Procedures and conceptual integration?

[rpkall]

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Hi all;

First time posting over here... I'm an MS2 who might be interested in the field.

I was wondering if there are any surgical procedures performed by radonc physicians; I'm also curious about how radonc docs integrate the basic sciences of oncology and radiation physics with anatomy, conventional radiology, and pathology disciplines. In theory, this specialty seems like a great idea for people interested in various different aspects of medicine--including some of the psychosocial aspects of serious illness and the physician/patient relationship there. But in practice, do you really feel like you're really integrating those various disciplines in the care of patients, or is it more routine, sticking mainly to the radiation biology/physics of the patient's care?

I'd appreciate any thoughts on either of these two things.

Thanks in advance!

 

[stephew]

erm, that's quite a post. check out the faq to begin with. i will also point you to a chapter (that i wrote) in brian freemans The Ultimate Guide to Choosing a Medical Specialty

 

[rpkall]

Hey there. I think I've read both before, actually, and they're both very good. Maybe someone can tell me more about the radonc doc's role in brachytherapy procedures? Is there ever any "surgery" performed, per se, or is it more that the surgeon on the case calls you over to the table, and you slip the pellets into where they need to go?

As far as the integration of disciplines, I was just curious if this is really something that happens in a challenging way on a daily basis, or if there are so many routine protocols established at each institution that there's really not much of this anymore.

Thanks for the leads, and the info. 😉

 

[G'ville Nole]

In general, radiation oncologists take the lead in performing:

-Prostate seed implants
-Intracavitary/interstitial implants for gyn tumors
-Multi-catheter interstitial breast brachy (where offered)
-Head and neck brachy inplants (increasingly rare in the IMRT era, but some folks still keep in practice)
-Mammosite breast brachy (surgeons are usually and rightly engaged in this process)

Procedures where there variable practice patterns:

-Radionuclide injection (not that exciting, but an interesting turf war b/w rad onc and med onc)

Procedures where the rad onc is along for the ride, and surgeons are doing most/all of the work:

-Eye plaque brachytherapy
-Lung brachytherapy (endobronchial and mesh implants after wedge resection)
-Head frame placement for radiosurgery
-Intra-arterial SIRS sphere injection
-Intravascular brachy (increasingly rare)
-Intra-operative RT (Our facility doesn't have this, so I'm not sure of the exact role of the rad onc, but I know we don't excise the tumor)

I'm sure I've forgotten some procedures, but this is a reasonably representative list.

As you can see, our interaction with surgical oncology is both robust and tremendously important. Our chairman likes to talk to interviewees about becoming "comprehensive oncologists", and this is really what is required to be a good radiation oncologist. You need to have a reasonable familiarity with medical and surgical oncology (including some of the seminal literature), and your day to day functioning will require that you become comfortable with diagnostic radiology, radiologic and general anatomy, and pathology.

So, yes, there are quite a few procedures you can do. And yes, the interdisciplinary interaction is active and occurs on a daily basis. There are no "routine" protocols; there are evidence-based standards of care, and while many patients fit quite nicely into these standard treatments, part of the "art of medicine" is gaining a sense of when these standards apply and when they don't. It's a great field to be a part of, and I'd certainly encourage you to set up some time to shadow your local clinicians if you haven't already. This forum is a nice resource, and any additional questions you have are welcomed.

 

[rpkall]

G'ville;

Thanks very much for your prompt and informative reply. 👍 I'll try to arrange some shadowing time this summer.

Do you know of any online/print resources that are decent for med students to use during 4-6 wk electives in radonc?

 

[stephew]

ill tweek this a bit:

-Mammosite breast brachy (surgeons are usually and rightly engaged in this process)

Surgeons always involved. I think it will take less of a role over time. Also catheters (same deal)


Procedures where there variable practice patterns:

-Radionuclide injection

not med onc turf war so much as nuc medicine.


Procedures where the rad onc is along for the ride, and surgeons are doing most/all of the work:

-Lung brachytherapy (endobronchial and mesh implants after wedge resection)

radonc very involvled

-Head frame placement for radiosurgery
the planing is (or should be when its not) radonc.

-Intra-arterial SIRS sphere injection

radonc involved)

-Intravascular brachy (increasingly rare)
be glad its increasingly rare

-Intra-operative RT (Our facility doesn't have this, so I'm not sure of the exact role of the rad onc, but I know we don't excise the tumor)

will also become more rare with IGRT.

radoncs are very big on being comprehensive oncologists and typically academically superior in their fund of knowledge. they also let let other services treat them like a tech service. its a problem. its bad for the patient when folks who aren't trained for several years in radonc are allowed to think they know about radiation perscription. but i digress.

 

[Gfunk6]

As can be seen in G'ville Nole's and stephew's posts, there is significant inter-department variation in RadOnc procedures. A lot of it depends on the relative political clout of RadOnc relative to other surgical sub-specialties as well as MedOnc.