At that time the head of the Department of Radiation Oncology & Nuclear Medicine was Prof. dr. Ismail Kazem. He was of Egyptian descent and had received his medical training in the UK and Germany. He was quite a character, best illustrated by the fact that apart from being an excellent physician, he was also a poet. As a teacher he believed in throwing his trainees in at the deep end, which was challenging at times, but also resulted in rapid acquisition of knowledge in a very short time. He considered his trainees ompetent physicians from day one and considered every treatment plan you came up with carefully before making some suggestions for improvement. During my training he left and was succeeded by Prof. dr. W.A.J. van Daal. I finished my training in 1986. During my training I was also involved in pediatric radiotherapy.
It is virtually impossible to compare radiotherapy of those days to that of today: for instance, in those days treatment fields were drawn with the use of a simulator only.
drs. F. Oldenburger
In the early days a CT-scan was mostly used for diagnostic purposes and an MRI was not available. Patients were mostly treated by means of a 60Cobalt machine or with an 18 MV linear accelerator, depending on the tumor. The treatment planning system we used delivered a simple 2-dimensional isodose plan. Nowadays treatment fields are determined by means of a CT-simulator, which is a machine that enables us to integrate the CT-simulation images with diagnostic CT, MRI or 18FDG-PET data. Patients are currently treated with highly sophisticated linear accelerators with image guided radiotherapy (IGRT) and adaptive radiotherapy (ART). The modern treatment planning systems offer 3-dimensional and even 4-dimensional plans. These modern developments the treatment of patients has allowed treatment to be more accurate and safe.
During my training I learned the importance of multidisciplinary meetings, which were instigated by Prof. Kazem who believed radiation oncologist should have a pivotal role in the treatment of cancer. In 1986, when I started at the AMC in Amsterdam, there were just 4 radiation oncologists (headed by Prof. Gonzalez Gonzalez) and 2 physicists . Each of us treated all tumors. Today the department consists of 12 radiation oncologists + 8 in training, 3 physician assistants and 5 physicists (+ 2 trainees). As a result of the increasing complexity of cancer treatment it has become inevitable to specialize within radiation oncology. For many years now I have been responsible for the radiation treatment of children with cancer. This is an axciting field with new developments such as brachytherapy and proton therapy.
In my years as a radiation oncologist I experienced many changes in medicine in general and in my field in particular. Participation in national and international trials has become standard practice to improve treatment outcome and reduce toxicity. New agents are continuously introduced and it is a challenge for the radiation oncologist to understand these agents and to include them into radiotherapy practice. Yet, despite these spectacular technical developments, ‘old-fashioned’ skills are as important as ever. Scrupulous anamnesis, physical examination (in combination with the diagnostic information) and a thorough knowledge of the different cancers are still of vital importance in choosing the right treatment, curative or palliative.
Looking back on my career as a radiation oncologist I can say that although my choice for this specialization was made in a rather peculiar way I have never regretted it. I have experienced my work as a physician in this field as immensely satisfying.
I was born in 1950 and raised in Leek ( Groningen). I studied medicine in Nijmegen and was trained as a radiation oncologist at the Radboud University Nijmegen Medical Center. In the beginning of my career I treated all kinds of malignant tumours, nowadays I specialize in pediatric cancers, hematological malignancies, bone & soft tissue tumours, at the department of radiotherapy of the Academic Medical Center of the University of Amsterdam. My research interest is in pediatric oncology and I am the co-authors of 32 publications and member of 8 different societies or study groups.
Choosing radiation oncology as a speciality was the result of an accidental meeting with a young radiation oncologist on a Sunday afternoon during the winter in George’s jazzcafe in Arnhem. Having just qualified as a doctor I was not sure which route to follow in medicine. After my three-year residency in the hospital of Bennekom, where I worked as an “odd-jobber” (a so-called “wissel-assistent”) and gained a lot of clinical experience, I decided to pursue a career as a gynaecologist. Unfortunately, I did not manage to acquire a position as a resident in that field. Being at a dead end in 1982 I happened to meet the radiation oncologist in the aforementioned café. He was very enthusiastic about his specialism and told me a lot about what radiation oncology actually implied. As luck would have it, I stumbled on an add in a national newspaper for a traineeship at the Radiation Department of the St. Radboud Hospital in Nijmegen. I applied and was successful because of the considerable clinical experience I gained at previous jobs.