients are not actively radioactive, there are able to be near small children, pregnant women or even pass through Xray detectors in airports because of this fact. It is completely safe to be near your pregnant wife, to go about your daily activities including sharing foods.

Mei Zhen answered 2 years ago

My father has stage 3 non-small cell lung cancer. His doctor said he is not fit for surgery due to his heart condition. He is now undergoing radiotherapy. Is it safe for his enlarged heart valve? And is it effective to do radiotherapy without surgery?

Dr Francis Chin replied 2 years ago

Stage 3 lung cancer is usually not an operable condition and radiation therapy is a standard treatment technique with or without chemotherapy. The doctor administering and planning the radiotherapy can selectively avoid the heart and can be made safe even for people with enlarged hearts by limiting the dose. As above, the condition is not suitable for surgery and radiotherapy is the standard treatment.

Belinda answered 2 years ago

Chemotherapy has made my father lose a lot of weight. His doctor has suggested he postpone his radiation therapy. But we are worried his disease will progress and worsen. What’s your advice in this position? How far will weight loss pose as a problem for someone who is about to undergo radiation therapy?

Dr Francis Chin replied 2 years ago

Without knowing further details on what stage and type of cancer it is. Usually we defer radiotherapy to allow the patient to build up strength to start. Because it would be deleterious to start and then have to interrupt the radiotherapy treatment, the doctor can make a risk benefit judgement, not deferring the radiation too late but allow time to prepare the patient for the next course. Usually a weight loss of more than 10% from normal baseline weight shows a worser prognosis. A course of nutritional therapy and advise of a dietician on cancer nutrition may help.

Claudia answered 2 years ago

Hi Dr Chin. What do you think of brachytherapy? Is it still the best form of radiotherapy for cervical cancer? How about the side effects? Are there any less harmful but reliable options?

Dr Francis Chin replied 2 years ago

Brachytherapy by using radioactive seeds are an effective integral part of treating cervical cancer, usually with some form external beam radiation given over daily. The advantage of brachytherapy is being able to deliver high doses to the tumor around the cervical and have a sharp dose fall off to limit dose and side effects to the surrounding small intestines and bladder. The other options for early stage cervical cancer is an operation, but more advance stage cervical cancer is radiotherapy with or without chemotherapy.

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