A synopsis of radiation oncology in Australia, with particular reference to New South Wales.

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.