3. We roll deep.
Radiation oncology is exemplary of “the art of medicine.” We fuse anatomy-based treatment design with advanced technology and orchestrate the daily functions of a large medical team.
But, the treatment plan and delivery would not be possible without the input and care given within a large multi- and intradisciplinary team of oncologists, medical physicists, dosimetrists, radiation therapists, nurses, social workers, and other support staff. Radiation oncologists participate in regular tumor boards with surgeons, medical oncologists, pathologists, and radiologists to optimize interdisciplinary management of complex patients, providing a thoughtful tumor localization and treatment plan, as well as to better understand an individual’s ongoing symptoms and well-being as a whole. Considering all aspects of what a patient may need involves communication with fellow physicians, nurse navigators, and social workers.
Within our own department, treatment plan creation and quality checking or verification can sometimes take over 2 weeks, with detailed input from dosimetrists and medical physicists. The actual treatment delivery involves daily communication with the radiation therapists who are dedicated to each treatment machine – like the linear accelerator – and symptom management with clinic nurses and supportive staff, such as physical therapists and registered dietitians.
This massive team effort is required to get each patient through daily radiation treatments that can last 7 weeks and may require rapid replanning if the tumor shrinks or the patient loses weight.
As part of this team, radiation oncologists are uniquely positioned to quarterback each play and guide the entire game strategy.
4. Radiation therapy takes a lot of heat.
Radiation therapy is often blamed for issues unrelated to the treatment. Irradiating the pelvis for prostate cancer, for instance, does not cause a headache or heartburn during or after treatment.
Other than fatigue, associated side effects are localized and related to the total radiation dose and fraction size – how much and how fast – that reaches the surrounding tissues.
Our colleagues often swap stories of the bizarre things radiation therapy has been blamed for, including dental problems in someone receiving vaginal cylinder treatment, heart dysfunction in someone treated for rectal cancer, and hip fracture in someone treated for breast cancer because the radiation “destroyed” their bones. At best, these are humorous stories, but at worst, they can delay diagnosis and treatment of what is truly causing someone’s symptoms.
5. We truly believe that less is more.
One of the most fundamental aspects of radiation oncology is our drive to optimize treatment delivery and continually improve patient care – sometimes at our own field’s economic detriment. We’re dedicated to showing that patients may get the same benefit from less and less radiation.
In the past 2 decades, the evolution and adoption of photon IMRT and proton therapy has allowed radiation plans to successfully spare surrounding tissue while improving our targeting. This evolution is coupled with technological and imaging advances that allow us to delivery of doses to certain tumors via SABR/SBRT in one to five total fractions.
A prime example: Treatment to eradicate lung or gastrointestinal tumors, which used to span up to 6 weeks, can now potentially be delivered in as little as 1 week.
For other common cancers, hypofractionation – slightly higher radiation doses per fraction at fewer total fractions overall – has revolutionized patient care, providing less radiation without impacting survival or increasing treatment toxicity.
Take breast cancer care: 50 years ago, virtually all patients with breast cancer received a mastectomy and lymph node dissections. Today, surgical techniques for lumpectomy paired with radiation therapy to the whole breast now allows us to preserve disease-free survival for those who elected to keep their breasts.
Over the past 20 years, the standards of care have shifted from 6-7 weeks of treatment to 3-4 weeks using a hypofractionated model that involves daily whole-breast radiation. The most recent clinical trials have shown that whole-breast radiation can be delivered safely and effectively for select women in as few as five fractions with either whole or partial breast targeting. Additional research driven by the idea of “right sizing” radiation treatment has even shown that certain women may not need radiation at all.
This evolution in radiation therapy illustrates how our subspecialty is constantly working to improve survival and patient well-being, form deep connections with our patients, and push the boundaries of medical innovations.
We are proud to be radiation oncologists and happy to share more. Want to know more about what goes on in the basement? Come on down, we’re happy to show you around.
Dr. Giap is a resident in the department of radiation oncology at the University of Florida, Gainesville. Dr. Chino is an assistant attending in the department of radiation oncology at Memorial Sloan Kettering Cancer Center, New York. Neither reported any relevant conflicts of interest.
A version of this article first appeared on Medscape.com.