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The changing face of radiation oncology in Australia 1950-1995: a personal view.

In 1950, orthovoltage X-rays were used to treat a wide spectrum of malignant disease but results were impaired by poor depth dose and significant reactions; radium and radon were used commonly and superficial X-ray therapy was used for a large number of skin cancers as well as many benign skin conditions. Since megavoltage X-ray therapy was introduced to Australia and with earlier diagnosis, high standards for qualification as a radiation oncologist set by the Royal Australasian College of Radiologists (RACR), improved imaging and tumour localization, improved beam characteristics, computerization and dosimetry, patients are now better treated with improved local control and less morbidity. Public facilities have been chronically underfunded by governments resulting in waiting lists for treatment, and free standing private practices are important in sharing the ever increasing workload consequent to the increasing and ageing population. The use of brachytherapy has fallen but is enjoying a resurgence of interest. Chemotherapy has emerged. Radiobiology has had some influence on radiation treatment. Health education has improved and the needs and expectations of patients better appreciated and helped. Cancer societies have made an important contribution. Statistical evaluation of treatment is better understood. Undergraduate training and academic positions remain insufficient. The formation of the Faculty of Radiation Oncology of the RACR has given fresh impetus to the specialty.