BackTable Vascular & Interventional

Why might the standard RECIST criteria fail to accurately track success after tumor ablation, and what should you look for instead? In the 4th installment of the 2025 NSCLC Creator Weekend™ series, hosts Drs. Scott Genshaft and Kavi Krishnasamy are joined by specialists from UCLA and USC to discuss and debate advanced treatment options for primary lung cancer. --- This podcast is supported by an educational grant from Johnson & Johnson and Varian. --- SYNPOSIS The panel, including interventional radiologists, pulmonologists, and a radiation oncologist, discusses the intricacies of photon versus proton therapies, the physics behind radiation treatment, and the evolving landscape of ablation technologies. The conversation covers the efficacy and limitations of different treatments, patient selection criteria, and the role of newer technologies like electroporation and robotic-assisted bronchoscopy in enhancing precision and outcomes. Additionally, the panel addresses the practical challenges of intraprocedural imaging, the importance of adequate margins, and the complexities of managing local recurrences and radiation-induced toxicities. --- TIMESTAMPS 00:00 - Tumor Ablation and Recurrence Rates12:53 - Advancements in Ablation Technologies23:31 - Bronchoscopic Approaches in Lung Cancer Treatment38:46 - Challenges in Radiation Dose and Delivery49:21 - Ablation and Radiation Margins01:07:19 - Final Thoughts --- RESOURCES Thierry de Baere Paper on Ablation Margins https://pmc.ncbi.nlm.nih.gov/articles/PMC9815739/

Dr. Gabriel Werder, an interventional radiologist from Florida, shares his expertise on thrombin injection for treating pseudoaneurysms. He discusses essential procedural techniques, including optimal needle positioning and sedation protocols. The conversation highlights unique cases, balloon-assisted methods, and managing complex pseudoaneurysms. Werder also emphasizes the importance of comprehensive ultrasound assessments and tailored post-procedure care to ensure successful outcomes. Tune in for practical insights and best practices that can enhance your understanding of vascular intervention!

Dr. Karen Reckamp, a thoracic oncologist at Cedars-Sinai, and Dr. Scott Atay, a thoracic surgeon at USC, delve into the complexities of lung cancer treatment. They discuss the latest in lung cancer staging and cutting-edge systemic therapies. Key insights include the evolving role of molecular diagnostics, the importance of tailored treatment plans, and the integration of new therapies in surgical decision-making. They also explore the implications of pollution and genetic factors on non-smoker EGFR risks, highlighting a future focused on personalized cancer care.

Dr. Steven Abramowitz, a vascular surgeon and physician executive director at MedStar, discusses the latest guidelines on deep venous thrombosis (DVT) management. He delves into the implications of the ATTRACT trial and the CLOUT registry, emphasizing how mechanical thrombectomy is evolving. Abramowitz highlights key techniques like IVUS for treatment endpoint determination and the importance of collaboration with referring physicians. He also touches on the role of anticoagulation and the need for redefining DVT to improve patient outcomes.

What should you know before applying to an interventional radiology residency program? Get 70 minutes of free advice in this week's episode of BackTable featuring Georgetown IR fellow Dr. Neil Jain and host Dr. Chris Beck, covering everything from building your IR resume to crushing your interviews. SYNPOSIS The conversation starts by covering the essential steps that medical students can take to build their resume prior to the application cycle, including involvement in the medical student sections of SIR, CIRSE, and local symposiums. Dr. Jain highlights the importance of mentorship and research, strategies for obtaining strong letters of recommendation, and effectively navigating both home and away rotations. The discussion also extends to interview preparation, program selection, signaling updates, and the rank list construction. The episode also touches on the SOAP process for unmatched applicants and the avenues to secure a match. Importantly, Dr. Jain emphasizes the significance of fit over prestige and finding a program that aligns with your values and professional goals. --- TIMESTAMPS 00:00 - Introduction03:07 - Building Your Resume for IR10:43 - Away Rotations and Letters of Recommendation 23:54 - Personal Statements: Importance and Tips30:07 - Application Strategies: IR and DR Programs41:48 - Utilizing Signaling in the Application Process44:19 - Evaluating Programs During Interviews49:58 - Letters of Interest and Intent54:33 - The Interview Day Experience01:04:47 - Building Your Rank List01:08:56 - The SOAP Process01:12:50 - Final Advice and Closing Remarks --- RESOURCES 2025 NRMP Match Data https://www.nrmp.org/wp-content/uploads/2025/03/Advance_Data_Tables_2025.pdfSociety of Interventional Radiology Trainee Websitehttps://www.sirweb.org/in-training/ VI 372 - IR Pathways Unveiled: Matching, Training & Beyond https://www.backtable.com/shows/vi/podcasts/372/ir-pathways-unveiled-matching-training-beyond VI 554: Optimizing the IR/DR Curriculum & Experiencehttps://www.backtable.com/shows/vi/podcasts/554/optimizing-the-ir-dr-curriculum-experience

Dr. Jason Hoffman, an interventional radiologist at NYU Langone, dives deep into microwave ablation for liver lesions. He stresses the importance of educating patients and collaborating within multidisciplinary teams. Hoffman compares the benefits of microwave ablation to traditional methods and shares insights on patient selection and ideal lesion characteristics. The discussion also covers innovative technology from Varian and how AI could shape the future of the field. His expertise provides a compelling view on advancing interventional oncology practices.

Join Dr. Karen Reckamp, a medical oncologist focused on neoadjuvant strategies, Dr. Scott Oh, a radiation oncologist discussing local therapies, and Dr. Scott Atay, an interventional pulmonologist specializing in staging, as they tackle a complex NSCLC case. They debate the best approaches for treating isolated brain metastasis, the implications of nodal disease, and the optimal sequencing of chemoimmunotherapy and radiation. Their multidisciplinary insights shed light on the balance between surgical risks and systemic benefits in challenging cancer cases.

Dr. Miguel Montero-Baker and Dr. Lucas M Ferrer Cardona, innovative vascular surgeons, dive deep into the transformative technique of deep venous arterialization (DVA). They share personal insights on its evolution and the hybrid approaches that enhance outcomes. Discussions include the significance of patient selection and the role of family support in successful limb preservation. They also explore new devices like the Aveera Boomerang and the future of DVA, emphasizing ongoing research to refine these life-saving methods.

Dr. Karen Reckamp, a thoracic oncologist, joins Dr. Alan Lee, a radiation oncologist, Dr. Scott Atay, a thoracic surgeon, and Dr. Scott Oh, an interventional pulmonologist, for a rich discussion on lung cancer management. They explore the dynamics of tumor boards, emphasizing collaborative decision-making and the benefits of hybrid meetings post-COVID. The panel dives into the significance of tissue diagnosis, mediastinal staging, and the evolving role of ablation therapy, highlighting challenges and strategies in treating early-stage and metastatic lung cancer.

As breast imaging is becoming increasingly sensitive, is cryoablation the next frontier for treating small cancers or patients who are poor surgical candidates? Learn from expert Dr. Robert Ward, associate professor and program director of the Breast Imaging Fellowship at Brown University as he provides a contemporary overview of the innovative field of breast cryoablation. --- SYNPOSIS Dr. Ward shares his journey to becoming an expert in breast cryoablation, from his start in residency to his well-developed service line today. He details his experience enrolling patients in the FROST Trial, which is investigating the role of breast cryoablation as an alternative for surgery in patients with early stage invasive breast cancer. The conversation also covers the intricacies of the procedure, patient selection criteria, pre- and post-procedural care, and the significance of receptor positivity and clinical markers in treatment choices. Dr. Ward talks through the challenges in needle positioning prior to ice ball formation and the possibility of treating tumors close to the skin surface given appropriate wound care. The discussion concludes with a future look at how cryoablation could change the current paradigm of breast cancer care. --- TIMESTAMPS 00:00 - Introduction 01:39 - The Rise of Breast Cryoablation06:40 - Challenges and Considerations in Cryoablation07:59 - Patient Referral and Evaluation Process13:35 - Equipment and Techniques for Cryoablation23:29 - Procedure Steps and Needle Positioning26:11 - Post-Procedure Thawing and Patient Expectations28:35 - Post-Procedure Care and Follow-Up34:20 - Future of Cryoablation in Breast Cancer Treatment38:01 - Conclusion --- RESOURCES FROST Trialhttps://clinicaltrials.gov/study/NCT01992250 Brown et al., Strategies to Optimize Success in Breast Cancer Cryoablation, Journal of Vascular and Interventional Radiologyhttps://pubmed.ncbi.nlm.nih.gov/41083146/