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A 喵咪社区 radiation oncologist discusses top shifts in radiation oncology. 

The world of medicine is fast-changing, and radiation oncology is no exception. While many changes pose new challenges to radiation oncologists and their patients, there are positive impacts, too, says May Lin Tao, MD, a radiation oncologist with 喵咪社区 Norris Comprehensive Cancer Center, part of 喵咪社区. Tao serves as medical director of the cancer program at the 喵咪社区 and Henry Mayo Newhall Hospital joint venture in the Santa Clarita Valley. She also directs clinical operations for Keck Medicine鈥檚 regional radiation oncology clinics. She is a clinical associate professor in the Department of Radiation Oncology at the Keck School of Medicine of 喵咪社区. 

Here are seven of the biggest influences on the radiation oncology field. 

1. Financial challenges

鈥淥ngoing Medicare payment cuts and increased expenses for delivering care are affecting not only who we can treat but also the financial stability of radiation oncology practices and many specialties in medicine,鈥� Tao says. 鈥淭hese factors are affecting both the workforce and patient care, putting the landscape of the field at risk.鈥� 

Within the high-tech specialty of radiation oncology, which involves costly equipment, those expenses are likely to only increase as technology advances. While advances in technology will bring about better results, the financial cost of specialized equipment can complicate the business of radiation oncology.  

鈥淢edicine is still, to some extent, a business in the sense that to be able to take care of patients, we have to be viable,鈥� Tao says. 

2. Practice consolidation 

There鈥檚 also been a recent trend towards fewer and larger radiation oncology practices, rather than many smaller private practices, Tao says. in the International Journal of Radiation Oncology, Biology, Physics examined data from 2015 and 2023 and reported an overall 16% increase in practicing radiation oncologists 鈥� but a drop of 13% in the overall number of practices employing them. Additionally, large practices grew by 51%, while solo ones decreased by 27%.  

鈥淭his trend goes hand in hand with increased financial challenges and the increased expense of being able to deliver care,鈥� Tao says. 鈥淭o do what we need to do, we need multimillion-dollar machines, and it鈥檚 very hard for a solo practitioner to have that kind of capital readily available.鈥� 

Whether consolidation will improve or worsen patient care is hard to predict, Tao adds. One thing it can do, however, is reduce the number of care centers, giving patients fewer location options and potentially requiring them to travel outside of their neighborhoods for care. But, in theory, consolidated centers can also result in more types of clinicians and oncologists working together in one place, fostering an environment of multidisciplinary care.聽聽

3. Increased multidisciplinary approach 

There is an increasing trend of multidisciplinary care and personalized medicine, Tao says: 鈥淔or example, at Keck Medicine, we have a multidisciplinary tumor board where multiple oncology disciplines, as well as supporting disciplines like pathology and radiology, are represented and review and make recommendations together on individual cases.鈥� Similarly, multidisciplinary clinics exist for certain cancer types, like breast cancer, where a patient is seen by multiple types of specialists for a holistic treatment plan.  

4. Better integration of biology in tailoring treatment  

鈥淲e use a more precise biologic risk classification so that we are dose-intensifying, de-escalating or omitting treatment when appropriate in an effort to reduce the burden and side effects of treatment while maintaining a high cancer control or survival rate,鈥� Tao explains.  

5. Higher precision and more automation 

鈥淚n radiation oncology, you are physically targeting something like an arrow,鈥� Tao says. 鈥淲hen we have better ways of imaging, better ways of controlling any motion of the target and an automated way of using computers and other technology, all of this makes our targeting faster and more precise.鈥� 

Keck Medicine also offers a new approach to radiation treatment called biology-guided radiation therapy (BgRT). This technique uses the tumor鈥檚 own biological activity 鈥� captured in real time through its positron-emission tomography (PET) signal 鈥� to continuously track the tumor鈥檚 position. By following this 鈥渓ive鈥� signal, clinicians can precisely guide radiation delivery even as the tumor moves with breathing or natural body motion. 

鈥淏etter precision also allows us to spare normal tissue from any ancillary damage,鈥� Tao says. 鈥淏gRT is a transformative leap forward that marries this technology with tumor biology.鈥� 

Artificial intelligence is also helping move the field toward higher precision and automation. 鈥淢ore and more, we鈥檙e using artificial intelligence to do some of the work for us, or at least the first part of the work,鈥� Tao says. 鈥淲e determine and specify what target we want, while accounting for tumor motion and daily variances. Then we specify dose avoidance to adjacent normal tissues and use a computer algorithm to generate a plan, which we evaluate. The process is reiterated until an optimal solution is found.鈥�  

Additionally, new imaging techniques help with targeting. In the past, X-rays were used to localize the tumor target. But now, radiation oncologists can use more advanced, multimodality imaging to plan and guide treatment, she says.  

鈥淲e have imaging modalities that are integrated in the treatment delivery machine, allowing us to actually see, in real time, the target, which may be slightly moving since the patient is breathing or might have other slight movements while lying on a table,鈥� Tao says.  

6. Fewer radiation treatments to achieve the same 鈥� or better 鈥� goal of cure or palliation 

As technology has allowed physicians to more precisely target tumors at a sub-centimeter level and avoid adjacent normal tissue, physicians are now able to compress treatment timelines so that they can deliver more dosage over fewer treatment sessions.  

鈥淭his can lead to a greater ability to both cure and palliate patients,鈥� Tao says. 鈥淔or example, we can reduce the pain caused by a tumor while lessening the burden on patients in terms of time spent in the doctor鈥檚 office receiving treatment and reducing negative side effects.鈥� 

7. Resurgence of very-low-dose radiation for benign inflammatory diseases 

Low-dose radiation therapy for benign inflammatory conditions is experiencing a resurgence, especially in the United States, after decades of being used more commonly in Europe, Tao says. Low-dose radiation therapy uses small, carefully targeted doses of radiation 鈥� far lower than those used for cancer treatment 鈥� to treat non-malignant, inflammatory or degenerative conditions. Typical doses can be 1% or less than what is given for cancer, delivered in one to six sessions, depending on the situation. At lower doses, radiation has an anti-inflammatory and immunomodulatory effect.  

鈥淐linicians are recognizing radiation as a biologically active tool, not just a cancer treatment,鈥� Tao says. It鈥檚 useful for conditions like painful osteoarthritis, tendonitis, plantar fasciitis, Dupuytren鈥檚 contracture and hidradenitis, heterotopic ossification prophylaxis and keloids, she adds.  

鈥淟ow-dose radiation therapy is as attractive as it is noninvasive. It has very low toxicity, it鈥檚 short in duration, and it has good evidence of durable symptom relief,鈥� Tao says. 鈥淚t鈥檚 especially compelling for older adults or those who have exhausted other therapies. The resurgence reflects a combination of patient need, clinical evidence, technological refinement and broader multidisciplinary awareness.鈥� 

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Mollie Barnes

Mollie Barnes is a digital writer and editor with 喵咪社区.

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