The Future of Global Radiation Oncology As Part of Accurate, Precision Cancer Medicine
Authors: Coleman C.N. , Dosanjh M.K. , Buchsbaum J. , Formenti S. , Pistenmaa D.A. 
Published: September 2018

Background: When global health and cancer care are discussed, it is usually in the context of underserved communities, inadequate resources, standards of care below that in the developed world, loss of talented individuals to upper-income countries and the inability to recruit and retain a robust regional workforce. While such conditions may now exist, they are by no means “guaranteed” to be so in the future. Aim: To consider a visionary future for the radiation sciences to encourage investment by individuals in their careers and countries in their cancer care resources such that the current resource-limited facilities will be on the leading edge of accurate, precision radiation medicine. Such a change in perspective can greatly impact recruiting and retaining expertise. Methods: As part of building a visionary strategic plan for radiation oncology and the radiation sciences for the next few decades, a personal opinion paper was prepared by authors from the US National Cancer Institute, Conseil Européen pour la Recherche Nucléaire (CERN)/European Organization for Nuclear Research and the International Conference on Translational Research in Radio-Oncology/Physics for Health in Europe. Considering the critical role for global involvement in the future of radiation sciences, the paper provides a path forward via “win-win” sustainable partnerships formed by current resource-limited and resource-rich countries, as envisioned by the International Cancer Expert Corps ( www.iceccancer.org ). Results: The manuscript “ Accurate, precision radiation medicine: a meta-strategy for impacting cancer care, global health, nuclear policy, and mitigating radiation injury from necessary medical use, space exploration and potential terrorism” is in press. A figure (the Radiation Rotary) illustrates that there are a number of crossroads facing the radiation sciences best addressed as part of a rotary. Four sets of issues are illustrated: 1) cancer care with radiation therapy as both technology and biology, 2) global collaboration in technology development ranging from improved linear accelerators for resource-challenged environments to particle therapy for highly specialized uses, 3) nuclear policy, from energy to the potential for nuclear terrorism and conflagration, and 4) mitigating radiation injury including enabling long-term space exploration, helping reduce the fear of radiation and producing drugs to mitigate radiation injury. Conclusion: Many of these technology, research and development issues must involve LMICs. This is in addition to understanding the differences between upper- and lower-income regions in cancer biology and the environment, including infectious etiologies, diet and the microbiome. The talent and capability of radiation oncologists and related professionals within LMICs are essential to global health and economic development and provide incentives and unique opportunities for world-leading careers and contributions. Disclaimer: The content is the personal opinion of the authors and not their organizations