Talk:Radiation Oncology/Standards

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Nice write-up Brim! Of course, now I have to go back and make sure I (mostly) conform to this. I do have a question about the chronological order - I find it generally easier to cite the most recent studies first, since they tend to be "more" relevant. That way, I don't have to wade through lot of potentially obsolete studies, and it's easy to see at a glance how current the material is. Any thoughts on that? Tdvorak 19:29, 1 October 2005 (UTC)

As it stands, some of these "standards" are really a suggestion, or a call to make the wiki have a uniform look. Some of the standards should be taken as law, such as do not plagiarize, and others, such as providing references, are pretty much common sense. As for the formatting of the article entries, I think that's more flexible, and it should be open to debate. As I stated, it's just a guide to one suggested format. I think it's important for certain elements to be present in a logical format, but the format itself isn't as important. At this time, I think we should strive for a somewhat consistent look, in that the entries don't look startlingly different from one another, but we need not have all entries look exactly the same. This wiki is still maturing and finding its identity. Over time, we may all agree to adopt a certain look, but right now I think it's a little early to do that, since it might change at some point in the future. If you have any ideas for how we should do the formatting, I'd love to hear it. Right now we have really only 4 regular contributors and a few others who contribute occasionally. I'd like to hear from them about what they think too.

As for the order of the studies, I think listing them in chronologic order within sections makes more sense. The development of radiation oncology happens in stages, with one type of treatment being compared against another treatment, and then against another, and so on. Findings from one study influence the design of future studies. Therefore, I think it makes the most logical sense to present data in chronologic order. It's the way that all textbooks, journal articles, reviews, and protocols discuss the trials.

I understand the convenience of having the most recent article at the beginning, however. We did adopt that for the listing of all the RTOG studies, since I agree that in that case, we're usually searching for more recent RTOG studies and it's easier to have those on the top. But in the case of other sections in this book, I still think that it makes most sense to order the studies chronologically by date. I realize that this approach requires us to use a little bit more effort to see the most current studies, but again, I think this works much better than trying to learn radiation oncology backwards from the most current era to the past. In general it shouldn't be that difficult to locate a desired article. The only problem I see is for very large topics (like prostate) where we have tons of information. One thing that might help would be to have a section at the top titled "Current standard of care" where the way we treat currently is listed with a list of the studies that defined that standard of care. I'm not sure if this would really help though. Any ideas? — Brim 23:19, 4 October 2005 (UTC)

I agree with having a "Current standard of care" section, or even a page. I slowly started to develop that in prostate (summarizing the info underneath section headings), since I found myself drowning in information. It was brought home to me now as I am doing some work on cholangioCA. It's a rare CA, without that much literature, and yet ... there is a lot of info. For now, I have a section that I called "Treatment Overview" and I am mulling how to highlight the defining studies, as opposed to the bibliography I put there so far. It could work to have one (short) form page for each CA, which would give an overview of the disease. Epidemiology-Work Up-Staging-Pathology-Treatment Overview, without citing any studies, just saying something like: low risk disease RT dose xx fields yy, no chemo; high risk disease RT dose aa fields bb, chemo cc. And then a separate page for Treatment, having as you suggest the current treatment repeated with supporting seminal studies on top, followed by whatever random assortment of other studies gets put in.

As for chronology, it definitely makes sense in a textbook. Or in a paper Intro introducing a given topic. But I guess it depends on what the ultimate goal of this wikibook is. Is it a textbook to learn a topic "from scratch"? Or is it more a reference compilation? If more a textbook, then chronologic order makes sense. If more a reference, then I would lean toward reverse chronology, to more easily look up "what's new", assuming some underlying knowledge of the subject. I think I have been treating this more as a reference book to quickly look up/review current state of a given subject Tdvorak 17:10, 5 October 2005 (UTC)

I think it may be worthwhile to associate a page with each cancer that would be "Stuff to absolutely know for boards"; not having started my residency training, I don't have a sense of whether this would be all that different from the "Current Standard of Care" section, but the advantage would be that you could easily link all these "study" pages into a comprehensive syllabus. Tdvorak 15:18, 11 October 2005 (UTC)

I envision its goal being both a textbook and a compilation of papers. Ultimately, it should provide as much information as a textbook. However, because ease of use is a prime goal of this project, I don't think the wiki should become full of prose like a textbook. I'd like for it to offer all of the important information on a topic, such as background, epidemiology, and all the treatment information. It should even include pictures, such as the design of radiation portals. We don't have any pictures like that now, but I hope that one day it will be comprehensive enough to include all that. The sky's the limit. As the project grows more complex, as it is already doing, there will be the problem of having too much information, and how to organize the information and keep it easy to use. My goal is to keep it easy to use, so it can be used as a reference. That's how it will primarily be used, I imagine. In a sense, that's really what print textbooks are for radiation oncology. Textbooks aren't good at teaching radiation oncology; that's what residencies are for, and no textbook that I've seen does a good job of being an instruction manual for how to be a radiation oncologist. So this wiki shouldn't aspire to that task. Rather, what textbooks are good at is for putting into perspective the history of the trials that led up to way we treat patients. They give a historical overview, and they provide references to the data and the papers. So that's what I think this wiki should be. An interested person should be able to come here to this wiki, read up on a topic (for example: head & neck cancers), and be able to understand the evolution of the trials, how standard radiation came to be replaced by hyperfractionation and then chemo/RT; what other methods (e.g. radiosensitizers) have been tried, etc. The wiki should be organized so that it answers simple and meaningful questions: is chemo/RT better than RT alone? Is chemo+hyperfractionation better than chemo+standard RT? and so on.

Someday the wiki is bound to become crowded with information. At that point, and we're starting to reach it now in some chapters, I think it would be wise to organize the information into levels of increasing complexity. For example, a section on hormonal therapy for prostate cancer might list a few of the most important trials and give a brief overview of their findings, and then you click on a hyperlink for a particular study to view details. Sort of like what we have for the page of RTOG trials for prostate cancer. For crowded sections with lots of trials listed, it can be difficult to skim and read the section, so it might make sense to list only the important or landmark studies on the top-level page and then have a hyperlink to something like "See other studies..." which brings you to a page with some of the other studies.

I think your idea of having a section of "Stuff to know for boards" is a brilliant idea. Most residency programs have collections of board exam recall questions, and we could implement those into a section on the boards, broken down into major topics or questions that are often asked on the boards, and providing links to the studies. — Brim 00:50, 12 October 2005 (UTC)