Three discipline collaborative radiation therapy (3DCRT) special debate: Equipment development is stifling innovation in radiation oncology.

Abstract

The field of radiation oncology has recently experienced a period of remarkable transformation of our technical capabilities. These technical and computational advancements have resulted in a tremendous improvement in our ability to precisely and accurately deliver radiation dose. However, this increased emphasis on technical capabilities may be inadvertently diverting attention and funding from scientific developments in other areas, even at a time when exciting new advances are occurring in cancer biology. Much of our recent technical development has been promoted and subsidized by the manufacturers of radiation oncology equipment. The question now becomes “who will encourage and subsidize the research needed to bring our recent biological advances to clinical fruition?” In a recent commentary which inspired this debate, Brown and Adler suggest that we “…are in a golden age of radiation and cancer biology” and that “…the industry's current focus on equipment development alone is undermining significant potential clinical advances in radiation oncology.”3 This is the subject of this month's 3DCRT debate. Arguing for the proposition will be Drs. Leonard Kim, Stephanie Markovina, and Samantha Van Nest. Dr. Leonard Kim has worked on defining microscopic disease target volumes for breast cancer radiotherapy at William Beaumont Hospital and Rutgers Cancer Institute of New Jersey. He is currently Chief Medical Physicist at the MD Anderson Cancer Center at Cooper. Dr. Stephanie Markovina is interested in improving therapeutic response to radiation in cervical cancer and other solid tumors by better understanding molecular mechanisms of radiation induced tumor cell death and survival. She is an Assistant Professor of Radiation Oncology and Cancer Biology at Washington University in St Louis where she specializes primarily in the treatment of patients with gynecologic cancers. Dr. Samantha Van Nest has worked to establish spectroscopic techniques for the personalization of radiation therapy. She is currently a Postdoctoral Associate at Weill Cornell Medicine in New York, where her research investigates the effects of radiation on tumor immunity, with a particular focus on improving our understanding of the abscopal effect. Arguing against the proposition will be Drs. Subarna Eisaman, Lakshmi Santanam, and Julie Sullivan. Dr. Subarna Hamid Eisaman is the clinical director and assistant professor at the University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center Department of Radiation Oncology at the J. Murtha Pavilion in Johnstown, Pennsylvania. She serves as co‐chair of the Radiation Oncology Lung and Lymphoma Via Oncology Pathways Physician Advisory Committee. Her clinical practice includes treatment of breast, GYN, lung, CNS, head and neck, skin and musculoskeletal malignancies. Dr. Lakshmi Santanam is an attending medical physicist at Memorial Sloan Kettering Cancer Center. Her primary interests include motion management and patient safety. She currently serves as vice chair for the AAPM Working Group on RO‐ILS and the Task Group on the Management of Respiratory Motion in Radiation Oncology. Dr. Julie Sullivan is a biologist at the U.S. Food and Drug Administration's (FDA) Center for Devices and Radiological Health. Her scientific interests include the use of radiation‐emitting medical devices in clinical trials and the medical planning for and response to radiological and nuclear incidents.