Bridging the Divide Between Radiology, Interventional Oncology
Deeper collaboration between radiology and radiation oncology is necessary to realize the full potential of the two specialties whose paths diverged nearly 50 years ago, said Damian E. Dupuy, M.D., who presented the Annual Oration in Diagnostic Radiology as part of the RSNA Opening Session on Sunday.
"Our patients and the medical community will reap the benefits of a stronger collaboration," Dr. Dupuy said in his presentation, "We Must Stand on the Shoulders of Giants."
Dr. Dupuy contrasted the role of the two specialties from the 1970s to today. "In the good old days, it was 'we image and diagnose' and 'you treat,'" said Dr. Dupuy, director of tumor ablation at Rhode Island Hospital and a professor of diagnostic imaging at the Warren Alpert Medical School of Brown University in Providence, R.I. "Today, we must look at our strengths and weaknesses and work together to treat patients."
In his appeal for collaboration, Dr. Dupuy invoked the words of Anthony L. Zietman, M.D., M.B.B.S., a professor of radiation oncology at Harvard Medical School and presenter of the RSNA 2012 Annual Oration in Radiation Oncology. Dr. Zietman has noted that radiation oncology is very good at irradiating the microbes of small volume disease, while most ablative technologies handle larger tumors but they don't address microscopic disease. "Imagine how powerful it could be if we put them together," Dr. Dupuy said.
There are financial benefits to collaboration, he added. In the treatment of inoperable non-small cell lung cancer (NSCLC), interventional oncology may be able to provide a more cost-effective treatment, he said. "Radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT) have similar treatment outcomes for inoperable NSCLC, but RFA is about a third of the cost of SBRT," Dr. Dupuy said. "That's something we need to look at when the cost of lung cancer care in the U.S. is projected to be $14 billion by 2020."
In the new healthcare paradigm where evidence-based medicine is an increasingly important determinant of treatment decision-making, Dr. Dupuy said a cohesive team approach to cancer care makes the most sense. In order to change practice patterns, he said, it is also critical for novel technologies, such as image-guided tumor ablation (IGTA), to be rigorously studied in the National Cancer Institute's multicenter format, Dr. Dupuy said. IGTA and SBRT are currently the two alternative treatments for inoperable NSCLC patients.
"We need the collective participation of interventional radiology and interventional oncology groups to help fund and develop protocols to evaluate the cost, safety and efficacy of new technologies, as well as randomized trials with competing technologies," Dr. Dupuy said.
Dr. Dupuy urged radiologists to help in the reunification process by seeking greater interdepartmental activities and sharing resources like medical physics and imaging. "If I have seen further than others, it is by standing upon the shoulders of giants," he said, recalling the timeless words of Sir Isaac Newton.
"The giants have given us the tools," he added. "We must continue to innovate, to collaborate and provide less invasive, less costly and less toxic cancer therapy."