The importance of the White Book of Radiation Oncology

Abstract

The current issue of Clinical and Translational Oncology includes an article that summarises and contextualises the recently published Libro Blanco de la Oncologia Radioterapica, a book written by members of the Spanish Society of Radiation Oncology (SEOR). The White Book of Radiation Oncology is the fi rst of its kind in Spain and its importance cannot be overstated. The White Book consists of 13 chapters on a wide range of topics that cover all aspects of radiation oncology and its role in cancer care in Spain. The aim of the book is to give a comprehensive overview of the current state of radiation oncology in Spain and to serve as a reference for physicians, health care administrators and hospital managers. Although it may be hard to remember a time when radiation oncology did not exist as a distinct speciality, it was only just over three decades ago (in 1978, to be precise) that the Association of Radiotherapy and Oncology (AERO) was created. In 2006, the name of the association was changed to SEOR to refl ect the fact that specialists in our fi eld are oncologists fi rst and radiotherapy experts second. The SEOR has grown signifi cantly since its founding and now has more than 750 members. In addition, the SEOR is also active internationally and has signed numerous agreements for cooperation with other medical societies, including the European Society for Therapeutic Radiology and Oncology (ESTRO). The rapid technological progress that has been made in the last decade allows us to deliver radiation with increasing precision and effectiveness, thus increasing the number of tumour localisations amenable to treatment with radiation therapy. As a result, approximately half of all cancer patients are now treated with radiotherapy. While these technological advances are clearly welcome, they also present new challenges, as specialists must constantly strive to keep up to date with the latest techniques and equipment. Technologies that seemed cutting edge only a few years ago, for example intensity-modulated radiotherapy (IMRT), are now considered standard treatment for certain tumours. Still, many of the newer technologies–4D radiotherapy, image-guided RT (IGRT), breathing-synchronised RT, SBRT, radiosurgery and intraoperative RT (IORT)–have yet to be installed in smaller clinics, even as they become increasingly common in larger RT centres. In Spain, radiotherapy centres tend to purchase and incorporate “new” machinery slowly (for a myriad of reasons, not least of which is cost) and it seems clear that we need to fi nd ways to accelerate the purchase of newer, more effective technologies for the benefi t of our patients. Even as we recognise the importance of state of the art technologies, it is important to remember that we are physicians fi rst and our main priority is to provide the patient with the best care possible. Quality care in our fi eld depends not only on fi rst-rate technology, but also on the skill and training of the specialists responsible for treating patients. Radiation oncologists must be experts in both the technical and clinical aspects of radiotherapy. Cancer treatment in general has become more interdisciplinary, thus requiring the cooperation of a larger number of specialists. The growth of tumour boards, where complex cases are discussed, is a prime example. It is during these meetings that each specialist can share his/her specialised knowledge so that a well founded treatment decision can be made. Important changes have also occurred in training new specialists (residency) and continuing education for current staff. Spain, along with all other member countries of the European Union, has had to reorganise its university curriculum to bring it in line with the new European standards as established by the Bologna Agreement. As a result, students must now complete 360 European credits (9000 hours) to obtain a degree in medicine. Although the current transition period has been challenging, it also offers new opportunities for our fi eld, and several universities have proposed new courses that combine aspects of both medical and radiation oncology. These courses are intended for the fi fth or sixth year of the degree programme. F. Guedea ( ) Department of Radiation Oncology Catalan Institute of Oncology Gran via, s/n km 2,7 ES-08907 L’Hospitalet de Llobregat, Barcelona, Spain e-mail: guedea@iconcologia.net