Future of Radiation Oncology and the Physicians/Scientists/Radiobiologists

The medical specialty of radiation oncology has undergone significant changes over the last 100 years. Most of these changes relate to the machines and delivery systems used in clinical radiotherapy. The ability to focus radiation on targeted areas that are identified by CAT, MRI, and PET scanning has provided physicians with the ability to minimize normal tissue damage and streamline the approach toward treating small areas including early-stage tumors and metastasis. However, medical students and physicians recognize the limitations of the use of clinical radiotherapy, given the increasing number of biological response modifiers and targeted therapies that can potentially remove all cancer regardless of anatomic location and thus, obviate the need for radiotherapy. Furthermore, the molecular pathology approaches now allow diagnosis of a specific subtype of each cancer and the targeted therapies that may apply for each individual patient. Unlike other medical specialties, radiation oncologists cannot rapidly adapt to an environment in which there is no need for radiotherapy. Training programs for radiation oncologists naturally include training in associated medical specialties including medical oncology, where physicians will deliver systemic chemotherapy and other targeted systemic agents and immunotherapies. Thus, radiation oncologists can provide general medical approaches toward managing and caring for cancer patients without the need for radiotherapy machine. At a future time when radiotherapy is not needed, radiation oncologists will still have a role to play. The challenge is for medical students to consider why they should choose a residency in a specialty that may have a limited usefulness.