Hottest areas in Rad Onc

[allopathic]

I'm starting this thread to gather everyone's opinion on what the hottest areas of radiation oncology are and will be in the near future. My picks include IMRT and brachy. What do you think about others including cyberknife, proton therapy, radiolabeled antibodies, etc?

Will radiation oncologists be trained to perform image-guided interventional procedures like radiologists for cancer patients in the future? Examples include radiofrequency ablation for liver tumors or similar procedures using hyperthermia?

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[Htowngsp]

Okay, this is a really tough one- there are several areas that I believe, IMHO, are going to stay hot for a while that we are moving along on in radiation oncology, mostly image-guided and conformal treatments. Everyone will get IMRT and brachy capability eventually.

At the same time, what going to really light up our field is less changes in treatment techniques (brachy has been around since radium) but the imaging to go with it. So now you'll have real-time MR-guided brachy, or ultrasound targeted radioablation in liver, or FDG-PET targeted IMRT. We have the guns already, so to speak, all we need now are better ways to target. The wave of innovation from radiology is going to augment the conformal therapies we have in a synergistic way. In the future, I think, the nuc med and diagnostic rads overlap in our field will be real strengths as innovative uses of existing ideas hit the ground (i.e. Andersons "CT on rails" for prostate or the Tomosite megavoltage CT-IMRT machine).

 

[stephew]

Mark my words.

 

[stephew]

my hot picks?
IMRT and brachy.: not the future: is now. IMRT however needs to be used appropriately and not just because its flavor du jour. Also dose rates are an issue-tomotherapy can deal with this [watch this space].

cyberknife: a version of it, but not cyberknife per se. Stereotactic body, yes. Set up on cyberK not impressive. Probably tomo here again can do the trick with better verification.

Proton therapy: again, with cheaper tomo, this isn't needed so vital in the mass market, but several places are seriously looking into it.

radiolabeled antibodies: the new flavor -some potential here but not the be and end all.

Will radiation oncologists be trained to perform image-guided interventional procedures like radiologists for cancer patients in the future? Not really. Anymore than we do already (see "concerns" below for relevant tangent)

Hyperthermia is not going anywhere.

RFA...more likely interventional will do.

My concern is the extent to which rad onc ISNT doing enough with rad antibiodies (nuc med competes) and neurosurgery does SRT and urologists for urology, cardiologists in cardi brachy (well ok, I might give on that one). There is a very important role for all these folks in rad onc procedures but rad onc should be under the auspices of rad onc.. We partake in surgical procedures for, say, sarcoma but dont run the surgical show nor should we- other services shouldn't be poaching on rad onc turf-its not best for the patient and rad onc docs really need to stand up for its identity here.