Radiation Oncology is a field that you probably have heard very little about. It is similar in a sense to surgery. The patients you will see have a very real illness and you will be able to offer them a very real benefit. This is because the patients have already been diagnosed by a pathologist and are coming for either curative treatment or palliative treatment. For most patients, radiation offers the definitive local control after surgical excision, it eliminates micro-metastasis that cannot be identified at the time of surgery and for many patients (esp. breast cancer) spares them a disfiguring surgery. It is important to note that for many patients a cure is an unrealistic goal and the intent of treatment is palliation. Even here radiation offers a real benefit in improving the quality of life at the end of life. For these patients you may not add years to their life, but you will add life to their years. As a radiation oncologist you will work both independently and collaboratively because most cancer patients receive multi-disciplinary treatment. Finally, if you love making the diagnosis, playing the hero in acute situations or preventive medicine then this is not the field for you because the diagnosis will already be made, acute situations are rare and it is too late for primary prevention in the patients you will see.

Most programs have similar schedules involving resident lectures, tumor boards, or case presentations in the morning and then four types of patient visits. The initial visit: this is a very directed H&P to stage the tumor, identify risk factors for the disease and side effects of treatment, and then to educate the patient about the treatment. Simulation: this is the real nuts and bolts of defining the treatment fields, making sure the tumor is within the treatment fields, and limiting as much dose as possible to the important structures. On treatment visits: these occur once a week to monitor the development of side effects from radiation, and provide treatment for these side effects. Finally, the most rewarding visits of all are the follow-up: again these are very directed to the disease for which the patient was treated. Any patient with a diagnosis of cancer deserves to have two doctors. Frequently, it is the radiation oncologist or the medical oncologist who monitors the patient for recurrence.

Radiation Oncology is a small field so a glowing letter of recommendation from a program director at an academic institution goes a long way. Obviously high marks in the third year are helpful, but honest enthusiasm for the field during a rotation and good letters are probably the most important. At BU, Dr. Delaney (who splits his time between BU and MGH) runs the department and he is an excellent resource for advice. Some excellent institutions to visit are: The Joint Center for Radiation Therapy, MGH, UPENN, Fox Chase, Sloan Kettering, U. of Michigan, St. Louis (malignant), M.D. Anderson, U. of Chicago, and UCSF. There are other great programs, of course but the attendings at these programs are the ones writing the books that residents are learning from at other programs. A letter from an attending at these programs will be recognized everywhere. Some other great programs a little smaller in size include Baylor, U. of Wisconsin, UNC, Duke (malignant), Seattle, U. of Utah, Emory, and U. of Florida.

Radiation oncology relies heavily on physics and technology so these are the tangible things to look at when evaluating a program (I won’t comment on intangibles like location, atmosphere, etc). Do they have 3-D treatment planning, do they have Multi-Leaf Collimation, and how much Brach-Therapy do they do? These are all fairly important. Other things to consider: do they use intensity modulated radiation therapy (IMRT is very new and unproven but may be important in the future)? What do residents do during the required 6 mo.-1 yr. of research time (bench work, clinical projects, MPH degree)? How many kids do they see per year (peds is always the smallest patient population thankfully)? Do they run multi-disciplinary clinics (path/radiology/surgery/medicine/rad onc all in the same clinic--these are a great learning experience)?