The point isn't that chemotherapy didn't replace radiation therapy. The bigger point here is that SOMETHING eventually will, whether it'll be 10, 20, or 30 years... we don't know. However, when that something does come, it won't be in the hands of rad onc. If it is a totally new treatment modality that isn't radiation or surgical in nature, then medical oncology will likely have control over it, because they control patient flow due to direct management of medical problems. This would be similar to how cardiology destroyed CT surgery at the advent of stenting. Seeing patient after patient in clinic and dealing with their many problems sucks, but it is one of the only things in medicine with perpetual intrinsic value.
I would counter the following:
1. The trend in medical procedures is towards
minimally invasive and
non-invasive approaches. You see signs of this all over: trauma surgeons are increasingly studying non-operative management, da Vinci robots and/or laparoscopic approaches are all the rage, a lot of biopsies are being farmed out to IR rather than being done openly, etc. Radiation Oncology is on the bleeding edge in this field. SBRT > lobectomies, SRS > craniotomies. Also, in many cancers, surgery has now been marginalized and/or eliminated (e.g. H&N, anal) and is heading that way in others (e.g. rectal).
2. Three trends in Radiation Oncology that are gaining steam are
hypofractionation (shorter treatment duration),
better IGRT (more accurate), and
higher MUs/no flattening filter (shorter treatment length). This will make getting radiation safer and more convenient for patients.
Finally, cancer is an incredibly heterogeneous disease. Not only is each site different, but each individual cancer is markedly different (e.g. an adenocarcinoma which is not EGFR/Alk mutated has a much worse prognosis than an adenocarcinoma with such mutations). Therefore, there will never be a
universal cancer cure (barring the introduction of micromachine nanobot assassins, which will put all procedure based specialties out of business). Furthermore, cancer is a micro-evolutionary process and is ever adapting to therapy. The sure fire ways to "kill cancer" to obtain a cure are to surgically remove it or irradiate the bejesus out of it. In 99% of cases where Medical Oncologists have touted a chemo or small molecule "cure" the cancers come back as more resistant. Case in point is imatinib.
We area always hearing about sexy new therapies but what are among the mainstays of the Medical Oncology arsenal?
Cisplatin (FDA approved in
1978)
Cyclophosphamide (FDA approved in
1959)
Adriamycin (FDA approved in
1960s)
Bleomycin (FDA approved in
1978)
Vincristine (FDA approved in
1963)
Paclitaxel (FDA approved in
1992)
These are not some obscure chemotherapy agents that are used in exotic diseases - they are currently the primary agents used in a variety of common malignancies (breast, lymphoma, gyn, H&N).
. Surgeons do not want XRT because of fears of lymphedema and unacceptable cosmetic outcome given the immediate reconstruction. Justify with Z11 and B04 
