Radiation Oncology: Residency

The MD Anderson Cancer Center residency program in radiation oncology provides physicians preparing to practice full-time radiation oncology comprehensive clinical training and introduces them to clinical research. Physicians with long-term academic goals also have opportunities to pursue intensive research, both clinical and laboratory. Certified by the Accreditation Council for Graduate Medical Education, the four-year MD Anderson radiation oncology residency program can be expected to supply broad experience not only in oncologic clinical radiotherapy, but also in radiation physics, radiobiology, and research.

The program aims to equip physicians-in-training with professional competence in overall management of radiotherapy cases and proficiency with advanced radiotherapy techniques and brachytherapy procedures. Residents participate in the total radiotherapeutic management of all cases of their supervising staff, and with their advancement comes progressively increasing responsibilities.

Residents also learn through observation of and direct participation in surgical, chemotherapeutic, hormonal, and immunologic treatment of many types of malignant disease. Multidisciplinary clinics and conferences offer collaborative decision-making experiences. Research projects, elective rotations, and interdisciplinary clinics, as well as regular departmental and institutional conferences and lecture series, are all part of this challenging curriculum.

Objectives of the Radiation Oncology Residency Program

Objectives of the Radiation Oncology residency program guide its efforts to promote training in patient care and research. They are:

  • To provide a well-rounded educational experience for clinical training in radiation oncology, with comprehensive understanding of oncologic principles, radiation oncology treatment techniques, radiation dosimetry, radiation physics and experimental radiobiology
  • To provide an environment that promotes clinical expertise in oncology, with exposure to the details of treatment for the full spectrum of disease sites, the pathology in each disease site, the key radiographic findings and the surgical and medical options
  • To foster a multidisciplinary approach to cancer care through participation in disease site-oriented conferences that combine highly specialized medical oncologists, surgical oncologists, pathologists and radiologists
  • To introduce and promote clinical research through retrospective and prospective evaluations of patients treated at MD Anderson Cancer Center
  • To provide as an elective a background in the fundamentals of laboratory research in either physics or radiobiology

Clinical Experience

Clinical experience that is both broad and deep draws graduate students to MD Anderson’s Division of Radiation Oncology. The division comprises three distinct yet integrated departments: Radiation Oncology, Experimental Radiation Oncology and Radiation Physics.

Clinic Operations

The clinical operation of the Department of Radiation Oncology is divided into specialty services either by disease or anatomic region. Each faculty member practices in one or two areas and supervises both clinical and research activities within them. The overriding goal of the clinical research effort is to improve the efficacy of radiotherapy as a cancer treatment modality. The results of laboratory research projects throughout the division are used as a basis for developing strategies to improve the therapeutic ratio and for refining treatment planning and delivery techniques.

The Department of Radiation Oncology has 65 full-time medical faculty, 24 residents and three to four fellows. Each member of the radiation oncology staff has one or more designated areas of special interest with advanced expertise. All staff members provide consultations, attend multidisciplinary conferences, teach and treat patients in their subspecialty.

An active clinic practice provides diverse learning opportunities of exceptional depth.  During fiscal year 2012-13, 6,130 new patients were treated using electron radiotherapy representing a 3% increase over the prior fiscal year.  Our Proton Therapy Center – Houston treated 870 new patients on par with the prior year.  There were over 600 intracavitary and over 300 interstitial brachytherapy procedures performed in that same fiscal year.  In the area of stereotactic radiotherapy, over 400 gamma knife procedures and over 300 stereotactic body procedures were performed.  Cases span the gamut of neoplastic diseases.  Eighty percent of patients are referred for curative therapy; others are treated with palliative intent.

Trainees in the Department of Radiation Oncology acquire technical proficiency with a wide variety of radiotherapeutic equipment and techniques. Residency rotations last 8 - 9 weeks, and residents usually work one-on-one with a clinical staff member. During this time, the resident participates in all aspects of the radiotherapeutic management of all cases under the supervision of the faculty member. Initial evaluation, work-up, treatment planning, simulation, treatment delivery and follow-up are all part of the residents’ scope of care. Resident progress is evaluated and discussed on an individual basis following the completion of each clinical rotation.

Resident responsibilities rise as training advances. During the first and second year of training, each resident rotates through the major radiotherapy services. Rotations through some (for example, head and neck, gynecology and breast) will be repeated, usually during the third or fourth year. The institution’s multidisciplinary/ multimodal approach offers residents the opportunity to learn about oncologic surgical, chemotherapeutic, hormonal and immunologic treatments of malignant disease through observation, participation in numerous multimodality clinics and care of patients who receive these treatments in the department of radiation therapy. All residents have 8 months of research time (typically in the latter portion of the third year and beginning of the fourth year); requests for a full year are considered on a case by case basis.

Residents’ Sample Clinical Schedule

Year 1

  • Thoracic
  • Head and neck
  • Breast
  • Genitourinary
  • Gynecology
  • Brachytherapy

Year 2

  • Head and neck
  • Lymphoma
  • Sarcoma/Melanoma
  • Gastrointestinal
  • Central nervous system
  • Pediatrics

Year 3

  • Research
  • Elective
  • Thoracic

Year 4

  • Breast
  • Head and neck
  • Gynecology
  • CNS/Peds
  • Genitourinary
  • Elective

Clinical Research

Clinical research in the Department of Radiation Oncology continues to be directed toward improving the efficacy of radiotherapy as a curative modality with emphasis on preserving normal structures and function. Residents also have the opportunity to participate in basic research activities whose results are translated into treatment strategies.

The department is heavily committed to protocol research, at both the institutional and national levels; as of August 2015, there are 49 active treatment and 21 pending protocols in the department on which our radiation oncologists are principal investigators Our physicians also collaborate on many other protocols throughout all areas of the institution. Most protocols fall into one of the following five categories: 

  1. Multimodality treatment for organ preservation
  2. Multimodality treatment for advanced disease
  3. Altered dose-fractionation schedules to exploit radiobiological differences between tumors and normal tissues
  4. Intraoperative radiotherapy, including brachytherapy
  5. 3-D and 4-D treatment planning. 

The department is a major contributor to the Radiation Therapy Oncology Group (RTOG), both in terms of patient accrual and new protocol development.

In addition to involvement in prospective protocol studies, the faculty makes extensive research use of the department's radiation oncology treatment records dating back to 1948 and various site-specific databases. These resources allow detailed retrospective analyses of treatment outcome, patterns of relapse and complications resulting from therapy. The results of such analyses are an integral part of clinical research and have frequently led to major changes in radiotherapy technique and philosophy.