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The future of radiotherapy as a discipline
171
Editorials
The Future of Radiotherapy as a Discipline JERZY EINHORN,
W
MD*
IxnwDUuro~ of megavolt therapy and improved dose planning radiotherapy has made spectacular advances over the last two decades. The main problem at present, however, would seem to be the recruitment of young people to the discipline. The existence of this problem would seem to be widely recognized, though perhaps it is receiving less attention than it deserves: It is not difficult to understand the motives of young physicians who hesitate to choose a discipline relying on one particular mode of treatment for a single disease entity. The recruitment of radiotherapists in the past has been to a large extent from among the diagnostic radiologists. There is at present a strong movement towards the separation of radiotherapy from diagnostic radiology. This is a sound tendency that is to be encouraged. It does, however, mean the potential loss of a field of recruitment. We can probably survive these difficulties, but what will be the quality of life of our discipline? Particularly in those countries where there is the competition of medical oncology, a discipline that must appear highly attractive to young doctors interested in clinical oncology, offering, as it does, the opportunities for research and development in chemotherapy, hormone therapy, immune therapy, and whatever medical cancer therapy may offer the patient in the future. Medical oncology also has the benefit of a rich field for recruitment in general internal medicine. It is valid to say that radiotherapists are at present the only specialists having a long and vast clinical experience of malignant tumors, apart from the few surgeons concerned exclusively with onIn those countries cological surgery. where medical oncology has been established as a discipline it will, however, be 17‘~ THE
only for a few more years that radiotherapists will be able to assert this. What should be done, then? The answer will, of course, depend on the form that the organization of cancer care takes in the various countries, and of the place that radiotherapy holds in this organization. In some countries, radiotherapists have the opportunity’of also pursuing the methods of treatment for malignant tumors by drugs: this too leads to a formal modification of the discipline. In, for example, Sweden and Norway radiotherapy will be responsible for all nonsurgical cancer therapy and the name of the discipline shall be modified accordingly. This has already proved to have an extremely beneficial effect on the recruitment of young physicians to the discipline. In countries where a separate speciality for medical oncology has been formed it would seem logical that the initial part of the specialist training for medical oncologists and radiotherapists should be the same. This vvould provide radiotherapy with a new area for recruitment and a more rational one than that of diagnostic Another important question is whether these two disciplines should remain separate. Radiotherapy and chemotherapy are used for the same type of disease and often on the same patient. They have essentially the same effect and similar side effects. Still more important is the fact that the same methods are being used in clinical and experimental research in radiotherapy and chemotherapy. It would seem, therefore, that there is much to be gained, if all nonsurgical methods for the treatment of cancer should be brought together in the same department or even in the same discipline. There would prob* Radiumhemmet, Karolinski 01 Stockholm 60, Sweden.
institute.
104
172
ably be some subspecialization, just as has occurred in other major disciplines, especially at large hospitals. This subspecialization might be based on the methods of treatment, but it might also be based on the organ systems. At Radiumhemmet, in Stockholm, Sweden, where all nonsurgical cancer therapy is covered by one discipline, we have found after a period of trial that it is more rational to subspecialize within nonsurgical oncology according to organ systems than according to the method of treatment. The physicians that are working in the lymphoma division know more about chemotherapy,
Editorials
those working in the division for head and neck tumors know more about precision radiotherapy, while those working in the breast division have special experience in hormone therapy. Since, however, all are working in the same department the conditions are favorable for the accumulation of knowledge in different aspects of nonsurgical oncology in that department, and for the cross-fertilization of ideas. The patients can retain the same physicians during the various stages of their disease. The organ-specialized surgeons always have the same counterparts for discussion with nonsurgical oncologists.
Editorials
The Future of Radiotherapy as a Discipline JERZY EINHORN,
W
MD*
IxnwDUuro~ of megavolt therapy and improved dose planning radiotherapy has made spectacular advances over the last two decades. The main problem at present, however, would seem to be the recruitment of young people to the discipline. The existence of this problem would seem to be widely recognized, though perhaps it is receiving less attention than it deserves: It is not difficult to understand the motives of young physicians who hesitate to choose a discipline relying on one particular mode of treatment for a single disease entity. The recruitment of radiotherapists in the past has been to a large extent from among the diagnostic radiologists. There is at present a strong movement towards the separation of radiotherapy from diagnostic radiology. This is a sound tendency that is to be encouraged. It does, however, mean the potential loss of a field of recruitment. We can probably survive these difficulties, but what will be the quality of life of our discipline? Particularly in those countries where there is the competition of medical oncology, a discipline that must appear highly attractive to young doctors interested in clinical oncology, offering, as it does, the opportunities for research and development in chemotherapy, hormone therapy, immune therapy, and whatever medical cancer therapy may offer the patient in the future. Medical oncology also has the benefit of a rich field for recruitment in general internal medicine. It is valid to say that radiotherapists are at present the only specialists having a long and vast clinical experience of malignant tumors, apart from the few surgeons concerned exclusively with onIn those countries cological surgery. where medical oncology has been established as a discipline it will, however, be 17‘~ THE
only for a few more years that radiotherapists will be able to assert this. What should be done, then? The answer will, of course, depend on the form that the organization of cancer care takes in the various countries, and of the place that radiotherapy holds in this organization. In some countries, radiotherapists have the opportunity’of also pursuing the methods of treatment for malignant tumors by drugs: this too leads to a formal modification of the discipline. In, for example, Sweden and Norway radiotherapy will be responsible for all nonsurgical cancer therapy and the name of the discipline shall be modified accordingly. This has already proved to have an extremely beneficial effect on the recruitment of young physicians to the discipline. In countries where a separate speciality for medical oncology has been formed it would seem logical that the initial part of the specialist training for medical oncologists and radiotherapists should be the same. This vvould provide radiotherapy with a new area for recruitment and a more rational one than that of diagnostic Another important question is whether these two disciplines should remain separate. Radiotherapy and chemotherapy are used for the same type of disease and often on the same patient. They have essentially the same effect and similar side effects. Still more important is the fact that the same methods are being used in clinical and experimental research in radiotherapy and chemotherapy. It would seem, therefore, that there is much to be gained, if all nonsurgical methods for the treatment of cancer should be brought together in the same department or even in the same discipline. There would prob* Radiumhemmet, Karolinski 01 Stockholm 60, Sweden.
institute.
104
172
ably be some subspecialization, just as has occurred in other major disciplines, especially at large hospitals. This subspecialization might be based on the methods of treatment, but it might also be based on the organ systems. At Radiumhemmet, in Stockholm, Sweden, where all nonsurgical cancer therapy is covered by one discipline, we have found after a period of trial that it is more rational to subspecialize within nonsurgical oncology according to organ systems than according to the method of treatment. The physicians that are working in the lymphoma division know more about chemotherapy,
Editorials
those working in the division for head and neck tumors know more about precision radiotherapy, while those working in the breast division have special experience in hormone therapy. Since, however, all are working in the same department the conditions are favorable for the accumulation of knowledge in different aspects of nonsurgical oncology in that department, and for the cross-fertilization of ideas. The patients can retain the same physicians during the various stages of their disease. The organ-specialized surgeons always have the same counterparts for discussion with nonsurgical oncologists.