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Introduction to Clinical Oncology

Dr Benjamin Taylor Clinical Oncology Guy’s and St Thomas’ Hospital

Aims of talk
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What is Clinical Oncology What is Radiotherapy? Technology of radiotherapy Career paths Questions?

What is Clinical Oncology?

Treatment of cancer using both chemotherapy, targeted agents, and radiotherapy techniques, often in combination 2011 – consultants in the UK  715 (677 WTE) Clinical Oncology  282 WTE Med Oncology consultants

What is Radiotherapy?

Treatment using ionising radiation to damage DNA Radiation may be in the form of  X-rays (photons), electrons neutrons/protons)  Radioactive isotopes

History
 Suggested

by Wilhelm Roentgen 1885  1st medical use –1896 (by Emil Grubbe)  Now – up to 45% of all cancer patients in the UK will require RT at some point during their treatment

2/3 curative intent (either alone, or in combination with surgery/chemotherapy) 1/3 palliative intent

Aims of Radiotherapy Treatment
 Radical • Neo-adjuvant • Primary  Adjuvant  Palliative

Radiotherapy planning
‘Designing our treatment’  What are we going to treat  What dose we want to deliver  How best to localise tumour  How to ensure reproducibility  Maximise dose to tumour whilst minimising dose to organs at risk  Complexity of process depends on site of tumour and intent of treatment

Clinical mark up Conventional simulation CT planning – 3D (or 4D) conformal
Shells for head and neck treatment

Breast board

Intensity modulated radiation therapy (IMRT)
 Uses

same xrays but sophisticated planning system  Multiple beams  Allows highly conformal dose distribution including concave shapes

Linear Accelerator Brachytherapy Radio-isotope therapy Cyberknife Treatment Gamma Knife Treatment Proton Beam Treatment

Career in Clinical Oncology


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Very varied – IP/OP, Pts, Chemo, RT, BrachyTx Constantly developing Multidisciplinary Practical Physics, radiobiology, cancer biology, pharmacology Rewarding – curative or palliative Opportunity for research But – long training, exams (3 chances), demands on free time, hard work, commuting, geographic uncertainty until training finished

RCR advice to prospective trainees:
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Get a good CV as a medical student Consider taking an intercalated BSc Gain good grounding in general medicine and surgery during Foundation Years Get a place on a Core Medical Training, possibly including a placement in medical or clinical oncology, or palliative medicine Medical/clinical audits Spend some time finding out about how the cancer services work in the UK Pass MRCP examination

Training posts
 2013
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150 applicants 50 NTNs Academic training posts

5

year training +/- 1-3 yr PhD/MD/Fellowship  MRCP before training  FRCR Part 1 Part 2
Radiobiology Physics Pharmacology Statistics

2 written papers OSCE exam Viva

My route


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Undergraduate – Dundee 2003 PRHO 2003-2004 SHO 2004-2007  Oncology on rotation, and applied for RMH SHO post before applying for ST3 MRCP - 2006 2007 – NTN Clinical Oncology FRCR – 2011 Currently – MD Imaging Sciences 6 months from CCT

Contact – benjamin.taylor@gstt.nhs.uk Royal College of Radiologists Clinical Oncology Training - http://www.rcr.ac.uk/content.aspx?PageID=61