Favourite disease site to treat?

Started by Raygun77
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Raygun77

Raygun77

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And why 🙂?

Just curious to see which area residents/attendings like to treat. I'm guessing H and N will be up there given it's complexity and the definitive role that RT plays in curative treatment.

Personally I've taken an interest in brain tumours- gotta love MR imaging!
 
I think a lot of people like H&N for the reasons you've mentioned (myself included). Intricate anatomy and planning coupled with the fact that you really feel like you're making a difference (because the alternative surgery could be quite morbid). I can't say I get the same feeling from treating someone's DCIS after lumpectomy or someone's Gleason 6 Prostate CA involving 1% of one core with a PSA of 4.2 (not that there's anything wrong with that --- different strokes for different folks).

I also like SRS/SBRT for both brain and lung --- it's pretty neat to give 10x a normal daily dose to a tumor for several fractions and watch it disappear, particularly when the patient has no other option for treatment (many medically-inoperable early-stage lung cancers out there).
 
I agree with MedGator on the H+N and SBRT lung. I also enjoy doing brachy implants for prostate.
 
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Fun/interesting: Head and neck, ano-rectal, lymphoma
Not too bad: lung, esophageal/gastric, pancreas
Tolerable: prostate, breast
Shoot me: Gyn, CNS

I've found that I've begun to like palliation a lot more than I used to. There's many ways to skin a cat, and it's neat to hear anecdotes about what worked and what didn't for particularly challenging situations (a locally advanced esophageal CA patient who refuses chemo, unresectable pancreatic ca in an otherwise healthy person, a femur met in a breast cancer patient with no other site of disease, muscle invasive bladder CA in an old, unhealthy patient).

For example, as much as I've had hammered home by the evidence about single fx treatment for bone mets, when I convince my attendings to listen to me and treat that way, I've found it just doesn't work as well. I don't think I'll do it any more...
 
I enjoy treatment planning for H&N and Lung, probably followed by CNS and lymphoma. Quite a bit of clinical decision-making and nuance are involved in these sites, whereas early stage breast and prostate are frequently (but certainly not always) a bit more of a cookie-cutter process.

The important caveat here is that treatment planning is only part of "treatment". Managing complications is another significant aspect, and knocks H&N in particular down the ladder overall. These folks get sick during treatment, and despite aggressive pain management/skin care/nutritional management it's tough to watch, even at this point. CNS and GI are two others that quickly come to mind that can be challenging to manage as treatment goes on.

I also agree w/ Simul re: palliation. Skin cancer is another area that comes to mind where one has a lot of latitude with set-up techniques and dose-fractionation, allowing a very patient-specific approach based on the overall clinical scenario.
 
Eh ... Just not that into the brain 🙂
Not even that into SBRT/SRS, but I'm willing to do it.
-S
 
I've heard some people (residents) say there is less satisfaction in CNS because your treatment outcomes aren't as good
 
After 8 months in practice, I realized that treating head and neck cancer with chemoRT at a major university with supportive services is completely different than treating them at a freestanding center.

One situation is interesting/rewarding, the other is fraught with sheer terror - on the good days.

S
 
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