Is it possible to combine radiation and interventional oncology?

[Eggheads]

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Hi all
I am a new member of the forum, only attracted to become so after extensively reading the very interesting posts on rad.onc.
I am a graduate currently working in medicine and was initially planning to pursue hem/oncology. However, I did an elective in rad.oncology and found it quite interesting, much more than hem.onc, partially due to the physics and technicality involved, as well as the opportunity to do some interventions- ie brachytherapy. Few questions yet remain unanswered to me and I would like some help from any seniors in the field:

1. Is it possible to combine radiation oncology and interventional oncology- which is really a branch of diagnostic radiology-- interventional radiology? I mean a rad.oncologist knows the anatomy very well and, if becomes a brachytherapist, would have some interventions done too. So would it be possible with some further training to become an interventional oncologist too? Do you know anyone who has combined both or is planning so?
2. One of the reasons am attracted to the oncology field is research. Therefore, I would like to know how vastly advancing and versatile are the research opportunities in rad.oncology. Is it as good as in medical and hem.oncology?

Many thanks

 

[Gfunk6]

1. Is it possible to combine radiation oncology and interventional oncology- which is really a branch of diagnostic radiology-- interventional radiology? I mean a rad.oncologist knows the anatomy very well and, if becomes a brachytherapist, would have some interventions done too. So would it be possible with some further training to become an interventional oncologist too? Do you know anyone who has combined both or is planning so?

No, there is no directly combined path (like Med-Peds or Psych-Neuro). It would probably be impossible to get the training of one recognized by the other (except for an internship). So you would have to do an internship, four years of radiation oncology, four years of diagnostic radiology and two years of interventional radiology or eleven years total (ten if you went DIRECT). Pardon my saying so, but you would have to be insane to undergo that much clinical training because you would be only using a fraction of what you learned in those 10-11 years on a daily basis.

If I were you, I'd go with one path or the other. You'd have to go to the Radiology forum for more info on IR. From a Rad Onc perspective, you can be a dedicated brachytherapist (generally in an academic setting) and spend nearly all of your time in the OR. Though obviously, in either the case of IR or brachy the scope of your practice would be limited. But honestly, from a brachytherapy perspective you have a large variety of interventions which should keep you happily diversified (prostate, GYN, breast, lung, H&N).

2. One of the reasons am attracted to the oncology field is research. Therefore, I would like to know how vastly advancing and versatile are the research opportunities in rad.oncology. Is it as good as in medical and hem.oncology?

Rad Onc is research heavy. Our basic/translational research is not as developed as Med Onc but our clinical research is very robust and we also have the added dimension of physics research if that floats your boat.

 

[youngdoc8205]

I'm not either IR or radonc, but was a rads resident and can weigh in a little, if you'll let me 🙂

If you're interest lies in cancer and research odds are rad onc may be more your speed.

While interventional oncology is a new field with tons of research opportunity, it is somewhat more narrow than rad onc in terms of what they can treat: liver cancer primarily, but also RCC with percutaneous cryoablation, osseous mets with RFA (usually in EBRT failure cases) etc. there is new stuff coming out like intra-arterial chemo for retinoblastoma.

Also the training is different; IR is much more than oncology, and if you are on call at a busy center odds are you will be in the hospital coiling GI bleeds, spleens, doing AV graft declots, doing TIPS for variceal bleeds so and so forth. In the really big places you will also be doing arterial work with vascular surgery like aortic dissections and cold legs. So you won't get 100% oncology, or even 50%. Unless you go to a place like MSK or MDAnderson or Dana Farber. Though then you will be relatively limited to a career in academics, b/c if you want a private practice job you should do all of IR.

That being said, there is a lot of research going on in IR, particularly oncology, it's pretty much whatever they can think they will try, because there are always patients who are not candidates for established therapy.

Like someone already mentioned RadOnc you can spend a ton of time doing procedures, but again from what I understand one the draws to the field is the patient interaction.

so to summarize: no you can't do both
if you like cancer and research, rad onc is probably your best bet
if you deseprately want to do both go ahead 🙂, you will probably have no trouble securing an academic position after

 

[kepler]

You may be interested in reading this article by Zietman in the Seminars in Radiation Oncology: The Future of Radiation Oncology: The Evolution, Diversification, and Survival of the Specialty (PMID: 18513631).

In it, he discusses the possibility of merging of training in both rad onc and interventional radiology (as well as diagnostic radiology).

With the increasing number of tumor ablations performed, it is interesting to think of, in essence, a fourth 'arm' of oncology (in addition to surgical oncology, medical oncology, and radiation oncology)- the 'ablation' expert, who has expertise with thermal ablation, SBRT, electroporation, HIFU...

 

[youngdoc8205]

kepler, I think you have hit the nail on the head, with a 4th arm of oncologic managmenent; unfortunately I don't think it will end up combinging any of the 3 current specialties, because of the diverse skill sets.

rad onc and surge onc are particularly procedure driven, and as countless research has shown the higher the number of procedures you do the better you are, so it is unlikely that a rad onc doing breast, prostate, GI or surge onc doing liver resections/breast/skin etc would also be able to be good at intra-arterial therapy or even percutaneous therapy. Although surgeons already do some percutaneous ablations, but mostly intra-operative ablation/electroporation. Also these patients need to be managed pre and post-operatively, and can develop some truly heinous complications (PE from Y90 or TACE; Budd-chiari or portal vein thrombosis from y90, all kinds of nerve damage from ablation), and interventional oncology currently also includes treatment of osseous mets including with peripheral IV radopharmaceutics, mediport placement, thromboembolic therapy, etc.

Even within IR, though the skill set is relatively the same from intra-arterial stuff, the percutaneous stuff is different. I think ultimately IR will split off and start to sub-specialize in oncology, arterial work, peds etc similar to what rad onc did. Now this may be a good time for IR and rad onc to work together, but again, the amount of knowledge you need to be a good rad onc, IR onc, surge onc, or heme/onc is just too great to merge any of these 2 specialties together.

What will likely happen is cancers will be managed in multi-disciplinary clinics by all 4 specialties, and people may decide to have overlap of practice.