BackTable Tumor Board

How can urologists and radiologists work together to improve kidney cancer treatment? In this episode, BackTable Tumor Board brings together Dr. Jason Abel (Professor of Urology and Radiology at the University of Wisconsin), Dr. Louis Hinshaw (Section Chief of Abdominal Imaging Intervention at the University of Wisconsin), and Dr. Ruchika Talwar (Assistant Professor of Urologic Oncology at Vanderbilt) for a multidisciplinary conversation regarding the treatment of renal tumors. --- This podcast is supported by: ⁠⁠Ferring Pharmaceuticals⁠ --- SYNPOSIS Their discussion covers the history and benefits of collaboration between urology and interventional radiology (IR), advances in image-guided procedural technologies, and the importance of teamwork in improving patient outcomes. The episode also considers the encouraging, but limited data in IR treatments such as microwave ablation and discusses the lasting role for surgery. Finally, Dr. Abel and Dr. Hinshaw share their experiences in establishing a successful interdisciplinary kidney cancer program. Ultimately, they conclude that the future of renal tumor treatment lies not in silos, but in collaboration. --- TIMESTAMPS 00:00 - Multidisciplinary Collaboration in Renal Tumor Treatment05:59 - Advancements in Ablation Techniques: From Cryoablation to Microwave10:13 - Ablation vs. Surgery: Patient Selection and Clinical Decision Making14:00 - Technical Considerations and Complications in Ablation Procedures24:19 - Patient Experience and Recovery Post-Ablation36:17 - Importance of Teamwork in Modern Medicine --- RESOURCES Society of Urologic Oncologyhttps://suonet.org/home.aspx

What does it take to deliver truly personalized, multidisciplinary care in testicular cancer? Get an inside look in this episode of BackTable Tumor Board, where renowned testicular cancer experts Dr. Nabil Adra and Dr. Richard Matulewicz join host Dr. Aditya Bagrodia for a virtual tumor board session on the nuanced management of germ cell tumors. --- This podcast is supported by: ⁠Ferring Pharmaceuticals --- SYNPOSIS The expert panel uses specific patient cases to review their decision-making processes on the use of surgery, chemotherapy, and radiation. They highlight the importance of a multidisciplinary approach, particularly for advanced disease and challenging surgical scenarios. The episode reviews patient-specific factors, standard treatment protocols, post-treatment surveillance, and the latest research. This episode also highlights the benefits of personalized cancer care. --- TIMESTAMPS 00:00 - Case Presentation: 23-Year-Old Male with Testicular Mass09:53 - Surveillance vs. Adjuvant Therapy Debate13:53 - Recurrence, Comprehensive Staging, and Next Steps23:09 - Case Study: 44-Year-Old with Mixed Non-Seminoma Germ Cell Tumor27:47 - Surveillance and Surgery Recommendations28:11 - Case Study: 17-Year-Old with Developmental Delay and Cancer30:10 - Chemotherapy, Surgical Timing, and Prognosis44:58 - Case Study: 21-Year-Old with Scrotal Swelling47:12 - Surgical Considerations and Multidisciplinary Approach --- RESOURCES Society of Urologic Oncologyhttps://suonet.org/home.aspx

There are now multiple phase 3 studies on combination transarterial chemoembolization (TACE) and immunotherapy showing a significant benefit over TACE alone. How do these findings change the hepatocellular carcinoma (HCC) treatment algorithm? In this multidisciplinary episode of the BackTable Podcast, Dr. Richard Finn (Medical Oncologist at UCLA) and Dr. Julius Chapiro (Interventional Radiologist at Yale University) join host Dr. Chris Beck to discuss immunotherapy, TACE, emerging trends in HCC treatment, and the future of the field.---This podcast is supported by an educational grant from Guerbet.---SYNPOSISThe doctors highlight the importance of high quality clinical data and the pivotal studies shaping current best practices. They explore the role of the different players on the multidisciplinary team and compare the oncologic and radiologic perspectives. Additionally, they discuss the synergy between TACE and immunotherapy, the criteria for selecting appropriate treatments, and the ongoing need for research and collaboration.---TIMESTAMPS00:00 - Introduction 03:35 - HCC from an Oncologic Perspective 05:33 - Radiological Perspective on Liver Cancer06:50 - Referral Patterns and Organizing a Multidisciplinary Approach18:01 - Explaining TACE and Variations in the Procedure27:27 - Choosing the Right Procedure for HCC36:13 - Making a Decision on Medical Treatment Candidacy 42:23 - Importance of Data Driven HCC Treatment, Practical Insights, and Studies to Know55:30 - Planning an Approach for a TACE Procedure01:02:26 - Final Thoughts and Future Prospects in Liver Cancer Treatment---RESOURCESBarcelona Staging System:https://www.ncbi.nlm.nih.gov/books/NBK569796/table/Ch3-t0001/TRACE Trial:https://pubs.rsna.org/doi/full/10.1148/radiol.211806PREMIERE Trial:https://www.gastrojournal.org/article/S0016-5085(16)34971-X/fulltextEMERALD-1 Trial:https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.LBA432LEAP O12 Study:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02575-3/abstract

Medical, surgical, radiation, and interventional oncology all play vital roles in delivering care to patients battling liver cancer. How do we optimize outcomes when so many specialties have something to offer the same patient? The answer is collaborative oncology. Dr. Robert Martin (Director of Surgical Oncology, University of Louisville) and pioneer in liver-directed therapies, joins host Dr. Sabeen Dhand to discuss a collaborative approach to oncology and recent advances in locoregional therapy.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISDr. Martin discusses the importance of a growth mindset in advancing medical techniques and fostering collaborations between specialists. He then shares insights into minimally invasive procedures, such as microwave ablation and irreversible electroporation (IRE). The doctors also touch on the evolution of liver cancer treatments, emphasizing the significance of clinical trials on the horizon. To conclude, Dr. Martin encourages young professionals in surgery and interventional radiology to stay open-minded, be life-long learners, and find synergistic ways to integrate new technologies into patient care.---TIMESTAMPS00:00 - Introduction02:31 - Dr. Martin’s Background and Career Path06:18 - Evolution of Liver Directed Therapies10:12 - Collaboration Between Specialties18:34 - Clinical Trials and Emerging Therapies36:08 - Advice for Young Professionals39:15 - Conclusion---RESOURCESRadioembolization Oncology Trial Utilizing Transarterial Eye90 (ROUTE 90) for the Treatment of HCC:https://clinicaltrials.gov/study/NCT05953337?term=NCT05953337&rank=1Intratumoral Injection of IP-001 Following Thermal Ablation in Patients With CRC, NSCLC, and STS (INJECTABL-1):https://clinicaltrials.gov/study/NCT05688280Immunophotonics, CIRSE, and Next Research Announce Innovative Phase 2/3 Clinical Trial: INJECTABL-3:https://immunophotonics.com/news/immunophotonics-cirse-and-next-research-announce-innovative-phase-2-3-clinical-trial-injectabl-3/

Do you ever wish you could be a fly on the wall at a tumor board meeting? In this episode of BackTable, we’re excited to give you an insider’s view of the real case discussions that take place during hepatocellular carcinoma (HCC) tumor boards. Host Dr. Zach Berman sits down with a multidisciplinary team, including Drs. Adam Burgoyne (medical oncologist), Heather Patton (hepatologist), Siddharth Padia (interventional radiologist), and Gabriel Schnickel (transplant and hepatobiliary surgeon).Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125743---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISThe team walks through a range of diverse HCC cases, reviewing patient histories, imaging, and treatment options. They cover eight cases in total, each featuring patients with varying treatment histories, comorbidities, liver function, and lesion characteristics. For the full educational experience, we recommend watching the video format on our YouTube channel.---TIMESTAMPS00:00 - Introduction00:47 - Case 1: Small Lesion in a Young Patient05:01 - Case 2: Moderate Sized Lesion in an Older Patient11:10 - Case 3: Multifocal HCC with Dominant Lesion21:09 - Case 4: Dominant Lesion with Portal Hypertension32:08 - Case 5: Ruptured Solitary Lesion34:34 - Case 6: Rupture with Multifocal Lesions44:08 - Case 7: Portal Vein Invasion52:12 - Case 8: Metastatic HCC After Transplant---RESOURCESCME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Are you seeking to build your reputation and patient base within interventional oncology? In this episode, host Dr. Zachary Berman interviews Dr. Siddarth Padia, Dr. Tyler Sandow, Dr. Kavi Krishnasamy, and Dr. Kevin Burns about their journeys into interventional oncology (IO) and their experiences providing care in different practice settings.Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125742---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISThe doctors begin by discussing how they became interested in interventional oncology, with most of them recognizing opportunities to address unmet needs in the field. Each guest shares insights on the timelines and challenges involved in starting their IO practices, which vary significantly today. For instance, telehealth clinics are particularly viable in private practice IO, thanks to conferencing software and virtual translators. Hybrid care models, which combine in-person and remote consultations, can help overcome patient-level barriers such as time and transportation. The panel also emphasizes how increased clinic availability can significantly drive growth in procedural volume. Finally, they offer advice for starting an IO practice, including the importance of having clinic support staff, building strong relationships with referring physicians, and staying up to date with new technologies.---TIMESTAMPS00:00 - Introduction05:38 - Balancing Career Interests and Expectations07:10 - Building an Interventional Oncology Practice13:42 - Gaining Trust from Referring Physicians17:33 - Importance of Open Communication19:19 - Comparing Clinic Settings26:01 - Essential Components of a Clinic33:28 - Narrowing Your Interventional Practice40:09 - Introducing New Technology---RESOURCESCME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Is surgery truly the "cure" for hepatocellular carcinoma (HCC), and when is it a viable option? In this episode, Dr. Sabeen Dhand leads a roundtable discussion with interventional radiologist Dr. Siddharth Padia and transplant/hepatobiliary surgeons Dr. John Seal and Dr. Gabriel Schnickel, delving into the complexities of surgical treatments for HCC and the evolving landscape of liver resection and transplantation.Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125741---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISThe doctors begin by discussing how they manage patient expectations regarding both palliative and curative treatments, highlighting the risk of recurrent HCC as a new lesion. They then outline key factors that influence their recommendations for liver transplant versus resection, such as the extent of underlying liver disease, the function of the future liver remnant, body habitus, overall health, and organ availability. The surgeons also review various surgical approaches to liver resection and recent advancements in liver transplantation, including living donor transplants and the ability to refer patients for downstaging procedures.Dr. Padia explains the original role of Y90 as a bridging treatment to downstage tumors and promote hypertrophy in the non-diseased liver segments, preparing the organ for surgical resection. However, Y90 treatment can also lead to the formation of adhesions, which may complicate future surgeries. Finally, the doctors discuss strategies to improve care coordination between community physicians and transplant centers to optimize patient outcomes.---TIMESTAMPS00:00 - Curative vs. Palliative Treatment04:03 - Choosing Between Transplantation and Resection05:47 - Liver Resection Types07:27 - Bridging Role of Y9012:14 - Evolving Landscape of Liver Transplantation20:59 - Patient Counseling in Minimally Invasive Procedures28:40 - Considerations for Surgery After Y9033:32 - Coordination Between Specialists40:08 - Immunotherapy as a Bridge to Transplant---RESOURCESCME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

The process of liver transplantation involves many complexities, and each patient's path to transplant is unique. To offer insider perspectives on this process, Dr. Zachary Berman sits down with transplant and hepatobiliary surgeon Dr. John Seal, as well as transplant hepatologists Dr. Heather Patton and Dr. Steve Young.Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125740---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISThe panel begins by discussing the multidisciplinary pre-transplant evaluation process, which assesses factors such as liver function, comorbidities, surgical risk, and the availability of psychosocial support. Once a patient is listed for transplant, they enter a system that prioritizes those with the highest Model for End-Stage Liver Disease (MELD) score. During the waiting period, several comorbidities should be carefully monitored. Dr. Seal explores the impact of portal vein hypertension and portal vein thrombosis, explaining how these conditions may necessitate intraoperative thrombectomy or bypass. Dr. Patton and Dr. Young focus on considerations for using anticoagulation in patients with a high baseline bleeding risk and selecting the appropriate anticoagulant for patients listed for transplant.For patients with hepatocellular carcinoma (HCC), eligibility for MELD exception points may depend on factors such as time spent on the waiting list, adherence to the Milan criteria, and the presence of extrahepatic complications of liver disease. The panel also discusses bridging therapies to transplant, including Y90 and TACE. In the peri-transplant phase, they highlight innovations such as living donor transplants, liver perfusion pumps, and the use of hepatitis C- and HIV-positive organs. Finally, the discussion turns to post-transplant considerations, including surgical complications, organ rejection, immunosuppression, predictors of HCC recurrence, and long-term surveillance.---TIMESTAMPS00:00 - Introduction01:16 - Current Landscape of Liver Transplantation03:22 - Transplant Evaluation Process09:48 - Timeline from Listing to Transplantion11:16 - Treating Portal Vein Thrombosis and Hypertension18:44 - MELD Exception Points22:05 - Bridging Therapies25:34 - Peri-Transplant Considerations30:53 - Post-Transplant Period37:39 - Repeat Transplantation---RESOURCESModel for end-stage liver disease (MELD) and allocation of donor livers (Wiesner et al, 2003):https://www.gastrojournal.org/article/S0016-5085%2803%2950022-1/fulltextLiver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis- Milan Criteria (Mazzaferro et al, 1996):https://pubmed.ncbi.nlm.nih.gov/8594428/Validation of the prognostic power of the RETREAT score for hepatocellular carcinoma recurrence using the UNOS database (Mehta et al, 2019):https://pmc.ncbi.nlm.nih.gov/articles/PMC6445634/CME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Treatment of hepatocellular carcinoma (HCC), like that of many other cancers, spans a spectrum from curative to palliative intent. To explore the "grey zone" of treatment goals for intermediate-stage HCC patients, Dr. Sabeen Dhand interviews a panel of experts in the field: medical oncologists Dr. Adam Burgoyne and Dr. Lingling Du, along with interventional radiologists Dr. Kirema Garcia-Reyes and Dr. Zachary Berman.Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125739---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISThe discussion begins with an explanation of the Barcelona-Clinic Liver Cancer (BCLC) staging system. While this system takes into account helpful factors such as liver function, performance status, and tumor burden, it fails to fully capture the true heterogeneity of the HCC patient population. Additional considerations include tumor biology, response to previous treatments, and the location of metastases. The specialists then share their experiences in treating patients with comorbid gastrointestinal cancers and mixed tumors, discuss the benefits of an interventional oncology clinic setting, and highlight virtual opportunities for connecting with tumor boards. They also offer advice on patient education regarding treatment options.---TIMESTAMPS00:00 - Introduction to BCLC Staging03:02 - Impact of Performance Status06:29 - Predictors of Survival in HCC09:51 - Palliative versus Curative Treatment Intent13:55 - Comorbid and Mixed Gastrointestinal Cancers16:51 - Adverse Effects of Treatment20:37 - Interventional Oncology in the Clinic Setting23:06 - Navigating Multiple Provider Viewpoints28:01 - Complex Case Examples---RESOURCESBCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (Reig et al, 2022):https://www.journal-of-hepatology.eu/article/S0168-8278(21)02223-6/fulltextCME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

For hepatocellular carcinoma (HCC) patients who are not candidates for liver transplant or resection, lesion ablation can be a curative treatment. With multiple ablation options available and still under investigation, it can be challenging to navigate the differences between them. In this episode, Dr. Tyler Sandow hosts a discussion with interventional radiologists Dr. Kirema Garcia-Reyes, Dr. Sabeen Dhand, and Dr. Kevin Burns on the various ablation options for HCC and when to use each one.Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125738---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISThe doctors first discuss Barcelona-Clinic Liver Cancer (BCLC) Stage A patients, where lesion size and location are key factors in deciding between ablation and transarterial therapies. They then compare cryoablation and microwave ablation, highlighting that cryoablation offers better visualization and control of the ablation zone, while microwave ablation is more effective for treating larger lesions.Dr. Burns introduces histotripsy, a noninvasive treatment that uses ultrasound energy to mechanically ablate tumors. He shares his experiences as an early adopter of this technology and discusses how intraoperative cone beam CT can help treat lesions located near critical structures or those poorly visualized on ultrasound. Finally, Dr. Garcia-Reyes and Dr. Berman provide insights into patient selection, pre-procedural imaging, and technical tips for Y90.---TIMESTAMPS00:00 - Introduction02:04 - Ablation vs Y90 in BCLC A Patients05:58 - Same-Day Y9015:55 - Y90 for Large Tumors17:51 - Ideal Cases for Cryoablation19:38 - Explanation of Histotripsy32:09 - Procedural Specifics for Histotripsy38:21 - Technical Tips for Y90---RESOURCESIncluding the Hollow Viscera (Stomach or Bowel) within the Ice Ball during Cryoablation: A Review of Adverse Events (Abramyan et al, 2024):https://www.jvir.org/article/S1051-0443(24)00681-X/abstractCME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf