disagree. would take surgeon any day. They also would not take you because most surgeons don’t respect rad oncs. You just draw circles and do what they tell you. We are the catfish at tumor board, and we love their crumbs that trickle down. The truth hurts, i know, but it has got to be said, folks!
Sorry man, but you have pathetic attitude and really dont know what your talking about. Are you a resident or something?
Lets look at the major causes of cancer death: 1) Lung Cancer, 2) Prostate Cancer, 3) Breast Cancer, 4) Colorectal cancer, and 5) Pancreatic Cancer.
For lung cancer do you think the surgeons have any real role in advanced disease?? They can grasp onto straws and maybe do a left sided pneumonectomy but not a right sided pneumonectomy? Its a joke, the STANDARD OF CARE, is radiation therapy with a low dose of radiosensitizing chemo followed by immunotherapy. In that regimen the radiation therapy is doing the majority of the cell kill, so read it YOU as a rad onc are doing the majority of the effective treatment.
Ok next what about prostate cancer, so do you think there is a great role for surgery in high risk or advanced disease?? No. Surgeons will certainly operate to support their salaries, but as you should know the rates of positive margins, ECE, SVI, etc are such that anyone with intermediate or high risk disease over 65 (which is many patients) should probably just do radiation with ADT. So that leaves low risk, which can be surveiled anyway. Would you want your 75 y/o grandpa undergoing a major surgery with recovery and becoming incontinent for a week? Are med onc's really needed for the curative treatment for prostate cancer? NO. Rad Onc's can give ADT just as easily.
Ok what about breast cancer? Neoadjuvant treatment, followed by surg +/- XRT. XRT has been demonstrated to improve OS. Main reason surg still has a role is because breast is easy to remove. You could argue that with the pathCR rates of neoadjuvant combos now whether we could just do neoadjuvant chemo followed by consolidative XRT and avoid a disfiguring surgery. Also bilateral mastectomies for DCIS? That is malpractice in my book and a horrific disfiguring unnecessary surgery for these women, pushed on women by plastic and general surgeons who are not adequately counseling their patients in those cases.
Ok what about colorectal cancer? Well neoadjuvant chemoRT followed by surgery. I think each modality plays a relatively equivalent role here, so you can pick your poison.
Ok what about Pancreatic cancer? Do you think surgery has a any real role in locally advanced disease? No. Majority of patients diagnosed with pancreatic cancer have metastatic disease when they walk in the door. Local therapy can help to slow or stop the primary from spewing out more mets, but this disease is going to be dominated by systemic therapy until we have an actual screening test so patients stop presenting due to symptomatic T3/T4M1 disease.
Ok what about Head and Neck cancer, do you think surgery has any real role in advanced HPV+ Oropharynx which is a majority of patients? CHEMORADS is a standard of care, and here do you think the med onc is really doing anything special giving a few doses of cisplatin according to some automated EPIC orderset?
Look I'm obviously grossly oversimplyfing things here, but the point is in academic or privates for that matter its a cage fight for power. Our specialty has historically let others take the lead and given up power to let others run the show, but that is many times our own doing and due to people with attitudes like yours. I've been in many tumor boards from top institutions where the Rad Onc RUNS the tumor board and discusses every patient and comes to a consensus on management. Its a decision you can make to represent and stand up. If you give up with that attitude before you even start what do you expect will happen? Some med onc's and surgeons highly respect rad onc's and if you show them you are more than capable they may respect you more,
especially when they know the best treatment for many of their patients involves radiation.