Morgan G W
Department of Radiation Oncology, St Vincent's Hospital, Sydney, New South Wales, Australia.
Aust N Z J Surg. 1998 Mar;68(3):225-35. doi: 10.1111/j.1445-2197.1998.tb04752.x.
The specialty of radiation oncology had its beginning in Australia in 1896 following the discovery of X-rays by Roentgen. The new technology was eagerly embraced and the use of X-rays and radium for the treatment of cancer, even in the early 1900s, produced results which, although far from satisfactory by today's standards, resulted in cure and palliation of more superficial tumours. In the era immediately prior to World War II the specialty was regarded as having only a limited role to play in cancer management. The introduction of cobalt-60 units and linear accelerators in the 1950s allowed for treatment of deep-seated tumours without the skin, bone and other complications of orthovoltage machines (deep X-rays). But the introduction of radiotherapy treatment into cancer care was blocked by other specialties anxious to preserve their own 'turf and by medical administrators who believed the counter-claims that either cancer was incurable or 'the cure for cancer was just around the comer' and it was therefore foolish to waste money on an expensive technology that had a limited future. With further developments in technology, modern radiotherapy is now a highly sophisticated treatment using sharply focused and deeply penetrating X-rays and electron beams. Specialized treatments, such as automated afterloading brachytherapy, total body irradiation, stereotactic radiosurgery and computerized 3-D planning to improve dose distribution, are now widely available. The outcomes of cancer patients with radiotherapy have also improved considerably and organ preservation (e.g. in breast and larynx cancer) has resulted in improved quality of life. However, the specialty has only recently begun to expand in specialist numbers and profile. This is partly due to the lack of undergraduate training in cancer in general and radiotherapy in particular and also because understaffing has meant that radiation oncologists have occupied a purely service role (in the basement with their machines) rather than being an active part of the treatment 'team'. As a consequence radiation oncology has not been projected as an important component in cancer management and as a challenging and fulfilling career option to medical students and new graduates. The failure to act on the (repeated) recommendations of the 42 reports, inquiries, etc. into radiation oncology in Australia since 1982 (in addition to many more at local level) would suggest that the 'message' has yet to be accepted by Health Departments and health administrators. As a result there has been a totally uncoordinated approach to provision of radiation oncology services. The restriction of services and specialist numbers and training posts has led to radiotherapy being underutilized and undervalued in the treatment of cancer, ultimately to the detriment of cancer patients.
放射肿瘤学专业始于1896年的澳大利亚，当时伦琴发现了X射线。这项新技术受到热烈欢迎，即使在20世纪初，用X射线和镭治疗癌症也取得了一些成果，尽管以当今的标准来看远不尽如人意，但确实治愈了一些较表浅的肿瘤并缓解了症状。在第二次世界大战前的那个时期，该专业在癌症治疗中被认为作用有限。20世纪50年代钴-60治疗机和直线加速器的引入，使得深部肿瘤的治疗成为可能，避免了使用深部X射线治疗机时出现的皮肤、骨骼及其他并发症。但是，放射治疗在癌症治疗中的应用受到了其他急于保住自身“地盘”的专业以及医疗管理人员的阻碍，他们相信那些反对观点，即要么癌症无法治愈，要么“癌症的治愈近在咫尺”，因此在一项前景有限的昂贵技术上浪费金钱是愚蠢的。随着技术的进一步发展，现代放射治疗现在是一种高度复杂的治疗方法，使用聚焦精确且穿透力强的X射线和电子束。诸如自动后装近距离放疗、全身照射、立体定向放射外科以及用于改善剂量分布的计算机三维规划等专门治疗方法现在已广泛应用。接受放射治疗的癌症患者的治疗效果也有了显著改善，器官保留（如乳腺癌和喉癌）提高了生活质量。然而，该专业直到最近才开始在专业人员数量和形象方面有所扩展。部分原因在于总体上癌症本科教育缺乏，尤其是放射肿瘤学方面的本科教育不足；此外人员配备不足意味着放射肿瘤学家一直只扮演纯粹的服务角色（在地下室操作机器），而不是治疗“团队”的积极一员。结果，放射肿瘤学在癌症治疗中未被视为重要组成部分，也未被医学生和新毕业生看作是具有挑战性且有成就感的职业选择。自1982年以来（此外还有许多地方层面的报告），针对澳大利亚放射肿瘤学的42份报告、调查等所提出的（反复）建议未得到落实，这表明卫生部门和卫生管理人员尚未接受这些“信息”。结果，在提供放射肿瘤学服务方面出现了完全不协调的局面。服务、专业人员数量以及培训岗位的限制导致放射治疗在癌症治疗中未得到充分利用且被低估，最终损害了癌症患者的利益。
