Radiation Oncology

[jargon124]

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I have a few specific questions about Rad Onc.

1. Are there fellowship options available after completion after the Rad Onc residency? I have tried to find info about this but have not been able to.

2. Do you guys think that radiation therapy will be an integral part of managing cancer patients in, say 20 years? I know that radiation is becoming more and more effective these days, and delivery is becoming more complex, but I wonder if this specialty might become obsolete as a result of pharmaceutical or genetic breakthroughs in cancer research.

Thanks in advance for any insights!

 

[Academic Radiation Oncologist]

Fellowships are available but I don't think it's absolutely necessary. If you want to gain expertise in specialties like brachytherapy or radiosurgery, you may consider doing a fellowship. But most programs provide adequate training in those areas. Or else you can do a three month away rotation in a program which excels in a specific area you are interested in during your residency. With the phenomenal job market right now, you really don't need to do a fellowship to secure a good position. And you can always learn on the job (the salary is 4-5 times as an attending). Regarding the possibility of RT phasing out in cancer care, I don't think this will happen. People have been talking about that for decades and so far they are not even close. Very few cancers can be cured with systemic therapy alone. I am trained in both med onc and rad onc and I find rad onc to be intellectually more stimulating. You never see any rad onc switch to other specialties but many med onc switch to rad onc. However, the board exam is one of the most difficult ones. We have to take both the writtens and the orals (4 hours of oral exam). We need to keep a log of all the cases we treat in order to be eligible for the boards. We are the only specialty that is precise to the millimeter. 🙂

 

[Voxel]

1) There are fellowships in Brachytherapy for Rad Onc docs, but most people do not do fellowship nor is there a need in the market place unless you felt that your training was deficient in some area.

2) Its hard to say that chemotherapy will replace radation therapy in 20 years. That is a long time. When you think of both treatment modalities, you should think of radation therapy as local therapy where as chemotherapy is systemic (and sometimes targeted like with Tamoxifen). Radation is also used not only for treatment but for pallation including pain and compression symptoms.

3)In addition, radation therapy has been proven time and time again to be beneficial IN ADDITION to chemotheraphy (including new drugs coming to the market) vs chemotherapy alone for certain cancers in specific stages.

3) For some disease such as breast cancer or prostate cancer, radation therapy currently offers the same survival benefits, but increased cosmetic effects (no mastectomy) and increase quality of life for prostate cancer.
4) Unless cures are found for both metastatic and local cancer using chemotherapy, radiation will continue to play its role in cancer treatment with intent to cure and to provide local control and/or palliation.

 

[Voxel]

One more thought on radation oncology... I am finishing an elective in radiation oncology. I was interested in oncology before starting medical school and if I wasn't so fascinated with diagnostic radiology, I would be a radiation oncologist in a heartbeat. You have to know about chemotheraphy, surgery, and radiation treatments for cancer including different trials. You have to know anatomy for treatment planning and radation biology+physics. You have to know about the typical presentations, physical exam findings, and methods of spread for many differnt cancers. You get to offer treatment that sometimes cures and often times provides palliation. You get to be in the OR to place brachytherapy catheters. New radiation technologies are being developed and you have to keep up with this technology. You are an expert in your area and provide expert consultation that other doctors respect. The pay (200K-400K) and hours (~9-5) are great and call is very limited to non-existant.

The one big down side with any oncology field is the prospects of seeing many patients in pain and who will die shortly day in and day out. The other downside of radiation versus diagnostic radiology is that spectrum of disease is usually limited to oncology.

I think the AcademicRadiationOncologist posted on an earlier thread why radiation oncology is great field.