Tri-State Regional Cancer Center - Radiation Oncology Team

Jeffrey P. Lopez, MD
Terry E. Justice, MD

A radiation oncologist is a doctor who specializes in the treatment of cancer patients, using radiation in the prescription for treatment.
Radiation oncologists prescribe such radiation to destroy cancer cells, by means of using high-energy particle accelerators or by the use of either temporarily or permanently implanted radioactive material. This is different from the medical oncologist who uses chemotherapeutic drugs in the prescription for treatment. Radiation oncologists work closely with surgical oncologists and other physician specialists to arrive at the most suitable set of treatment aims for every patient. Working in a radiation oncology department, they rely on the expertise of medical physicists for scientific accuracy. With technically skilled dosimetrists and radiation therapists also as resources, radiation oncologists determine the best course of therapy and consult with each patient.

Radiation oncologists use three-dimensional images to work out exactly where the tumor is and where the normal tissues are. Often, regular ultrasound images and x-rays are beneficial, although diagnostic scans such as CT, MRI, CT-PET and PET are mostly used for planning purposes, as they have the most detailed reconstruction possible and the highest resolution. Imaging may also include more invasive techniques. Used primarily by other physician specialists, these techniques involve the use of instruments that are guided through the body for visual identification, which is important to the radiation oncologist.

Radiation therapy involves various kinds of radiation treatment techniques. The most common types of radiation therapies in use are 3-dimensional conformal external beam radiation therapy (3DRT), intensity-modulated radiation therapy (IMRT), stereotactic radiosurgery (SRS) and various types of radioactive material treatments known as brachytherapy. These modalities are readily available at our facility. The radiation oncologist selects the most effective radiation technique, for each particular patient, to aim and destroy abnormal (cancer) cells while sparing the normal surrounding tissue. During radiation treatments, the oncologist will generally see the patients about once a week to assess their status and help manage any side effects they might have.

The radiation oncologist engages in hospital Tumor Board Conferences, reviews closeout statistics and morbidity-mortality surveys. This increases the effectiveness and educational awareness of modern treatment techniques available with various physician specialties, for an evolving consensus on the best treatment option for each cancer type. Statistical and survey analyses provide information to the radiation oncologist to gauge the growth and incidence of cancer in the community and identify potential patterns of disease and long-term successes. Regular physician interaction is sought after in order to follow each patient?s history and therapeutic outcome. Such follow-up includes an evaluation of the success of treatment in terms of tumor control and complications. A review of patient outcome studies is reviewed for each specific disease site. Comparisons with outcomes available are reviewed against literature. It may be seen by a radiation oncologist that remedial action can be taken when results are short of expected outcomes.

A consultative medical record is provided for the hospital and the referring physician from the clinical evaluation of a patient, where the consideration for radiation therapy is analyzed and documented.
The report identifies the conclusions from the radiation oncologist regarding the determination of patient's suitability for treatment, known history, physical exam, laboratory investigations to help determine tumor extent, real logic investigations as required for determining medical status of tumor stage, pathologic confirmation of a malignancy or statement of benign condition disease (except in rare cases such as emergencies or surgically inaccessible sites), establishment of tumor stage or extent and tumor location, statement of options for treatment with total dose in time, and the informed consent to be obtained prior to initiation of treatment.

The radiation oncologist is involved in every part of the treatment delivery process. The physician will monitor the patient (at least once weekly) during treatment to evaluate changes in clinical status, tumor response, and treatment toxicity. These evaluations include but are not limited to pertinent symptom elucidation and relevant physical findings, monitoring of weight and nutritional status, provide prescription for necessary drugs for aid to treatment related toxicities, consideration for alterations in the plan of treatment, such as changing the dose per fraction, total dose aim, treatment breaks, etc. as well as appropriate consultations for medical and surgical problems.

Becoming a radiation oncologist requires a long educational road. Most start with a Bachelor?s degree prior to being accepted into medical school programs. Radiation oncologists complete four years of medical school and then a year of internship before entering residency graduate education, which usually takes about four years. During this residency program, students will specialize in both radiation oncology and clinical oncology. The primary qualification for the practice of radiation oncology is certification in the appropriate physician specialty by the American Board of Radiology (ABR). Our radiation oncologists have achieved the qualifications stated below. To contact a radiation oncologist, please click on the link.

Radiation Oncologist [MD, DABR]
– Jeffrey P. Lopez, MD and Terry E. Justice, MD

Qualifications

• United States Medical License                     
• American Board of Radiology (ABR)
    - Diplomat in Radiation Oncology
• Kentucky State Approval
    - Medical Practitioner
    - Authorized User for radioactive material applications as needed
      at Tri-State Regional Cancer Center and King’s Daughters
      Medical Center
• King’s Daughters Medical Center privileged