Osagie Igiebor, MD, PGY4 Resident at the Medical University of South Carolina, contributed this piece.
The young boy said Spider-Man was his favorite superhero, so our radiation therapist decided to create a customized immobilization face mask that resembled the comic book character. Suddenly, the adolescent became excited and emboldened to fight the monster of diffuse midline glioma, laying still with his head confined to the treatment table wearing the special mask. The experience described above is that of a young patient who recently started his radiation treatment in our department. This is one example of why I love radiation oncology and the job I do on a daily basis. The compassionate team of physicians, nurses, therapists, physicists and dosimetrists fights against cancer, all of whom are willing to go “above and beyond” in caring for a patient.
Unlike most hospital-based specialties with hours of inpatient rounds, frequent admissions, consults and nursing orders, radiation oncology is a unique referral-based practice with much less urgency and unpredictability. Although multiple new patient consults may present to the clinic, the patient’s history, diagnosis and previous workup is provided during the referral which helps guide appropriate recommendations for treatment. In very complex cases, multidisciplinary discussion of a patient’s case in a tumor board or conference is performed ahead of time so the best evidence-based care plan is created for the patient.
Essentially, there are five components of the day-to-day practice of a radiation oncologist. The first component is consultation, in which a referred patient presents to establish care and discuss the indication for radiation therapy in their oncologic management. The manner in which the treatment is planned and delivered as well as the risk and benefits of such treatment is extensively discussed. Informed consent may be obtained during this initial visit if the patient decides to proceed with treatment. Component two is the simulation process. A 3-D image of the patient is obtained on a CT scanner in a position that is easily reproducible, while maximizing exposure and access to the tumor. Third is the planning phase, or as I like to call it the “digital operating theater” – delineation of the tumor and organs at risk to maximize adequate dose coverage while sparing adjacent normal tissues. Collaboration with medical physicists and dosimetrists ensures creation of a therapy plan that is deliverable and safe. The fourth component involves the actual treatment dosing by radiation therapists and management of side-effects. Finally, follow up visits after completion of the individualized treatment are scheduled to monitor and manage possible long-term sequelae of treatment and continue surveillance for any recurrence.
In conclusion, although some cancers such as diffuse midline glioma are not curable and carry a poor prognosis, the victories of patients with malignancies that can be treated are incredibly inspiring to the radiation oncology team. Relationships are forged with patients and their families as they undergo treatment. I enjoy seeing patients recover from a dark point in their lives and bravely shine their light during follow-up visits. If you are a trainee, please consider the rewarding career of a radiation oncologist!
