BackTable Vascular & Interventional Ep. 597 Ablative Treatments & Radiotherapy: The Latest in Lung Cancer Treatment with Dr. Alan Lee, Dr. Scott Oh, and Dr. Rob Suh
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Dec 12, 2025 Dr. Alan Lee, a radiation oncologist from UCLA, shares insights on photon and proton therapies, explaining their practical differences and costs. Dr. Scott Oh, an interventional pulmonologist at USC, discusses innovative bronchoscopic approaches, including robotic-assisted techniques. Dr. Rob Suh from UCLA highlights the evolution of lung ablation technologies and addresses the complexities of managing complications like pneumothorax. Together, they explore patient selection criteria, the limitations of traditional RECIST criteria, and the advancements aiming to enhance lung cancer treatment outcomes.
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Protons vs Photons: Practical Tradeoffs
- Protons can reduce exit dose but often offer no clear clinical benefit over photons for most adult cancers.
- Machine cost, size, and onboard imaging limit proton adoption despite theoretical advantages.
Be Intentional With SBRT Fractionation
- Use SBRT terminology correctly: five fractions or fewer is billed as SBRT in the U.S. and impacts treatment planning.
- Plan fractionation deliberately because billing labels and radiobiology influence delivery.
Cost Drives Radiation Infrastructure
- Proton center costs historically reach hundreds of millions, though single-gantry cyclotrons shrink footprint and cost.
- Cost and infrastructure remain central determinants of which modalities centers adopt.