Open or closed staff?

A competent medical contract lawyer should always review any contract prior to your signing. Physicians often rush into a contract under the press of the moment and the good behavior of all parties during the initial courtship phase. Situations can become very nasty during the termination phases of a contract, and you should have researched potential termination scenarios long before they become a reality. Every contract should have a strong non-compete clause clearly written into it. If your potential partner refuses to sign a contract with a strong non-compete clause in it, you may rest assured that this individual may have already coveted your position in the center. As a radiation oncologist, your best protection is to have some type of equity ownership and therefore a voice in the administration and direction of a freestanding center. This will give you the greatest possible security in terms of control over staffing, billing and managerial matters.

High dose rate sources in remote afterloading brachytherapy: implications for intracavitary and interstitial treatment of carcinoma.

Remote afterloading brachytherapy provides effective cancer treatment with zero personnel radiation exposure compared to conventional low dose rate systems requiring inpatient use of iridium, radium, or cesium sources. Clinical use of high dose rate brachytherapy is broadened to encompass curative treatment of cervical, endometrial, endobronchial, head and neck, esophageal, rectal, and prostatic carcinomas as well as palliation of intra-abdominal metastasis intraoperatively. Complications encountered with high dose rate sources will be compared to those of low dose rate systems commonly used in conjunction with external beam irradiation. Radiobiological effectiveness and economic benefits will be addressed to provide support for use of remote afterloading using high dose rate brachytherapy in palliative and curative treatment of selected carcinoma.

Significance of initial "performance status" in patients receiving halfbody radiation.

The excellent palliative value of halfbody radiation is well documented. The optimum time to use this modality for palliation of symptoms is unclear. Our department treated 44 evaluable patients with upper and lower halfbody radiation. Stratification according to a modified Karnofsky performance scale revealed an 86% response with a notable increase in median duration of survival in those patients exhibiting an initial performance scale of -1. The optimum benefit from halfbody irradiation is derived when administered at the earliest indicated time.

Influence of chest radiotherapy in frequency and patterns of chest relapse in disseminated small cell lung carcinoma. A Southwest Oncology Group Study.

The value of radiotherapy to the chest (RC) in disseminated small cell lung carcinoma (SCLC) has been questioned. Two protocols for disseminated SCLC from the Southwest Oncology Group (SWOG) have been compared. They were developed four years apart. The first one included radiotherapy (RT), 3000 rad in two weeks, to the primary tumor, mediastinum and supraclavicular areas, while the second one deleted any RC. Multidrug chemotherapy (CT) and brain RT were used in both protocols. Nonresponders to CT were removed from the study. Our main findings are as follows: (1) Initial chest relapses (patients with no initial extrathoracic relapse) have increased from 24-55% when RC is not given (P = 0.0001). Overall chest relapse (adding those patients that relapsed simultaneously in the chest plus other sites) in the second protocol was 73%. (2) Amount of response to CT does not influence the chances for relapse. Even complete responders to CT have a high chance for chest relapse. (3) Sites of relapse without RC are mainly in the primary tumor, ipsilateral hilus and mediastinum. (4) With RC, relapses shift to the chest periphery, mostly to the lung outside the radiotherapy field and to the pleura. (5) The two very different CT regimens have produced similar percentages and duration of response. (6) CT schema with periodic reinductions prolongs duration of response and survival over schema with continuous maintenance. Hence, interruption of CT to allow RC does not seem to adversely influence CT efficacy. From our results and the review of the literature we conclude that: (1) patients with disseminated SCLC that respond to CT should be given RC to decrease chest relapses. (2) A dose of 3000 rad in two weeks seems to be enough to produce a low percentage of chest relapse in disseminated SCLC, as survival of these patients is short and many will die prior to developing chest relapse. However, according to the literature, 4000-4800 rad is probably a more effective dose. (3) More studies and guidelines are needed to outline proper boundaries of radiotherapy fields, to decrease chances of peripheral chest relapses. (4) Median survival might not be a good parameter to evaluate the impact of RC in disseminated SCLC. The study of long-term survivors seems to be more important.

Angiosarcoma treated with radiation therapy alone.

A case of angiosarcoma of the thumb, treated with radiation therapy alone, is described., The patient is alive and well at ten-years post-therapy, with no evidence of disease.

Optimal radiotherapy treatment planning for carcinoma of the cervix uteri.

A study is described in which an optimal time-dose-fractionation (TDF) value for radiotherapy of carcinoma of the cervix uteri is found using clinical data for points 2 cm from the cervical os proximally along the direction of the cervical canal and 2 cm laterally to the canal. The optimal TDF value was found to be 127 +/- 10 for regimens utilizing external beam cobalt 60 irradiation (or external irradiation of equivalent quality) in combination with intracavitary radium irradiation.

Scattered radiation from trimmer bars in the cobalt-60 teletherapy machines.

The amount of scattered radiation resulting from four Cobalt-60 teletherapy units in four different hospitals when trimmer bars were fully extended was studied. Scatter was present for all machines checked at between 10% and 20% of the central axis dose. Clinical significance is also discussed.