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15+ Year Member
Mar 22, 2002
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I have done an elective in Rad Onc and have decided that I definately like the field and could see myself doing it for a living. Of course that is in regards to the current state of the field. I know this has been touched upon on this site before but I am really concerned about the future of the field.

It seems like degree of specialty of the field has left it little room for adaptability, and Rad Oncs don't seem too aggressive to claim newer treatments such as radioisotopes for throid cancer.

XRT is so non-specific and the Gamma knife hasn't turned out to be the saving grace as expected. Does anyone have some advice on where the fiueld is heading and new developments on the horizon that will allow it to compete with newer more specific treatments?

No one can predict the future, but I worry that in 30 years when I still hope to be practicing that there may no longer be a role for Rad Onc in the treatment of cancer. After 4 years of busting my butt in medical school and the prospect of training 4 more years in residency I would hate to be phased out during my career.

Any Thoughts?


SDN Super Moderator
Moderator Emeritus
15+ Year Member
Jun 7, 2001
I smile as I read this because I just had a conversation pertaining to this today. I was noting that one can't be too critical of a patients lack of understanding of the difference between med onc and rad onc since even people in the field dont understand it.

A few misconceptions: chemo will NOT replace radiation; similarly it wont replace surgery. The modalities are complimentary and work often synergistically. And no magic bullit (not even gleevac and photodynamic therapy, the panaceas of recent news items) is on the horizen.

Rad onc is evolving like no one's business. . . mostly with respect to treatment techniques to be more conformal and to spare normal tissue, in turn allowing for boosting doses to tumor to higher levels.

There is great growth with respect to radioisotopes. Iodine for thyroid cancer is quite old news. Gliasite balloons, HDR, samarium, lots of stuff is in the offing.

I have no idea how you mean XRT is non-specific so I can't answer that. It now occurs to me that perhaps you mean its not focal and conformal enough? Well you dont want it to be in many cases, particuarly before cone-down. You want to irradiate a field (GTV/CTV/PTV-nodal drainage included). And when you want conformality, try IMRT or cyberknife. And as for gamma knife- FSR with dynamic arcing and cyberknife is superior in my view. I dont know gamma knife or any modality (see first paragraph) is supposed to be a saving grace. Again, its multimodality which is part of the appeal of oncology treatment. You have to know anatomy, radiology, chemo, medicine and surgical approaches to do it really right. You will learn about chemosensitization and cytoreduction. Playing with radiobiological properies to maximize treatment and minimize complications.

I think you have a better understanding of rad onc than most medical students, but you have a lot to learn about the technology and indeed, the interdisciplinary nature of treating cancer. Its a field that I expect to be around for a while. Remember, Nixon's war on cancer 30 years ago? Its still here. XRT doesnt take the place of surgery; chemo doesnt take the place of xrt, immunotherapy wont take the place of chemo; the role for each is constantly evolving and interdisciplinary.

If you enjoy the field as you say, I think will enjoy the highly technical and rapid fire evolution of things.
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