Just trying to generate some discussion...

[AlexanderJ]

Hey, this board has been dead. Lot's of visitors but just a few people who post. To generate some discussion, I thought I would ask everybody why they chose, or are considering, the field of radiation oncology? Don't be shy, let's hear your reasons!

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[oscar]

Not only that, but I would also like to add this:

Just saw on the CNN Headline News news ticker something about a company reporting promising results on a new cancer vaccine. Now, having read nothing more or investigated no further on what they are talking about, it still made me think. While the possibility of a cancer vaccine to eradicate all malignancies does sound rather fantastical, it does bring up the idea of what the future of oncology is. I would say that while cancer has been around since the dawn of man, our medical advances in this day and age are being made at exponential rates, and it isn't out of the realm of possibility that some sort of breakthrough is possible within our lifetime, maybe sooner rather than later. What that would be of course I have no idea.

But if the landscape of oncology does change where we move beyond the traditional surgery, chemo, rads, where would we fit in the picture and how do these roles change??

 

[AlexanderJ]

I had the same thought before I decided to go into Rad Onc. My strategy was to get the worse possible scenario, so I went and asked a bunch of medical oncologists and surgical oncologists (approximately 15 total physicians) what their thoughts were on the future of radiation oncology. Every last one of them saw the role of radiation increasing in the future for the treatment of cancer. Every last one of them thought radiation oncology would be a wonderful field to enter at this time. No-one sees any kind of cure or "magic bullet" coming in the near or distant future. One medical oncologist went as far as saying that there will always be people dying of cancer to the end of time. They all seem to believe in the multimodality approach to cancer treatment, and radiation will always be a component of that. These people see cancer as a natural consequence of aging, and only see larger numbers of cancer patients to be treated in the future with our aging population. One doc told me that there are over 400 different kinds of cancer, and no matter what kind of chemotherapy you come up with, there will always be a subset of patients that will not respond. On top of that, some of the doctors stressed to me how cancer cells mutate to become resistant to chemotherapeutic agents, and that this was not nearly as much of an issue with radiation. And, with all the hot research going on Rad Onc these days, the new advances (e.g. IMRT), and all the smart people now entering the field, it seems to me that the future is bright for the Rad Oncs. I even asked a pediatric oncologists about the future of radiation therapy in peds cancer, and he saw no end in sight for radiation. That being said, I asked one medical oncologist, "what if everyone is wrong and radiation therapy does become obsolete - what will I do for a job?". He said, in that very unlikely event you would adapt your practice to the current field of oncology. i.e., we would jump on board and start utilizing whatever treatment technique made radiation obsolete. I guess because radiation oncology is such a small field we could probably just meld right into the oncology field. Anyway, no-one thought radiation would become obsolete, but I guess it was comforting to hear we could just adapt our practice. As far as a cancer vaccine goes, it seems to me that if cancer is a natural consequence of aging, there will be no way to cure all cancer unless you can cure "old age". According to the latest statistics, cancer causes about 1/4 of all deaths. If we cure cancer, what are people going to die from? Does anyone see us pushing the average life expectancy to 90 or 100 years in our lifetimes? What I think may happen in our careers is that cancer screening may improve so that we get more early stage breast cancers, prostate cancers, head and neck cancers, etc. If this happens, we will be able to increase our already impressive cure rates for our patients of 50-60% with radiation (at least this is impressive when you compare it to the medical oncologists cure rates) to an even larger percentage, making the field even more fulfilling. Anyway, I would love to hear what others think about this.

 

[AnnK73]

Hi -
I thought some about this too. I think that was a great idea AlexJ to talk to all those medical and surgical oncologists about this. I have talked to a couple people and have gotten a similar response. I think that the more that you know about the feild, the more you appreciate that there is a long road ahead for curing cancer. As for the cancer vaccine, there is that HPV vaccine that might really dramatically reduce the amt of cervical cancer. I dont know much about it but I think it looks promising. As for the rest of the cancer vaccines tho, immunotherapy hasn't really panned out so far. Melanoma being the most studied one and the one with the most promising antigens to target. Some of the new molecularily targeted drugs are promising, but there are so many mutations that contribute to cancer that it is unlikely that one drug would do the trick. (Gleevac being one good example of a great molecularily targeted drug). I think that in most cases the multi-modality approach is consistantly better than single modality. And like someone already said, there are lots of exciting advances in rad onc too. I think it will be an exciting time to be in oncology. I think that the way that things are constantly changing is one of the things that I like most about oncology.
Im not sure about radonc docs just switching to some other modality of cancer treatment if things changed dramatically. That could be interesting.
Other thoughts?
Ann

 

[AlexanderJ]

Hello again:

I agree wholeheartedly with Ann's post. As far as the cervical cancer vaccine, I agree that it does look promising. However, cervical cancer is unique in that it is caused by a virus, specifically the human papilloma virus. Consequently, making a vaccine to the virus (which is what the cervical cancer vaccine is) is somewhat routine, as we already have lots of experience making vaccines against other viruses (e.g. the flu vaccine). Extending this to other cancers is a whole different ballgame, as these cancers are not caused by viruses (at least that we know of). As Ann eluded to, immunotherapy for the treatment of cancer has been a huge failure for the past 30-40 years. Moreover, if the cervical cancer vaccine does pan out (and that's a big if), that would be wonderful, but it would not affect the field of Rad Onc as we already treat very few cases of cervical cancer because of the success of PAP smears.

As far as Gleevec goes, I think its great for the treatment of CML (which is not treated with radiation anyway). When I was asking all the doctors about the future of Rad Onc (see prior post), I forgot to mention I asked a well-respected neurosurgeon at my medical school who specialized in neuro-oncology about Gleevec. He said it was great for CML, a hematologic malignancy, but that many hematologic cancers were curable anyway by other means. He said that solid tumors, where radiation is used, are a whole different ballgame. He too saw no end in site for the use of radiation in the treatment of cancer. Incidentally, the field of Rad Onc has embraced Gleevec, as some hot research in the field deals with using Gleevec as a radiosensitizing agent - again stressing the multimodality approach to treating cancer.

As far as the Rad Oncs being able adapt their practice as medical advances take place, docs have been doing this since the beginning of organized medicine. If some revolutionary new treatment arises for cancer in our lifetimes (something no-one in the field of oncology that I have talked to sees happening), no-one is going to have a lot of experience with it. Seems to me that we would have just as much right to jump on board with the new treatment as anyone in the field of oncology. Just my thoughts. Please chyme in with yours!