Just curious if anyone out there is managing the patients and coordinating the care in the Radonc field? Our center has set up the division of labor between NucMed and RadOnc. Is this atypical?
Just curious if anyone out there is managing the patients and coordinating the care in the Radonc field? Our center has set up the division of labor between NucMed and RadOnc. Is this atypical?
. After the law changed to where IR docs could do Y90, I've seen a decrease in quality of treatment. They almost never do proper contouring for volumes, they routinely try to treat a single lesion with Y90, etc.
Probably true in our area too. I could see that happening.
IR guys in our neck of the woods are fairly unscrupulous...they'll get a referral for a lung biopsy and bring the patient in for consult and then go over path at f/u and tell them they should get RFA without consulting us or a surgeon in many cases
Ablation of small lung lesions have been found to be comparable to surgery. It is entirely possible that a patient expressed sentiment to not want to have surgery to an IR therefore the said IR did not refer to surgery but ablated instead.
The quality and breadth of data for rfa is pretty poor compared to sbrt and the data that is there suggests poorer local control for lesions above 1-2 cm.
. It’s another thing to claim people who use the said new modality as bad actors.
$10 says most IR guys have no clue what nccn guidelines are or why they should even know about themIR docs should not be making oncologic decisions. Period. They are not oncologists. That is well beyond the scope of their training. Their role in cancer care should be performing procedures ordered by an oncologist if they deem these procedures safe and potentially efficacious.
And yes, definitive management of a lung cancer qualifies as oncologic decision making.
$10 says most IR guys have no clue what nccn guidelines are or why they should even know about them
Do they go to the lung cancer conference? They don't show up to oursI am just a med student, but it seems like bad taste to bad mouth other specialities like this. There are IRs present in all the liver tumor conferences I’ve been to. To categorically say that someone have no say in oncological decision making reminds me of infancy of theraputic radiology when all of you guys were supposed to act only on med onc’s direction?
I would conjecture that performing RFA on a lung lesion without the patient being seen by a surgeon, medical oncologist or radiation oncologist would be borderline malpractice. Our IR (who come to lung tumor board) would never think about doing this.
There's never any reason clinically to do RFA up front for lung cancer. Maybe on recurrence if it's already been treated stereotactically. The data continues to show worse outcomes compared with SBRT.The only time I heard this happen, the IR consult note documented that pt is unwilling to consider surgery or radiation therapy despite being explained those modalities and refused referal to those services. Perhaps this was the case here?
We had the same problem with Quadramet back in the day...There's never any reason clinically to do RFA up front for lung cancer. Maybe on recurrence if it's already been treated stereotactically. The data continues to show worse outcomes compared with SBRT.
I agree that it's not great to bash other specialties, but it's important to understand that many radoncs are having to deal with IR docs offering substandard treatments to patients, taking advantage of the fact that they see them for biopsy, without fully explaining all the options to them.
Someone else asked about Lutathera at a freestanding center. Even with the purchasing power of our practice, which is enormous, the economics don't work in an outpatient center, as we would have lost money on the drug.
Why is IR explaining those options to begin with? They have no oncology training.... Moreover, in addition to having less data to support this less efficacious treatment, RFA carries a not insignificant risk of pneumothorax, something which is unheard of in SBRT.The only time I heard this happen, the IR consult note documented that pt is unwilling to consider surgery or radiation therapy despite being explained those modalities and refused referal to those services. Perhaps this was the case here?
The only time I heard this happen, the IR consult note documented that pt is unwilling to consider surgery or radiation therapy despite being explained those modalities and refused referal to those services. Perhaps this was the case here?
Makes total sense. I think that's what that urologist told me about all the high risk prostate cancer he was cryoing too. They all refused after a thorough discussion of the available standard of care options.
Also, curious about "that one time" that IR RFA'd a tumor without consulting other services and you had the opportunity to review their consult note. Sounds like they must have recurred and ended up in front of tumor board again?
When would an IR procedure ever be preferred over stereo XRT for a lung lesion?IR has a growing role in oncology with a fair number of interventionists now with sub specialization in the treatment of oncologic conditions primarily related to the liver, kidney, lung and bone.
As far as the lung, it is an option for patients with oligo metastatic disease and in patient's with limited options (ie not surgical candidate or SBRT candidate).
I think that in the setting of lung cancer, it should be considered in front of a tumor board type setting given the uncertain efficacy of RFA for limited lung cancer. I think PFTs, performance status, patient desires all should be considered. PET scanning, mediastinoscopy, Lobectomy/segmentectomy/SBRT etc should be considered. In more advanced stages we tend to pursue either definitive chemo/rt or neoadjuvant chemo/rt with potential surgery if downstage. Also with the different receptors especially in certain ethnicities and nonsmokers with more advanced disease. EGFR,ALK,ROS, BRAF,PD1 should be evaluated. It can be done with local anesthesia and mild sedation in a similar fashion to the biopsy.
Interventional radiologists have a significant role in the management of hepatocellular cancer with TACE/Y90/Ablation/portal vein embolization etc including in the setting of curative treatment and bridge to transplant .
We have a growing presence in palliative pain interventions in the oncology population including nerve blocks/ablative techniques /cementoplasty and screw fixation for osseous lesions.
Always impressed by the strong foundation of evidence based medicine that radiation oncology brings to the table of cancer care. This is something that interventional physicians really need to employ if they are to provide true advances in oncologic care. The field of Interventional radiology is at a crossroads much like radiation oncology was when they had ultimately left diagnostic radiology to become a "clinical" discipline.
The risk of pneumothorax is way too high for what is an inferior alternative to sbrt.When would an IR procedure ever be preferred over stereo XRT for a lung lesion?
recurrences are very rare, and most of these pts have bad and copd and few years out from primary sbrt. there would be excedingly few pts eligible for rfaFor SBRT recurrence, you can still SBRT again.
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