[DOTmed: What is your perspective on the current debate over health care reform?]

Dr. Williams: My contribution to radiation oncology has been through health care policy and economics. We don't pretend to have any solutions or sorcery for how to solve health care financing issues. One thing that we are sure of is that radiation oncology is a very effective therapy and it is very cost-conscious, as well. As far as expenses in our specialty, it has very expensive technology, but it's also very productive from the standpoint of the patient benefit that it yields. Our belief is that even though we can't tell you what the best path is to navigate health care reform, the future of radiation oncology is going to play a very big role in the management of cancer patient care. In the clinical specialty, we get more cancer training than any other specialty. Having four years of pure oncology training, plus a one-year internship, we see a bright future as a clinical practice. As far as whether we are going to be reimbursed on a case-rate basis, episode of care, fee for service, [those are] really not the issues as far as we are concerned. As long as we maintain our focus on quality, cost-effective patient care, the system will support us no matter how the reimbursement is structured.


[DOTmed: Are there any new trends in technology that you are seeing as far as the exhibition goes this year?]

Dr. Williams: I would say that the last five years have been about targeting. Everything in our specialty hinges on navigation and our ability to see targets inside patients and adapt to the motion of these targets during respiration and peristalsis and things like that. We've gotten much more adept at being able to correct for target motion during the time that the beam is actually being directed at the tumor itself. Those technologies have matured to the point where there is almost nothing that we can't target these days. There are very few cases where we find ourselves unable to localize the target inside of a three-dimensional patient volume. That is going to continue to mature over the next few years and demonstrate good results in clinical trials. Beyond that, we are really entering an era of molecular medicine and adaptive therapy and we'll be able to actually assess tumors as they go through a course of therapy and determine whether the sensitivity is being altered by extending factors - whether we need to intensify the dose or back away from the dose to address those normal tissue issues. Each individual patient will be approached differently so that we can take advantage of these new aspects of the tumor milieu or microenvironment. That opens up a whole new area of improvement in tumor control and patient outcomes.

Dr. Williams is a practicing radiation oncologist at Boca Raton Community Hospital in Boca Raton, FL. President-elect Dr. Anthony L. Zietman will begin his 2010 presidency officially at the 2009 ASTRO business meeting Tues., Nov 3. Keep checking back as our coverage of this year's ASTRO annual meeting continues with exhibitor interviews and product launches from the trade show floor.

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