It's now 2026! This blog covers from the near start of a career to the near end of that same career.
Why 21 years nearly a full career? Well I didn't start until the late 1990's, and I was already in my 40's when I started. I've worked in many units but two dominate in two countries, Australia and New Zealand.
Many things have changed.
At the time of the first blog, I have 2-3 publications, now I have >100 publications, once I started I averaged 5/year approximately. Not bad for some one working in a smallish regional unit. The secret? Go to your local university and attend research meetings until you find a group who know nothing about actual medicine and start making comments and being helpful, and enrol in a research degree to establish your bona fides. I did my research in the Information Science space, specifically in Radiation Oncology Knowledge Structure and then re-use of radiation oncology knowledge using Radiomics and Machine Learning techniques.
Radiation Oncology has changed. Starting in the days of chinagraph pencils, a 'conventional'* simulator, 100cm SSD treatment using open fields with Cerrobend blocks after 2D computer calculation on a PDP computer generally using a single axial line contour transferred from a paper outline, to electronic pencils, isocentric VMAT treatment using MLCs after inverse planning computer calculation on a multi-processor server on a 3D/4D CT scan provided by in-house scanners.
The largest technology jump in any part of medicine, including the surgical robots!
The span across the decades has been interesting. The 1990 were the decades of Chemotherapy where the motto Hope Springs Eternal was the best descriptor of the idea that we would find the correct chemotherapy drugs and regimes to cure all of the cancers through the mechanism of improving response rates. By the end of the 1990's, the Chemotherapy Winter had settled as this hope finally died on the lack of new drugs and the lack of improving response rates and lack of reliable cures. Then at the end of the 2000's came the appearance of immunotherapy. The 2010's once again heard the rallying cry of Hope Springs Eternal with a mass of trials , and a media campaign (Did Jimmy Carter really get cured by pembro after liver metastases were resected and brain mets treated with SRS? You can't cure someone who is already NED!). The 2020's have seen these immature trials being reported. Response rate is no where to be seen, only Progression Free Survival which a wonky end point affected by patient attendance. Some of these trials do actually report Overall Survival but the changes are no better than those seen by chemotherapy, i.e., modest to nothing. Those that use cross over procedures typically show no improvement in OS. But you have to go looking for the OS in the Supplementary trials, as it is NOT A PRIMARY ENDPOINT. Sorry but in my analysis that makes the results useless, as I'm trying to cure my cancer patients, but use more therapy without a known outcome. Yes, I am a statistical pedant!
I'll write about other Changes later.
FootNote:
* how I dislike that word! Conventional is what everyone does, not a particular technique. CTs are now conventional. In 5-10 years MRI will be conventional.
