The Royal Australian and New Zealand
College of Radiologists®
RADIATION ONCOLOGY
TRAINING PROGRAM
CURRICULUM
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
With the discovery of X-rays in the late 19th century and
the study of radioactivity by Marie Curie and colleagues
in the early 1900s, came a new era in medicine. The
realisation that some types of radiation (X-rays, electrons
and gamma rays from radioactive materials) destroy
malignant cells, infinitely expanded our capacity to treat
cancer. Over the last 100 years, the full potential of
radiation in curing many cancer patients, and relieving
distressing symptoms (palliation) for others, has unfolded.
This stream of medicine has grown into the modern
specialty of Radiation Oncology.
incorporates direct clinical management of patients of
all ages, with a uniquely effective treatment modality.
It is a specialty that will allow you to have meaningful
interactions with patients and their families, and to be
a key player in their overall care.
Again, welcome.
A/Prof. Sandra Turner
Chief Censor Radiation Oncology
Clinicians who specialise in Radiation Oncology play
an integral role in the complex multidisciplinary team
management of cancer patients. Their practice is strongly
underpinned by a detailed knowledge of the biological
effects and physics of radiation, of pathology and
anatomy as they relate to cancer and its control, and of
the application of sophisticated imaging and treatment
technologies. Paramount is an extensive understanding of
all clinical aspects of cancer management.
Radiation Oncologists are trained to be competent beyond
their role as clinical and technical experts. Our Fellows are
required to be excellent communicators, above all with
our patients, to work in a close and collaborative fashion
with radiation therapists, medical physicists, surgeons,
medical oncologists, palliative care physicians and
radiologists amongst others; to practice evidence-based
medicine, and to take part in research and other academic
pursuits, including teaching. These skills and expertise
enhance the value of the specialty for the community.
They are required to advocate effectively for their patients
and for their profession.
Welcome to this, Version 2, of our modern curriculum for
training in Radiation Oncology. This document refines and
updates the previous ‘new’ curriculum without changing
the overall statements of the knowledge and skills
required for our speciality.
If you are commencing training in Radiation Oncology,
you are entering an intellectually challenging and exciting
career. This is a rapidly evolving specialty incorporating
many varied specialised procedures and options for
academic pursuits. It is highly rewarding in that it
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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CURRICULUM
INTRODUCTION
Foreward by the Chief Censor
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
TABLE OF CONTENTS
GOALS OF TRAINING PROGRAM CURRICULUM
BACKGROUND TO CURRICULUM DEVELOPMENT
9
TRAINING PROGRAM STRUCTURE
11
• LEARNING PORTFOLIOS
11
• THE TRAINEE AND NETWORK TRAINING CENTRE(S) PARTNERSHIP
12
INTRODUCTION TO THE CanMEDS ROLES
13
• ROLE STATEMENTS
14
HOW TO USE THIS CURRICULUM DOCUMENT
15
ROLE 1: MEDICAL EXPERT17
• RADIATION ONCOLOGY PHYSICS
21
• RADIATION AND CANCER BIOLOGY
27
• ANATOMY 32
• PATHOLOGY
35
RADIATION ONCOLOGY CENTRAL KNOWLEDGE & SKILLS SUMMARY (ROCKSS)
39
MEDICAL EXPERT SUPPLEMENT TOPICS
42
• Breast 43
• Lung and Mediastinum
47
• Head and Neck
53
• Skin
57
• Male Reproductive System
61
• Female Reproductive System
67
• Urinary Tract
73
• Gastrointestinal Tract
77
• Central Nervous System
87
• Haematology
97
• Musculoskeletal and Connective Tissue
103
• Paediatrics
109
• Endocrine
113
• Metastatic Disease
117
• Non-Malignant
121
• Clinical Oncology
123
LEARNING OPPORTUNITIES
127
ROLE 2: COMMUNICATOR131
ROLE 3: COLLABORATOR135
ROLE 4: MANAGER139
ROLE 5: HEALTH ADVOCATE143
ROLE 6: SCHOLAR147
ROLE 7: PROFESSIONAL151
DESCRIPTION OF ASSESSMENTS
155
GLOSSARY
161
ALPHABETICAL INDEX OF MEDICAL EXPERT SUPPLEMENTS
165
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
CURRICULUM
INTRODUCTION
CURRICULUM INTRODUCTION
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
CURRICULUM
INTRODUCTION
Goals of the Radiation Oncology Curriculum
This document aims to:
• Articulate the knowledge, skills and attributes of a Radiation Oncologist
• Provide direction to help trainees acquire the necessary competencies
• Provide stimulus for potential learning opportunities and give guidance as to how to maximise benefit from these
• Demonstrate the integration and links between various areas of knowledge and their application in clinical practice
• Present a framework for trainee progression through the program
• Describe the assessments used across the training program
• Promote regular and productive interaction between trainees and supervisors, through the use of formative
in-training assessments
• Indicate where learning materials and resources may be found
Background to
Curriculum Development
The process culminating in the publication of the first
edition of this document occurred between 2004 and
2008. It involved widespread consultation between
the Fellows of the Faculty of Radiation Oncology (“The
Faculty”) of The Royal Australian and New Zealand
College of Radiologists (RANZCR) as well as many other
parties.
In 2004, the Faculty Board advised that a comprehensive
review of the Radiation Oncology training program be
undertaken. The impetus for change emanated from
three areas. The main trigger was evolution of modern
educational and evidence-based adult-learning concepts,
including the increased use of formative in-training
assessments. At the same time, recognition by Fellows
and trainees of the vagaries of the previous syllabus and
assessment led to a desire to increase the objectivity and
clarity of all aspects of training. Furthermore, important
governmental bodies in the realm of accreditation of
Medical Colleges (in particular the Australian Medical
Council) were arriving at similar conclusions that were
reflected in requirements to all Medical Colleges.
As the initial step, the Curriculum Advisory Committee
(CAC) was convened, including many members of the
Faculty significantly involved in education, as well as
others with an interest to become more involved. It also
included trainee representatives, representatives of the
public (consumer representatives) and RANZCR secretariat
members, in particular the newly appointed RANZCR Head
of Education and Research. A consultant expert in postgraduate medical education from the University of New
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
South Wales advised throughout the development process
and remains involved.
The process of defining the scope of the modern
Radiation Oncologist’s role was followed by establishing
a framework for the shape of the new program, in parallel
with filling out the content of the curriculum document.
The common core competencies evolved and continued
to be refined by the CAC group during the course of the
project. Most members of the Faculty were involved in
writing and reviewing one or more sections dealing with
specific tumour sites. Most topics were reviewed several
times and the final document draft was circulated widely
for comment.
Since the release of the first edition in 2008, several
ongoing reviews of curriculum components have been
completed and feedback has been sought through the
implementation phase of the ‘new’ (now considered
current) curriculum. This has resulted in some, mostly
minor, changes to subject content and scope. This has
been reflected by related in-training and summative
assessments, and training tools. This 2012 version (second
edition) contains all of these changes and updates. At the
time of printing, a formal independent (external) review of
all aspects of the curriculum, including training Network
operation and curriculum delivery, is in development.
The entire development and review of this curriculum
to date has occurred with the direct involvement of the
Education Boards - past and present - with members
listed below. The Faculty Board has retained oversight
of the curriculum development and subsequent updates,
with their input and approval sought in every matter.
As a subgroup of CAC and/or Education Boards,
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the Radiation Oncology Curriculum Editorial Teams
1 & 2 (ROCET 1 & 2), have had the task of editing,
organising and formatting these documents. ROCET’s
roles also included the coordination of the review
process, addressing comments, advising on artwork and
communicating Curriculum development issues back to
the Education Board and Faculty Board.
This Curriculum represents a large body of work achieved
as a cooperative effort by a large number of people
both within and outside The Faculty. This document will
continue to be reviewed and updated in order for it to
retain relevance and to meet the goals for which it was
designed.
Education Board Members 2006-2009
A/Prof Martin Berry (Chief Censor)
A/Prof Roger Allison (Dean)
Dr Sandra Turner
Dr Matthew Seel
Dr Chakiath Jose
Dr Rahul Mukherjee
Dr Tanya Holt
A/Prof Graham Stevens (Chief Accreditation Officer)
Dr Amy Shorthouse (Trainee Representative)
Dr Bronwyn King (Trainee Representative)
Dr Mark Sidhom (Trainee Representative)
Education Board Members 2010-2012
Radiation Oncology Curriculum
Editorial Team 1 Members 2007-2008
Dr Sandra Turner (Chair)
Dr Matthew Seel
Dr Mary Dwyer
Dr Kirsty Stuart
Ms Ally Keane
Radiation Oncology Curriculum
Editorial Team 2 Members 2011-2012
Dr Tanya Holt (Chair)
Dr Margot Lehman (co-Chair)
A/Prof Sandra Turner
Ms Bianca Heggelund
A/Prof Sandra Turner (Chief Censor)
A/Prof Chris Milross (Dean)
Dr Denise Lonergan
Dr Tanya Holt
Dr Margot Lehman
Dr Melissa James
Dr Mark Lee
Dr Michael Penniment
A/Prof Phillip Yuile (Chief Accreditation Officer)
Dr David Kok (Trainee Representative)
Dr Andrew Lee (Trainee Representative)
Dr Evan Ng (Trainee Representative)
Dr Angela Allen (Trainee Representative)
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
This curriculum document outlines the structure of our
training program, the knowledge and skills we expect
our trainees to develop and the nature of the various
assessments that occur throughout the training program.
The training program is structured in two major
phases. The two-phase structure is designed to aid the
organisation of learning through the course. Phase 1
extends from the trainee’s commencement in training
through to approximately 18 to 24 months into the
program. Phase 2 extends over the remainder of the
program, from the satisfactory completion of Phase 1
through to a minimum of 5 years from program entry.
The exact length of each phase is determined by trainee
progress and achievement of certain milestones, not a
pre-determined time period. Within Phase 1, there is
a loosely-defined ‘Foundation’ period (approximately
the first 6 months after entry) during which essential
background knowledge is acquired, as well as familiarity
with the new training centre.
Learning outcomes are closely linked to the various
assessments throughout the training program. See below
for further information on assessments and the concept
of Learning Portfolios. There is a Phase 1 examination
and a Phase 2 examination. Trainees who are progressing
well through Phase 1 are able to undertake some of the
activities (e.g. Case Reports) that are predominantly linked
to Phase 2 of the program. For more specific information
regarding individual assessments, please refer to the
Assessments section and the Assessment Toolkit.
Progression through the program occurs by the
achievement of regular satisfactory assessments made
or signed-off by Clinical Supervisors (all Radiation
Oncologists who work directly with trainees) and
Directors of Training.
LEARNING PORTFOLIOS
Each trainee will have a Learning Portfolio that is used
across the whole program to compile the “evidence”
of their learning and activities, helping to demonstrate
that the specified skills and knowledge of a Radiation
Oncologist have been acquired. These Portfolios provide
trainees with the opportunity to show how completely
they have met the requirements of the curriculum. There
are, therefore, minimum and mandatory requirements for
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
the contents of the Portfolio that become the core nonexamination based assessment for each trainee in
the program.
The Learning Portfolio also provides trainees with an
opportunity to individualise their learning within areas
of particular interest. This is achieved by the inclusion of
other materials and documentation that supports their
activities and study over the course of their training and
professional development. There are many examples
of potential learning activities contained within this
curriculum. In this way, the portfolio may represent a
type of “Curriculum Vitae” of an individual’s training
experience and achievements.
Modern assessment methodologies included in this
curriculum and contributing to the Portfolio are miniclinical evaluation exercises (mini-CEX) which provide
feedback to trainees on patient interactions and multisource feedback (MSF) surveys assessing trainee’s
communication skills and ability to work as a team
member. Other assessments include Clinical Supervisor
Assessments (CSA) of each term, Trainee Assessment of
Training Terms (TATTs) and a six-monthly review by the
Director of Training (DoT).
The Phase 1 Foundation Modules and Clinical
Assignments, aim to guide and ensure learning of
the Oncology Sciences subject material. These are
incorporated into the Learning Portfolio in Phase 1. There
are also requirements in relation to Practical Oncology
Experiences (POEs) which involve protected time spent
gaining exposure to facets of radiation treatment
planning, treatment delivery and oncology anatomy.
In Phase 2, trainees are required to meet the Statistical
Methods, Evidence Appraisal and (Trainee) Research
(SMART) requirements and these form part of the Phase
2 portfolio sign-off. Portfolios will also contain a number
of Case Reports (as a type of learning-focused ‘log book’)
dealing with management and technical issues across the
spectrum of tumour sites and special radiation therapy
techniques and cancer procedures, as well as some
general clinical oncology scenarios.
These special techniques and procedures have a practical
component and ensure some exposure, across the training
Networks, to brachytherapy, paediatrics, total body
irradiation, stereotactic radiation therapy and surgical
oncology procedures.
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CURRICULUM
INTRODUCTION
TRAINING PROGRAM STRUCTURE
THE TRAINEE AND NETWORK TRAINING
CENTRE(S) PARTNERSHIP
Trainees will require a satisfactory Portfolio assessment
in order to progress from Phase 1 to Phase 2 and to be
eligible to sit the Phase 2 examination.
Maintenance of the Learning Portfolio is the responsibility
of the trainee. As described above, this curriculum
describes the compulsory content requirements but
trainees are encouraged to include additional relevant
material. All activities undertaken should be referenced
to the learning outcomes in the Curriculum and/or those
outlined in the Portfolio itself.
Review of the Learning Portfolio will be undertaken sixmonthly by the Director of Training and the trainee, with
the expectation that barriers to successful completion
of assessments can be identified early and rectified. The
Faculty Trainee in Difficulty Policy details the processes
and flags for identifying and assisting trainees that are
not progressing or who are having other problems in
training. In addition it outlines tips and strategies for
remediation.
From January 2012, all trainees entering the Faculty of
Radiation Oncology training program will operate under
the accredited training Network rules and guidelines
(see the Training Network Guidelines Policy and Training
Network Accreditation Standards documents on the
College website for details at http://www.ranzcr.edu.au/
radiation-oncology/training-in-radiation-oncology).
The training Network and constituent centres are
responsible for ensuring each trainee has access to the
experiences and support required for completion of the
training program. Maximising these opportunities was
the main rationale for mandating networked training in
Radiation Oncology. Mentoring of the trainee is part of
the support expected.
Diagram of Training Program Structure
Phase 1
Phase 2
SMART Points
accural completed
Advanced
Trainee
(5th) Year
Research Project
submission
KEY
FoundationClinical Practical
ModulesAssignmentsOncology
Experiences
Case
Other Portfolio
Reports
Activities eg. mini-CEX,
TATTS, DoT Assessments
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Phase 1 & 2
Examinations
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
The Royal College of Physicians and Surgeons of Canada
described the seven roles of a doctor as: Medical Expert,
Communicator, Collaborator, Manager, Health Advocate,
Scholar and Professional. These were named the
Canadian Medical Education Directives for Specialists
(CanMEDS).
The role of Medical Expert is seen as central to the work
of a Radiation Oncologist. The other six roles are also
important, and together the seven roles are intended
to encompass all aspects of our profession. There is
much overlap across the roles, but this model does allow
for some individual focus on the various aspects of
professional life as a Radiation Oncologist.
Adapted from the CanMEDS Physician Competency Diagram,
with permission of the Royal College of Physicians and Surgeons of Canada. Copyright©2009
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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CURRICULUM
INTRODUCTION
INTRODUCTION TO THE
CanMEDS ROLES
ROLE STATEMENTS
This RANZCR Radiation Oncology Curriculum is built
around the general CanMEDS concepts and is organised
around the seven key roles as they relate to a Radiation
Oncologist.
Role 1: Medical Expert
Central to the role of the Radiation Oncologist is the
interaction with the person with cancer. The Radiation
Oncologist:
•Synthesises oncological knowledge with clinical
information to formulate and convey a plan of
management
•Applies technical expertise in carrying out planning
and delivery of management programs, in particular
those involving radiation therapy
•Devises and conducts an effective program of patient
assessment throughout and beyond initial treatment
•Coordinates psychosocial and physical care during
the follow up period, including delivery of further
courses of radiation therapy and management of
other cancer and treatment-related problems
The Medical Expert role draws on the competencies
included in the roles of communicator, collaborator,
manager, health advocate, scholar and professional.
Role 2: Communicator
The Radiation Oncologist:
•Establishes a professional relationship with the
patient and their family, and is sensitive to their
illness, social situation and cultural background
•Is expert in eliciting and synthesising relevant history
and patient preferences by directed questioning and
effective listening
•Discusses information with patients, their families
and their health care team, using appropriate
language
•Maintains ethical and effective verbal and written
communication with other practitioners, in all roles
Role 3: Collaborator
The Radiation Oncologist:
•Establishes and maintains interpersonal co-operative
relationships with patients
•Establishes and maintains interpersonal co-operative
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relationships with other healthcare providers
•Facilitates optimal patient care both in the outpatient and inpatient setting
• Participates in research and educational activities
Role 4: Manager
The Radiation Oncologist:
•Optimises decisions regarding individual patient care
in the context of finite health care resources
• Provides leadership in healthcare organisations
•Ensures effective work practices through staffing and
the development of policies and procedures based on
appropriate use of information systems
Role 5: Health Advocate
The Radiation Oncologist:
•Applies expertise and influence, whether individually
or as part of a group, to improve cancer services on
behalf of individual patients, groups of people with
cancer and the community at large
Role 6: Scholar
The Radiation Oncologist:
•Engages in life-long learning with the goal of
continuously improving his or her mastery of the
discipline
•Contributes to the collection, analysis and
interpretation of data that relate to health care
quality and outcomes
• Critically evaluates scientific literature and research
• Integrates emerging evidence into clinical practice
•Participates in the education of peers, trainees, other
health care providers, and community bodies
•Actively participates in advancing knowledge in the
clinical and laboratory settings
Role 7: Professional
The Radiation Oncologist:
•Delivers the highest level of patient care with
integrity, honesty and compassion
•Exhibits exemplary personal and interpersonal
behaviour, and practices ethically
•Practices with diligence and active concern for the
progress of the profession, while continuing to
improve mastery of the discipline
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
In this document, each of the seven roles of a Radiation
Oncologist is defined and expanded by the use of a role
statement and these statements are illustrated further
with learning outcomes. Learning outcomes describe the
expected abilities or competencies required of a Radiation
Oncologist.
When listed as a group of learning outcomes, these are
usually prefaced by the common stem “The trainee is
able to:”, indicating that these are defined expectations
of competence at a level necessary at the completion of
Radiation Oncology training.
It is important to recognise that the learning outcomes
within this curriculum are those that apply to a Radiation
Oncologist about to commence independent clinical
practice i.e. just at the completion of training. In
particular, a high level of sub-specialist knowledge is not
expected.
Not all learning outcomes need to be achieved to the
same level. The levels of achievement for the learning
outcome statements in this curriculum are denoted as
follows:
[D] =A Detailed level of knowledge, and ability to apply
this knowledge in clinical settings, is required
[G] =A more General level of knowledge, and minimal
application of this knowledge, is required
[I] =Ability to perform the specified activity essentially
Independently
[S] =Ability to perform the specified activity under
Supervision
trainees in achieving the learning outcomes. Not all
activities are required to be undertaken and some will
clearly be much more complex and challenging than
others. These opportunities are suggestions for activities
that the trainee may seek out during their training.
They will help the trainee develop and establish related
capabilities, and a better understanding of that particular
role.
When listed as a group of learning opportunities,
statements are prefaced by the common stem “The
trainee may:”, in order to capture the concept that
these are suggestions and not absolute requirements for
training. The list of learning opportunities provided is not
considered exhaustive. Trainees are encouraged to add
and substitute other activities and learning experiences
that will assist them in achieving the learning outcomes
stated under each role section. Refer to the notes on
learning portfolios for further information on possible
learning opportunities.
While participating in the suggested learning
opportunities the trainee should focus on the
development of learning outcomes listed in the relevant
section.
Supervisors may use the learning outcomes to help direct
the trainee to appropriate learning opportunities and also
to assess whether trainees are reaching the expected
standards of achievement.
More specific information about how different sections of
the curriculum relate to one another is found under the
Medical Expert role.
The level of required knowledge or skill is specified for
each learning outcome or group of outcomes in the
Medical Expert role. Where learning outcomes in a group
are all at the same level, the notation is shown next to
the subheading; where they differ, it is given next to
individual learning outcomes. For the remaining (nonMedical Expert) CanMEDS roles, the level of achievement
is represented by the ability to perform the specified
activities independently i.e. [I]
Within each Radiation Oncologist role, the learning
outcomes are followed by a set of suggested learning
opportunities or activities, which will assist individual
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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CURRICULUM
INTRODUCTION
HOW TO USE THIS
CURRICULUM DOCUMENT
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
MEDICAL
EXPERT
MEDICAL EXPERT
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Role 1: Medical Expert
Central to the role of the Radiation Oncologist is the interaction with the person with cancer.
The Radiation Oncologist:
•Synthesises oncological knowledge with clinical information to formulate and convey a plan of management
•Applies technical expertise in carrying out planning and delivery of management programs, in particular those
involving radiation therapy
•Devises and conducts an effective program of patient assessment throughout and beyond initial treatment
•Coordinates psychosocial and physical care during the follow up period, including delivery of further courses of
radiation therapy and management of other cancer and treatment-related problems
The learning objectives for the Medical Expert role are
encompassed in two major sections of this curriculum,
namely:
1.The Oncology Sciences
2.The Radiation Oncology Central Knowledge and
Skills Summary (ROCKSS) and the Medical Expert
Supplements (MES)
ROCKSS and MES
Oncology Sciences
Within ROCKSS, these principles are not linked to
individual tumour sites or specific clinical situations.
Rather, the learning objectives contained within ROCKSS
deal in a comprehensive manner with the processes of:
1.Assessment of patients a Radiation Oncologist will
see throughout the course of their practice, leading
to the establishment of a suitable management plan
2.Delivery and evaluation of this individualised
management plan, both from the perspective of
holistic patient care through and beyond treatment,
and in relation to technical aspects of treatment
delivery
The Oncology Sciences section comprises the subjects
considered fundamental to the clinical practice of
Radiation Oncology, namely:
• Radiation Oncology Physics
• Radiation and Cancer Biology
•Anatomy
•Pathology
Knowledge in these subjects at a foundation level is
considered necessary in order to attain the skills and
knowledge required for their clinical application. The
latter, more complex, applied competencies will be
developed in an ongoing, progressive manner throughout
the full length and breadth of the training program.
Consequently, where possible, learning outcomes for these
subjects are organised into:
• Phase 1
• Phase 2
This has been done to guide the trainee in prioritising
study in these subjects. It is important to recognize
however that all of the knowledge acquired in Phase 1 of
the Oncology Sciences is relevant to Phase 2 training and
the clinical application of this knowledge is examinable in
the Phase 2 examination.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKSS provides an overview of the clinical competencies
required by the Radiation Oncologist at the time of
completion of their training. This provides a detailed
framework for the scope of Radiation Oncology training
and practice.
Medical Expert Supplements direct the trainee’s learning
in relation to specific tumour sites and clinical situations.
It is essential that these be used in conjunction
with the ROCKSS, Pathology and Anatomy
documents.
The MES aim to focus the trainee on issues and areas of
study that are in some way particular or unique to the
topics. The ROCKSS competencies, however,
form the core requirements for all topics
covered by the MES and listed in the Table of
Medical Expert Supplement Topics.
The Table of Medical Expert Supplement Topics organises
cancer topics into those in which Radiation Oncologists
commonly play a central role in patient care and
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MEDICAL
EXPERT
Role Statement
management (major focus) and those in which Radiation
Oncologists play a more supportive role (lesser focus).
Topics are displayed and grouped for ease of reference
and not in order of priority for study.
It is recognised that the list of topics is not exhaustive and
that the Radiation Oncologist may be rarely called upon
to treat other diseases, and in these situations would base
their management plan on relevant learning outcomes in
ROCKSS.
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Radiation Oncology Physics inextricably underpins the
practice of Radiation Oncology. Continuous learning in
this subject from the start of training throughout the
program and beyond is critical to effective and safe
practice in this discipline.
Much of the material below overlaps with the learning
objectives contained within the ROCKSS and MES sections
of the curriculum, as a detailed understanding of the
physics of radiation and its application in the clinical
setting is central to the Medical Expert role.
Competencies (knowledge and skills) required within
this subject in Phase 1 will be assessed through the
Foundation Modules, Clinical Assignments and Phase
1 examination. Due to the importance of Radiation
Oncology Physics all components learnt in Phase 1 will
be assessable during Phase 2. In addition, during Phase
2 of training learning in Radiation Oncology physics will
be extended. Radiation Oncology Physics and its clinical
applications will be assessed through completion of
Case Reports and within all components of the Phase 2
examination, in particular the planning examination and
other viva components.
PHASE 1
1Radiation and interactions
with matter [D]
The trainee is able to:
1.1 D
escribe the fundamentals of an atom in
terms of:
1.1.1 S tructure - nucleus, orbital shells, energy
levels, binding energy
1.1.2 P articles - proton, neutron, electron,
positron
1.1.3 D
escription - atomic number, atomic
weight, isotope, isomer
1.1.4 E nergy - conservation of mass and energy,
mass-energy conversion
1.2 Describe the processes involved in photon
absorption, scattering processes and electron
interactions in terms of:
1.2.1 P hoton interactions i.e. coherent (elastic)
scattering, photoelectric effect, Compton
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
scattering, pair production, annihilation
radiation, characteristic radiation,
photonuclear reactions
1.2.2 Processes of attenuation: exponential
attenuation, energy transfer, energy
absorption
1.2.3 Interaction coefficients: coefficients of
attenuation, energy transfer and absorption
(in relation to relative importance of
interactions in photon beam therapy)
1.2.4 Electron interactions: ionisation, excitation,
heat production, radioactive interaction
(bremsstrahlung), relative rate of energy
loss and directional changes through
collisional and radioactive processes,
stopping power, range, scattering power,
linear energy transfer
1.3 Describe the basic principles of X-ray production
in terms of:
1.3.1 Bremsstrahlung and characteristic radiation
production by electron bombardment
1.3.2 Efficiency of x-ray production and its
dependence on electron energy and target
atomic number
2Fundamental radiation
quantities and units [G]
The trainee is able to define and give units for:
2.1 Absorbed dose, kerma, equivalent dose, effective
dose, attenuation coefficient
3Principles of image production and use
in radiation therapy [D]
The trainee is able to:
3.1 Describe the principles of imaging modalities
used for treatment planning:
3.1.1 CT scanning
3.1.2 Plain film, fluoroscopy, MRI,
ultrasonography, nuclear medicine imaging
including PET [G]
3.2 Describe imaging techniques used to verify
treatment accuracy e.g. port films, electronic
portal imaging, cone beam CT
Page 21
ONCOLOGY
SCIENCES
RADIATION ONCOLOGY PHYSICS
4External photon beam
radiation therapy [D]
The trainee is able to:
4.1 D
escribe the construction of a linear accelerator,
orthovoltage unit and superficial therapy unit and
explain how a photon beam can be generated
from each of these units
4.1.1 D
iscuss how the beam aperture can be
altered using Cerrobend blocking, multileaf
collimators and independent jaws
4.1.2 D
iscuss design and function of multileaf
collimators including awareness of issues
created by rounded leaf edges
4.1.3 D
escribe the different types of wedge filters
e.g. physical wedges and dynamic wedging
4.2 D
escribe the construction of a Cobalt–60 unit
and explain how a useful therapeutic radiation
beam is generated from it [G]
4.3 D
escribe the characteristics of kV and MV photon
beams in terms of:
4.3.1 Intensity and angular distribution
4.3.2 B
eam quality e.g. energy spectra, effective
energy, half value layer
4.3.3 B
eam variation e.g. change in
characteristics with maximum electron
energy, voltage, current and filtration as
applicable
4.3.4 B
eam edges and penumbra and their
relation to beam energy
4.6 Define the following terms and discuss how each
is used to calculate dose: tissue-air ratio, scatterair ratio, tissue phantom ratio, tissue-maximum
ratio, output factor, back scatter factor, peak
scatter factor, off-axis ratio, percentage depth
dose [G]
4.7 Describe the effects on dose distribution of
irregular or offset fields and the associated
clinical implications of changes in beam aperture:
compare and contrast the use of Cerrobend
blocking, multileaf collimators and independent
jaws
4.4 D
escribe measurements of an external photon
beam, including choice of suitable radiation
detector, specifically: [D]
4.4.1 B
eam measurement: radiation quality,
output and inverse square law
4.4.2 M
easurement protocols i.e. IAEA
megavoltage absolute dosimetry protocol
for megavoltage photon beams [G]
4.4.3 D
ose distribution - kV and MV beam
profiles, depth dose curves, construction of
isodose charts
4.5 D
escribe, with the aid of diagrams, the dose
distribution in tissue produced by external beam
photon radiation in terms of: [D]
4.5.1 R
adiation components i.e. primary and
scattered radiation
Page 22
4.5.2 Descriptors of dose distribution i.e.
percentage depth dose, beam profile,
isodose charts, flatness and symmetry,
penumbra, surface dose (entrance and exit)
and skin sparing
4.5.3 Factors affecting dose distribution and
beam output i.e. effects of field size and
shape, source-skin distance, beam quality
or energy; and beam modifying devices on
dose distribution and beam output
4.5.4 Effects of tissue heterogeneity and patient
irregularity i.e. effects on dose distribution
of patient contour, bone, lung, air cavities
and prostheses; and also dose within
bone cavities, interface effects, effects of
electronic disequilibrium
4.8 Discuss dose modification techniques in terms of:
4.8.1 Methods of compensation for patient
contour variation and/or tissue
inhomogeneity including wedging and
compensating filters
4.8.2 Shielding of dose-limiting tissues
4.8.3 The use of bolus and build-up material
4.9 Describe and contrast the physical aspects of the
following treatment techniques, namely:
4.9.1 Fixed SSD and isocentric techniques
4.9.2 Simple techniques: parallel opposed fields,
multiple fields
4.9.3 Complex techniques: rotation therapy (full
or partial), conformal therapy, IMRT
4.10 Describe the fundamental principles of Intensity
Modulated Radiation Therapy and be able to
distinguish features of step-and-shoot and
dynamic deliveries including dynamic arcs
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
6.2 Display a working knowledge of current ICRU
recommendations including definitions of the
terms used in these documents and choice of
prescription points or areas [D]
6.3 Describe and compare the processes of 2-D and
3-D planning [D]
6.4 Describe the principles of intensity modulated
radiation therapy and inverse treatment
planning [G]
6.5 Describe methods of determining body contour,
location of internal structures including critical
tissues and target volume including comparison
of CT, MRI and PET [D]
6.6 Discuss the choice of beam energy, field size,
beam arrangement and the use of bolus [D]
The trainee is able to:
5.1 E xplain how an electron beam can be generated
from a linear accelerator
5.2 D
escribe the characteristics of an electron
beam – energy spectra, energy specification,
variation of mean energy with depth, photon
contamination
5.3 D
emonstrate a basic understanding of the
difference between electron and heavy charged
particle (in particular proton) interaction with
matter
5.4 D
escribe the assessment of electron beam
radiation, including choice of suitable radiation
detector, specifically:
5.4.1 Beam measurement: radiation quality,
output
5.4.2 Measurement protocols i.e. the IAEA
megavoltage dosimetry protocol for mega
electron volt (MeV) electron beams [G]
5.5 D
escribe, with the aid of diagrams, the dose
distribution in tissue from an electron beam in
terms of:
5.5.1 Dose distribution i.e. percentage depth
dose, beam profiles, isodose charts,
flatness and symmetry, penumbra, surface
dose
5.5.2 Effects of field size and shape, source-skin
distance, energy, beam collimation on dose
distribution and beam output
5.5.3 Effects of heterogeneity and patient
irregularity i.e. effect on dose distribution
of surface obliquity, air gaps, lung, bone,
air filled cavities, external and internal
shielding
6.7 Discuss the use of, and problems associated with,
field junctions in terms of: [D]
6.7.1 Photon-photon junctions
6.7.2 Photon-electron junctions
6.7.3 Electron-electron junctions
5.6 D
iscuss methods of field shaping for different
beam energies and the effect on surface dose
6Treatment planning and delivery for
photon and electron beams
The trainee is able to:
6.1 D
iscuss different equipment and methods for
patient simulation [D]
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
6.8 Discuss the process involved in calculation of
monitor units and/or treatment time [G]
6.9Discuss dose calculation algorithms including
Clarkson (including equivalent tissue-air ratio
corrections), superposition/convolution, Monte
Carlo and pencil beam methods, their comparative
advantages and limitations [G]
6.10 Describe the accuracy of treatment planning
and delivery in terms of:
6.10.1 Methods of patient monitoring and
ensuring reproducibility of patient
positioning throughout treatment and
planning including immobilisation
methods, treatment set-up, lasers, portal
imaging [D]
6.10.2 Image-guided radiation therapy,
including the use of cone beam CT and
fiducial markers [G]
6.10.3 Tolerance levels for field shift
6.10.4 Consistency of patient contour and
position of normal and tumour tissues
during the course of treatment [D]
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ONCOLOGY
SCIENCES
5 Electron beam radiation therapy [D]
6.10.5 Accuracy of calibration, stability of
beam parameters, accuracy of isodose
calculation [G]
6.10.6 Determination of mechanical and
radiation accuracy of treatment
machines and simulators including the
light field, cross-wire images, optical
distance indicators [G]
6.10.7 Systematic and random errors [D]
6.10.8 Avoidance and detection of dose
delivery errors including record and
verify systems, select and confirm
procedures, and interlocks [D]
6.10.9Potential errors arising from computer
control of set up and treatment machine
operation [G]
6.10.10In-vivo dosimetry techniques [D]
7 Radiation Measuring Devices
The trainee is able to:
7.1 R
ecognise and describe the principles of
operation of radiation measuring devices
7.1.1 Ionisation chambers, semi-conductor
detectors eg diodes and MOSFETs,
thermoluminescent and optically
stimulated luminescence dosimeters (TLDs
and OSLs) [D]
7.1.2 P hotographic film, radiochromic film,
Geiger-Muller counters, scintillation
counters, chemical dosimeters [G]
7.2 D
iscuss the use of radiation phantoms and
dedicated dosimetry tools for fixed SSD and
isocentric patient treatments [D]
8Radioactivity
The trainee is able to:
8.1 Describe radioactivity in terms of: [D]
8.1.1 R
adionuclide decay processes e.g. alpha,
beta, positron, gamma, electron capture,
internal conversion
8.1.2 R
adionuclide production e.g. natural and
artificial radioactivity, [G]
8.1.3 E xponential radioactive decay e.g. decay
constant, half life (physical, biological,
effective), mean life, daughter products,
radioactive equilibrium
Page 24
8.2 Define the term and give units for: [G]
Activity, apparent activity, specific activity, air-kerma
rate constant and reference air-kerma rate
9Fundamentals of sealed source
radionuclides and brachytherapy
The trainee is able to:
9.1 Discuss the radioactive sources used in sealed
source brachytherapy in terms of:
9.1.1 Construction: source construction,
including filtration [G]
9.1.2 Properties: spectra of radiation emitted,
half-life, usual specific activity [D]
9.1.3 Measurement of source activity and dose
rates, choice of suitable detectors and
calibration [G]
9.1.4 Clinical decision-making: compare the
advantages of radionuclides in various
clinical circumstances [D]
9.1.5 Commonly used: caesium-137, iridium-192,
iodine-125, palladium-106,
strontium-90 [D]
9.1.6 Historical and less commonly used:
radium-226, cobalt-60, yttrium-90 [G]
9.1.7 Management: handling, cleaning,
inspection, storage and transport [G]
9.2 Describe sealed source brachytherapy in
terms of: [D]
9.2.1 Types of procedures: surface applications,
eye plaques, interstitial implants,
intracavitary techniques
9.2.2 Source Dose Rate: low, medium, high and
pulsed dose rate
9.2.3 Dose distributions: compare isodoses
surrounding ideal sources and clinical
sources
9.2.4 Delivery techniques: remote afterloading
machines, manual afterloading
9.2.5 ICRU dose specification system: current
ICRU recommendations for interstitial and
gynaecological treatment specifications
9.2.6 Current dosage systems: Paris system,
production of conformal dose distributions
using a single, stepping source
9.2.7 Procedures for beta emitters: surface and
ophthalmic applications, intravascular
techniques, techniques of delivery – unique
applicators and methods of use [G]
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
10 Unsealed source radionuclide therapy
10.2 D
efine physical, biological and effective half
life [D]
10.3 D
iscuss methods of dose estimation: the
Medical Internal Radiation Dose (MIRD) and
other methods of estimating dose to target
tissues and critical organs [G]
10.4 D
iscuss the radioactive sources used in unsealed
source therapy in terms of:
10.4.1 P roperties: spectra of radiation emitted,
half-life, physical form and technique
of delivery to patient and use in clinical
practice [D]
10.4.2 M
easurement of activity and dose
rates [D]
10.4.3 C
ommonly used: Iodine-131,
strontium-90, samarium-153 [D]
10.4.4 L ess commonly used: phosphorus-32,
yttrium-90 [G]
10.4.5 M
anagement: safe handling, storage,
transport, clean up of spills [D]
11 Radiation protection [D]
The trainee is able to describe and demonstrate
understanding of:
11.1 The ALARA Principle, Radiation Incident and
Radiation Accident
11.6 Evaluate the practice of radiation protection in
terms of:
11.6.1 Working procedures for use with
radiation sources including simulators, CT,
external beam therapy, brachytherapy and
unsealed sources
11.6.2 Minimisation of dose to patients, staff
and general public including safety
procedures for staff, control of areas and
radiation sources, radiation protection
surveys, personal monitoring, area
monitoring, construction of rooms to
house sources and radiation generators
11.7 Recommended dose limits for foetal exposure
and the human data from which these have
been derived
11.8 Documentation and reporting requirements
relating to radiation incidents and accidents
PHASE 2
1Applied external photon beam
radiation therapy [D]
The trainee is able to:
1.1 Discuss the clinical advantages and
disadvantages of intensity modulated radiation
therapy
1.2 Appreciate the differences between stationary
field and rotational (arc) IMRT, the latter usually
referred to as VMAT.
1.3 Discuss and compare image-guided radiation
therapy techniques
1.4 Interpret 3-D rendering and dose-volume
histograms
1.5 Discuss the physical aspects of total body
irradiation
11.5 Medical exposure in contrast to exposure of the
1.6 Describe the physical aspects including
limitations of stereotactic radiosurgery and
fractionated stereotactic radiation therapy
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 25
11.2 ICRP recommended dose limits; the basis for
international recommended limits; specific ICRP
and national radiation protection standards,
regulatory frameworks in Australia and New
Zealand (as applicable)
11.3 P ractical dose minimisation practices and
procedures (time, dose, distance, shielding)
11.4 Typical environmental dose levels and doses
from diagnostic medical exposures
ONCOLOGY
SCIENCES
The trainee is able to:
10.1 D
iscuss the concepts of uptake, distribution and
elimination [D]
public and occupational exposure (justification,
optimisation and dose limits)
in terms of:
1.6.1 The hardware and software components
of stereotactic equipment
1.6.2 S tereotactic planning principles i.e. the
steps involved in quality assurance for
stereotactic treatments, achievable target
dose homogeneity and peripheral dose
fall-off
2Applied electron beam
radiation therapy [D]
The trainee is able to:
2.1 S elect, compare and describe the physical aspects
of treatment techniques in terms of:
2.1.1 S imple techniques: single fields, multiple
adjacent fields, multiple energy
2.1.2 S pecialised techniques: electron arc
therapy, total skin electron irradiation [G]
5Selection of an appropriate modality
and technique to solve clinical
problems [D]
The trainee is able to:
5.1 Select and justify the choice of treatment
modality and technique for specific clinical
circumstances including choice of photons versus
electrons; external beam versus brachytherapy;
selection of beam arrangements and energies
and choice of other technical parameters
3Applied sealed source radionuclides
and brachytherapy [D]
The trainee is able to:
3.1 Discuss sealed source brachytherapy in terms of:
3.1.1 C
linical uses of surface applications, eye
plaques, interstitial implants, intracavitary
techniques
3.1.2 Selection of source dose rate: low, medium,
high and pulsed dose rate
3.1.3 P lanning: methods of reconstruction and
dosage calculation using radiography, CT,
MRI and US
3.1.4 ICRU dose specification system: current
ICRU recommendations for interstitial and
gynaecological treatment specifications
3.1.5 C
urrent dosage systems: Paris system,
production of conformal dose distributions
using a single, stepping source
5.2 Discuss the modifications to technique and
dosimetry, and quality assurance issues that may
apply to pregnant patients receiving radiation to
non-abdominal sites
6Commissioning and quality
assurance of external photon and
electron beam radiation therapy
equipment [G]
The trainee is able to:
6.1 Discuss the process of acceptance testing,
including the mechanical, optical, radiation and
safety considerations
6.2 Discuss the process of commissioning including
data acquisition and establishment of baseline
values for quality management of equipment
installation
6.3 Discuss quality assurance relating to radiation
therapy equipment including mechanical,
optical and radiation parameters for quality
management including frequency of testing
6.4 Exhibit an understanding of the concept of
tolerances and action levels in relation to quality
assurance measures
4 Proton beam radiation therapy [G]
The trainee is able to:
4.1 D
escribe the production of proton beams for
clinical use including the key principles and
advantages of the cyclotron and synchrotron
4.2.1 Beam profile and percentage depth dose
4.2.2 Clinical modification of Bragg peak and
beam collimation
4.2.3 Beams produced by passive scattering foils
and active scanning
4.2 D
escribe, including graphical presentation, the
dose distribution in tissue produced by proton
beam radiation in terms of:
Page 26
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Knowledge of radiation and cancer biology is an essential
component of the decision-making process used by
practicing Radiation Oncologists. This knowledge has
been developed through careful clinical observation,
laboratory investigation and rigorous clinical trials. Thus,
an awareness of its historical evolution is an important
foundation to understanding modern radiation and cancer
biology. Continuous learning in this subject throughout
the training program is critical to effective and safe
practice.
Knowledge required within this subject in Phase 1
will be assessed through the Foundation Modules,
Clinical Assignments and Phase 1 examination. Due
to the importance of radiation and cancer biology, all
components learnt in phase 1 will also be relevant to
Phase 2 learning. Radiation and cancer biology and its
clinical applications will be assessed in Phase 2 through
completion of Case Reports and within components of the
Phase 2 examination.
The Radiation and Cancer Biology curriculum overlaps
with the Pathology curriculum. The two should be
considered in conjunction rather than as independent
entities.
PHASE 1
1 Historical background (G)
The trainee is able to:
1.1 D
escribe the early empirical observations of the
effects of ionizing radiation, including:
1.1.1 The anti-proliferative effect
1.1.2 The relationship between radiosensitivity
and cellular reproductive activity:
“Law of Bergonie and Tribondeau”
1.2 D
escribe the developments leading to the
understanding of the therapeutic ratio, including:
1.2.1 The recognition and quantification of
normal tissue injury
1.2.2 The distinction between acute and late
reactions
1.2.3 The notion of treating to ‘tolerance’
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1.3 Describe the evolution of fractionated treatment,
including:
1.3.1 The ram’s testis experiment
1.3.2 The demonstration of clinical cures with
fractionated external radiation treatment
1.3.3 The adverse effect of treatment protraction
1.3.4 The evolution of “standard” fractionation
schedules
2Normal cell structure and functions
relevant to neoplasia (G)
The trainee is able to discuss:
2.1 Normal cell structure
2.2 The structure of eukaryotic genes e.g. open
reading frame, untranslated regions, introns,
exons, regulatory elements
2.3 Chromosome packaging
2.4 DNA replication and the importance of
maintaining genomic integrity
2.5 RNA transcription and translation
2.6 Epigenetic effects on gene expression
2.7 The cell cycle
2.7.1 Cell cycle phases and functions
2.7.2 Checkpoints and their molecular controls
2.7.3 Major cell cycle regulators e.g. pRB, p53,
cyclins, cyclin-dependent kinases
2.7.4 Cell cycle kinetic parameters
2.8 Physiological controls of the cell cycle
2.8.1 Extra cellular agents affecting cell growth /
survival e.g. growth factors, hormones
2.8.2 Growth factor receptors
2.8.3 Signal transduction e.g. MAPK/ERK, RAS,
RAF pathways
2.9 Changes in the physiological controls that occur
in, or promote oncogenic transformation
2.9.1 Over-expression of EGF
2.9.2 EGFR mutation and up-regulation
2.9.3 Autonomous functioning of signal
transduction pathways
2.9.4 HPV mediated loss of p53 and
pRB function
Page 27
ONCOLOGY
SCIENCES
RADIATION AND
CANCER BIOLOGY
3Mechanisms of malignant cell
transformation and progression (G)
The trainee is able to discuss:
3.1 Activation of oncogenes/loss of tumour
suppressor genes
3.1.1 M
echanisms including point mutations.
insertions, deletions, translocations, and
amplifications
3.1.2 M
ethods of quantification including
comparative genomic hybridization, in-situ
hybridization and spectral karyotyping
3.1.3 Stable and unstable aberrations
5Radiation-induced cellular damage (D)
The trainee is able to discuss:
5.1 The evidence for DNA being the clinically
relevant target for cell killing (G)
5.2 Other targets of radiation damage
5.3 Types of DNA lesions caused by ionising
radiation including double strand breaks (DSB),
single strand breaks (SSB), cross links and base
damage
5.4 DNA damage repair mechanisms including sublethal damage and potentially lethal damage
3.3 Epigenetic and telomeric changes
3.3.1 G
lobal demethylation, promoter
hypermethylation
3.3.2 Aberrant histone acetylation
5.5 Assays for DNA damage including: g-H2AX,
Comet assay, pulsed field electrophoresis,
plasmid based assay, micronucleus assay and
chromosomal aberrations (G)
3.4 Models of tumour initiation and progression
5.6 Radiation sensitivity in different phases of the
cell cycle
3.5 In vitro characteristics of transformed and
malignant cells
5.7 Modes of cell death including timing of cell
death and relative importance following
ionising radiation including: mitotic catastrophe,
apoptosis, radiation-induced senescence,
necrotic death, autophagy
5.8 Concepts of reproductive death and
clonogenicity
5.9 The bystander effect
5.10The titration of radiation dose according to
tumour cell ‘burden’ including macroscopic
versus microscopic disease (G)
3.2 Knudson’s 2-hit hypothesis
3.6 Tumour angiogenesis and vasculogenesis
3.7 Steps in the metastatic cascade
4 Tumour growth (D)
The trainee is able to discuss:
4.1 G
ompertzian growth of untreated cancers
including the concepts of:
4.1.1 Tumour doubling time (TD)
4.1.2 Potential doubling time (Tpot)
4.2 Determinants of tumour growth rate including
4.2.1 Cell cycle time (Tc)
4.2.2 Growth fraction (GF)
4.2.3 Cell loss factor
4.3 The effect of tumour microenvironment on
growth rate
4.4 The concept and mechanism of accelerated
repopulation following radiation
Page 28
6 DNA double strand break repair (D)
The trainee is able to discuss:
6.1 Processes involved in the DNA double strand
break (DSB) repair response including:
6.1.1 Sensing DNA DSB
6.1.2 Cell cycle arrest
6.1.3 Histone modifications
6.1.4 Recruitment of DNA DSB repair proteins
6.1.5 DNA DSB repair pathways
6.1.6 Homologous recombination and
Non-homologous end-joining
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
6.2 The genetic diseases that affect DNA repair/
clinically apparent radio-sensitivity (eg. ataxia
telangectasia)
7Quantifying cell survival
following irradiation (D)
The trainee is able to discuss:
7.1 The concept of cell survival curves
9The linear quadratic dose response and
the α/β ratio in clinical practice (D)
The trainee is able to discuss:
9.1 Relationship between dose/fraction and
tissue α/β ratio
9.2 Effect of incomplete repair between fractions
7.2 In-vitro and in-vivo techniques to generate
survival curves
7.3 Dose rate effects on cell survival
7.4 The linear quadratic formula in terms of:
7.4.1 The biophysical basis of α and β in the
linear quadratic formula
7.4.2 Clinically derived α/β ratios for:
7.4.2.1 Different types of cancer
7.4.2.2 Acute and late responding normal
tissues
7.4.3 Limitations of the linear quadratic formula
e.g. do not apply to high radio-ablative
doses per fraction
8 Fractionation and the ‘5 Rs’ (D)
The trainee is able to discuss:
8.1 The ‘5 Rs’ of fractionation and their significance
in clinical practice
8.1.1 Intrinsic Radiosensitivity
8.1.2 Repair
8.1.3 Reoxygenation
8.1.4 Redistribution
8.1.5 Repopulation
8.2 The definition and rationale for non-standard
fractionation schedules including:
8.2.1 Hyperfractionation
8.2.2 Accelerated fractionation
8.2.3 Hypofractionation
9.3 Biological Effective Dose (BED) and use the
appropriate formula to
9.3.1 Calculate iso-effective doses for different
fractionation schedules
9.3.2 Calculate partial/residual tolerance of
normal tissues
9.3.3 Correct BED for tumour cell proliferation
9.4 The meaning and impact of the ‘double trouble’
phenomenon
9.5 Dose rate effects in brachytherapy
10 Hypoxia and the oxygen effect (D)
The trainee is able to discuss:
10.1 Modification of radiation-induced DNA damage
by oxygen
10.2 The Oxygen Enhancement Ratio (OER)
10.3 Evidence supporting the clinical significance of
tumour hypoxia
10.4 Methods used to overcome the effect of
tumour hypoxia including their rationale: e.g.
fractionation, hypoxic cell sensitisers, hypoxic
cell cytotoxins, hyperbaric oxygen, high LET
radiation, and hyperthermia
10.5 Tumour responses to hypoxia occurring at
the molecular level including: the role of
transcription factor HIF1-α and its effect
on tumour metabolism, pH vasculature, and
angiogenesis (G)
10.6 Consequences of molecular responses to
hypoxia including: angiogenesis, increased
propensity for metastasis and genetic
instability (G)
8.3 The reasons behind the differences in ‘typical’
fraction schedules employed for curative versus
non-curative (palliative treatments) including
differences in treatment aim, differing concern re
late toxicity, dose required to achieve an effect
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 29
ONCOLOGY
SCIENCES
11 Radiation Quality (D)
The trainee is able to discuss:
11.1 Types of ionising radiation
11.2 L inear energy transfer (LET) and its relationship
to direct and indirect DNA damage, free radicals
and free radical scavengers
13.3 Functional sub units and the volume effect on:
13.3.1 Parallel arrangement of functional
sub units
13.3.2 Series arrangement of functional
sub units
13.4 Flexible and hierarchical kinetic models (G)
13.5 The abscopal effect (G)
13.6 Post radiation regeneration of normal tissues
13.7 The concept of normal tissue/organ tolerance
13.8 How the relationship between tolerance dose
and irradiated volume was determined
11.3 Relative biological effectiveness (RBE)
11.4 The relationship between LET and OER
12 Dose response for tumour control (D)
The trainee is able to discuss:
12.1 Shape of the dose-response curve
12.2 The determinants of the steepness of the
dose-response curve
12.3 The concept and significance of the
Therapeutic Ratio
12.4 Concepts of radiocurability and radiation
responsiveness
12.5 Major factors influencing tumour control
12.5.1 P hysical Factors including dose, dose rate,
radiation quality, temperature
12.5.2 C
hemical Factors including oxygen, radiosensitizers and radio-protectors
12.5.3 B
iological Factors including cell type and
radiosensitivity, clonogen number, host
factors
12.5.4 Technical Factors including geographic
miss
12.6 Tumour control probability curves
13Effects of radiation on normal
tissues (D)
13.9 The mechanism of effect and consequences of
radiation on:
13.9.1 Parenchymal tissues
13.9.2 Connective tissue
13.9.3 Vascular systems
13.9.4 The immune system
13.10 Acute syndromes following high doses of total
body radiation
13.10.1 Acute radiation syndrome
13.10.1.1 Prodromal period
13.10.1.2 Latent period
13.10.1.3 Manifest Illness (Critical Phase)
13.10.1.4 Recovery or death
13.10.2 Cerebrovascular syndrome
13.10.3 Haematological syndrome
13.10.4 Gastrointestinal syndrome
13.11 Methods of biological dosimetry for
unplanned / uncontrolled radiation exposure
including: blood counts, chromosome
aberrations in peripheral blood lymphocytes
(dicentric assay, translocation assay),
g-H2AX, mitotic index, micronucleus and
comet assays [G]
The trainee is able to discuss:
13.1 Acute, sub-acute and late toxicity from radiation
14Effects of radiation on the human
embryo and foetus (D)
The trainee is able to discuss:
14.1 The major phases of foetal development,
including CNS growth and corresponding
gestational age
13.2 The meaning of latency with regard to normal
tissue effects
Page 30
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
14.2 The nature of and reasons for effects caused
in utero
14.3 F actors influencing effect type and risk including
dose and stage of gestation
17.3 Mechanisms of cytotoxic enhancement by
chemotherapy eg, independent action, additive
and synergistic interactions
17.4 Biological cooperation e.g. hypoxic cell
sensitisers and cytotoxins
17.5 Temporal modulation e.g. EGFR blockade,
endocrine agents
17.6 Spatial cooperation including the concept of
‘sanctuary sites’
17.7 Normal tissue protection
17.8 The impact on acute and late side effects arising
from combining radiation with other treatments
14.4 The definition of doubling dose
15Quantification of radiation effects on
normal tissues (G)
The trainee is able to discuss:
15.1 P rinciples of toxicity scoring systems used in
current clinical practice including selection of
appropriate endpoints and quantification
15.2 E xamples of toxicity scoring systems used in
current clinical practice e.g. RTOG, Common
Toxicity Criteria, LENT/SOMA
15.3 Tolerance doses of normal tissues/organs
including the QUANTEC data and its limitations
16 Radiation carcinogenesis (D)
The trainee is able describe:
16.1 The shape of the dose-response curve for this
effect including the peak for leukaemias but not
for solid tumours
18Retreatment with radiation
therapy (D)
The trainee is able to discuss:
18.1 The radiobiological principles for consideration
of re-treatment including; initial radiotherapy
dose (EQD2), volume, volume of overlap,
technique used
18.2 The effect of radiation modifiers used in
treatment of the first tumour e.g. concurrent
chemotherapy
18.3 Time interval between therapy courses and
concept of forgotten dose
18.4 The re-irradiation tolerance of normal tissues
derived from experimental and clinical studies
for both early and late effects.
16.2 Threshold versus non-threshold uncertainty
16.3 Assumptions and recommendations for dose
limits in radiation protection
16.4 R
elevance of integral dose in radiotherapy to
second cancer induction risk
17Combination of radiation with
other therapies (D)
The trainee is able to discuss:
17.1 The radiobiological basis and rationale for
combining surgery and radiation in the
preoperative, postoperative and intra-operative
settings
17.2 C
ombining systemic therapies with radiation,
including:
17.2.1 The rationale and sequencing of therapies
PHASE 2
19Specialised radiation therapy
techniques (D)
The trainee is able to describe:
19.1 The radiobiological principles as they relate to
brachytherapy including low dose rate, high
dose rate and pulsed treatments
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
19.2 The radiobiological principles and implications
of specialised methods for external beam
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radiation delivery including ablative
stereotactic radiosurgery and radiation therapy,
tomotherapy, intensity-modulated radiation
therapy (IMRT) and charged particle therapy
21.7 RNA interference (RNAi)
21.8 Tissue microarrays (TMAs)
21.9 In-situ hybridisation e.g. fluorescent in-situ
hybridisation (FISH), chromogenic in-situ
hybridisation (CISH)
21.10 Systems biology and bioinformatics
including definitions, and application to DNA
microarrays and proteomics
20Further application of cancer biology to
systemic therapy (G)
The trainee is able to discuss:
20.1 A classification of systemic agents including:
cytotoxic chemotherapy, endocrine therapy,
cell membrane receptor blockers, cell signalling
pathway inhibitors and radio-sensitisers and
protectors
20.2 The mechanism of action of commonly used
systemic therapies including phase specific and
cell cycle specific agents
20.3 C
ommon molecular targets for therapy e.g.
angiogenesis, signal transduction, DNA repair,
apoptosis and examples of therapies directly at
these targets
20.4 Individualisation of systemic treatments based
on molecular features
21 Molecular analysis in oncology (G)
The trainee is able to discuss in general terms the
methods for and examples of usage of:
21.1 N
ucleic acid hybridisation including Northern
and Southern analysis, DNA microarrays,
competitive genomic hybridisation (CGH)
21.2 P rotein analysis: Western analysis,
immunoprecipitation, immunohistochemistry,
proteomics (2-dimensional gels, mass
spectrometry)
21.3 P CR(polymerization chain reaction), quantitative
RT-PCR
21.4 D
NA sequencing
21.5 D
etection of single nucleotide polymorphisms
(SNPs), mutations in tumours
21.6 K
nockout, knockin and transgenic mice
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ANATOMY
These learning outcomes should be used as a guide to
studying anatomy from an oncological perspective. A
comprehensive knowledge of anatomy in relation to
cancer medicine allows an oncologist to interpret a given
clinical situation or individual presentation in order to
formulate a diagnosis and to devise a management plan.
In addition, a good knowledge of anatomy is crucial to
the accurate delivery of a course of radiation therapy and
to the process of defining organs and regions as part of
the treatment planning process.
Knowledge of anatomy of all sites will be required by the
completion of Phase 1 of Radiation Oncology training.
Competencies (knowledge and skills) required within
this subject in Phase 1 will be assessed through the
Foundation Modules, Clinical Assignments and Phase
1 examination. Due to the importance of anatomy all
components learnt in phase 1 will be assessable during
Phase 2. Anatomy and its clinical applications will be
assessed through completion of Case Reports and within
components of the Phase 2 examinations.
PHASE 1
The aim of anatomy study and assessment in Phase 1
will be to ascertain that the trainee is developing an
oncological approach to this subject and has competence
when applying anatomical principles to the management
of cancer patients.
To guide learning, the organs and structures relevant to
the management of commonly encountered tumour sites
are listed in the following table.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1 L ocation of the structure or organ, including
definition of boundaries and normal variations
between individuals
7 “Critical” and clinically-relevant tissues and
anatomical regions related to the structure, organ
or tumour under study e.g. supraclavicular fossa for
breast cancer, rectum for prostate cancer
8 Landmarks (surface body, radiological, other
imaging techniques)
9 Neurological pathways and major arterial supply
and venous drainage to organs and structures,
especially those which impact on radiation
planning and treatment decisions
10 Lymphatic drainage of organs and structures
including major nodal stations
11 Important deviations from “normal” anatomy,
either developmental or arising from iatrogenic
causes
2N
atural variations occurring in a person in relation
to normal body functions e.g. respiration
3 In vivo (macroscopic) appearance of structure
or organ
4N
ormal histology (microscopic appearance) of
the organ
5 Appearance of structure or organ on relevant
imaging modalities
6 Routes of potential cancer spread, including:
6.1 Local planes/direct spread
6.2 Lymphatic spread
6.3 Haematogenous
6.4 Transcoelomic
6.5 Neurological
6.6 Iatrogenic
Phase 1 Anatomy Topics
Neuro-anatomy
Functional and anatomical compartments of the cerebrum and cerebellum.
Brainstem
Ventricular system
Cranial nerves including their origin and distribution (intra and extra cranial)
Spinal cord and cauda equina
Meninges
Brachial plexus
Sacral plexus
Innervation of the upper and lower limbs
Autonomic nervous system
Head and neck anatomy
Nasopharynx
Oropharynx
Oral cavity
Tongue
Paranasal sinuses
Major salivary glands
Larynx
Hypopharynx
Thyroid gland
Parathyroid glands
Pituitary gland
Orbits
Paranasal/facial sinuses
Course and relations of the internal and external carotid arteries and
their major branches bilaterally
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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For each anatomical site or organ listed, the trainee is
able to discuss and demonstrate the:
Head and neck anatomy
cont.
ourse and relations of internal and external jugular veins and their major
C
tributaries bilaterally
Anterior and posterior triangles of the neck
Supraclavicular fossa
Pterygopalatine fossa
Temporal and infratemporal fossae
Base of skull including pituitary fossa, cavernous sinus, Meckel’s cave, Rathke’s
pouch, clivus.
All vascular and neural foramina for major vessels, cranial nerves and their
branches traversing the base of skull
Thoracic anatomy
Mediastinum
Trachea and main bronchi
Lung
Pleura and pleural cavities
Heart and great vessels
Azygos vein
Oesophagus
Thoracic course of the thoracic duct
Breast
Chest wall anatomy
Pericardium
Abdominal anatomy
Stomach
Duodenum
Liver
Spleen
Gall bladder and billiary tract
Pancreas
Kidneys
Adrenal glands
Ureters
Cysterna chyli and abdominal course of the thoracic duct
Abdominal wall anatomy
Pelvic anatomy
Rectum
Anal canal
Bladder
Male and female urethra
Prostate
Testes, epidydimis, vas deferens, seminal vesicles
Penis
Ovaries
Fallopian tubes
Uterus
Cervix
Vagina
Vulva
Upper and lower limbs
Axilla
Inguinal and femoral canals
Dermatomes and myotomes of the upper and lower limbs
Muscular compartments and major muscles of the limbs
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
PHASE 2
Knowledge and revision of all of the Phase 1 anatomy
topics will be expected in Phase 2. For Phase 2 learning,
the Medical Expert Supplement (MESs) may highlight
learning outcomes specific to a particular tumour site
or considered worthy of emphasis over and above the
contents of the Phase 1 Anatomy curriculum. A trainee
will be expected to demonstrate their anatomy knowledge
through its clinical application, e.g. in the physical
examination of a patient, making a suitable management
decision based on natural history, interpretation of
diagnostic imaging and in defining tumour and normal
tissue volumes and doses during the radiation therapy
planning process.
Competencies (knowledge and skills) required within
this subject in Phase 1 will be assessed through the
Foundation Modules, Clinical Assignments and Phase
1 examination. Due to the importance of pathology all
components learnt in Phase 1 will be assessable during
Phase 2. Pathology will be further assessed through
completion of Case Reports and within components of the
Phase 2 examinations.
PATHOLOGY
These learning outcomes should be used as a guide to
studying pathology from an oncology perspective.
A comprehensive knowledge of pathology in relation to
cancer medicine allows an oncologist to interpret a given
clinical situation or individual presentation in order to
formulate a diagnosis and to devise a management plan.
Although some of the principles of cancer pathology
will be learned or revised in the early part of Radiation
Oncology training, the topic areas will be studied and
assessed with increasing depth, breadth and application
over the continuum of the program.
Learning outcomes in Phase 1 are divided into two broad
sections:
• The biology of normal and cancer cell function and
growth, on both microscopic and molecular levels
• An introduction to the integration of pathology
skills and knowledge into the management of
patients with cancer
In Phase 2, the additional learning outcomes are divided
into two broad sections as well:
• All aspects of pathology relating to site-based
neoplastic processes (trainees should refer to the
Medical Expert Supplement [MES] table to guide
their study, and also refer to the specific MES
which will highlight learning outcomes specific
to a particular tumour site considered worthy
of emphasis over and above the contents of the
generic learning outcomes listed here)
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
The Pathology curriculum overlaps with the Radiation and
Cancer Biology curriculum. They should be considered in
conjunction rather than as independent entities.
PHASE 1
1 Introduction to cancer pathology [G]
The trainee is able to describe and, where relevant, give
examples of the:
1.1 Introduction to neoplasms [D]
1.1.1 Major histological types of cancer
1.1.1.1 Carcinoma
1.1.1.2 Sarcoma
1.1.1.3 Lymphoma
1.1.1.4 Melanoma
1.1.2 Typical cytological features of
malignant cells as compared with those
of normal cells
1.1.3 Typical biological behaviour of benign and
malignant neoplasms
1.1.4 Neoplasia, differentiation, anaplasia,
aneuploidy
1.1.5 Cancer stem cells and cancer cell lineages,
monoclonality
1.1.6 Tumour heterogeneity
1.1.7 Pathways of spread
1.2 Molecular basis of cancer and cancer genetics
1.2.1 Molecular techniques [G]
1.2.1.1 Microarrays
1.2.1.2 Tissue arrays
1.2.1.3 RT-PCR
1.2.2 Dysregulations of cancer-associated
genes [G]
1.2.2.1 Chromosomal changes
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• An advanced application of pathology skills and
knowledge into the management of patients with
cancer, including working in a multidisciplinary
team
1.2.2.2 Gene amplification
1.2.2.3 Epigenetic changes
1.2.2.4 Polymorphisms
1.2.3 Carcinogenesis [D]
1.2.3.1 Initiation and promotion
1.2.3.2 Molecular basis of multistep
carcinogenesis including the
Vogelstein model of colorectal
carcinogenesis
1.2.3.3 Chemical, radiation and microbial
carcinogenesis
1.2.3.4 Malignant transformation
1.2.3.5 Precursor lesions and field effect
1.2.4 Self-sufficiency in growth signals [D]
1.2.4.1 Proto-oncogenes, oncogenes,
oncoproteins
1.2.4.2 Growth factors and growth factor
receptors
1.2.4.3 Signal-transducing proteins
1.2.4.4 Transcription factors
1.2.4.5 DNA repair defects and genomic
instability
1.2.5 Insensitivity to growth inhibition [D]
1.2.5.1 Tumour suppressor genes
1.2.5.2 Evasion of apoptosis
1.2.5.3 DNA repair defects and genomic
instability
1.2.5.4 Limitless replicative potential:
telomerase
1.2.6 Stromal microenvironment [G]
1.2.7 Mechanisms of invasion and metastasis [D]
1.2.8 Sustained angiogenesis [G]
1.3 Mechanisms of cell death
1.3.1 Apoptosis (in normal and tumour cells,
morphological and biochemical features,
molecular pathway leading to apoptosis
e.g. Bcl-2, p53-dependent and independent
pathways, ceramide) [G]
1.3.2 M
itotic death (types, cell division post
radiation and timing) [D]
1.3.3 N
ecrotic death and radiation-induced
senescence
1.3.4 O
ther modes of death e.g. autophagy,
entosis
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1.4 Tumour immunology
1.4.1 Tumour antigens
1.4.2 Anti-tumour effector mechanism
1.4.3 Immune surveillance
2Pathology of Radiation damange
in normal tissue [D]
The trainee is able to discuss:
2.1 The pathogenesis and clinical manifestations
of radiation injury to normal tissues/organs
including neural tissue, skin, mucosa, bone, the
eye, thyroid, lungs, heart, bowel, kidney, liver,
testis, ovary
2.2 The concept of tolerance dose (including TD5/5
and TD 50/5) for specific tissues/organs
2.3 Patient related factors that affect normal tissue
damage from radiation
3Introduction to Clinicopathological
Integration [G]
The trainee is able to describe:
3.1 The role of a pathologist in the multidisciplinary
team, including within the laboratory
3.2 The general principles of laboratory diagnosis of
malignancy
3.2.1 Biopsy methods
3.2.2 Handling of specimens
3.2.3 Histological analysis
3.2.3.1 Grading systems
3.2.3.2 Immunohistochemistry
3.2.4 Serum tumour markers
3.3 Staging and classification systems
3.3.1 TNM general principles and terminology
3.3.2 Commonly applied staging/ classification
systems
3.4 How to interpret a pathology report including
pathological prognostic factors
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4 Pathology of Specific Cancers [D]
For each tumour site and type listed in the Medical Expert
Table or in the Medical Expert Supplements, the trainee is
able to describe and discuss its:
4.1 Epidemiology (population statistics)
4.1.1 Incidence (in population)
4.1.2 Age (of onset)
4.1.3 Gender predilection
4.1.4 Geographical distribution
4.2 Aetiology (individual causative factors) and
pathogenesis
4.2.1 Genetic/Chromosomal abnormalities
4.2.2 Environmental
4.2.3 Nonhereditary predisposing conditions
4.2.4 Associated familial cancer syndromes
4.3 Natural History
4.3.1 Precursor lesions
4.3.2 Field effect
4.3.3 Patterns of spread and biological
behaviour
4.4 Clinical Presentation
4.4.1 Common symptoms and signs (link to
pathology)
4.4.2 Effects of the tumour on the host
4.4.2.1 Paraneoplastic syndromes
4.4.2.2 Cancer cachexia
4.4.2.3 L ocal effects e.g. destructions of
adjacent tissues, obstruction or
compressions of hollow structures
4.4.2.4 Hormonal effects
4.4.3 Characteristic imaging findings (link
to pathology)
4.5 Laboratory diagnosis of malignancy
4.5.1 M
acroscopic appearance and
growth patterns
4.5.2 M
icroscopic appearance and
growth patterns
4.5.2.1 Histological subtypes and
classification
4.5.2.2 L ink to predicted biological
behaviour
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4.5.2.3 Laboratory methods, including
frozen section analysis and electron
microscopy [G]
4.5.2.4 Characteristic cellular appearance
and architecture
4.5.2.5 Grading systems
4.5.2.6 Immunohistochemistry
4.5.2.7 Molecular techniques, chromosomal
changes, flow cytometry
4.5.2.8 Uncertainty in microscopic diagnosis
4.5.3 Normal histology and structure of tissue
of origin i.e. distinguish normal from
pathological areas
4.5.4 Differential diagnosis i.e. other histologies
to consider in relation to anatomical
location
4.6 Staging and classification systems [D]
4.6.1 TNM principles and terminology
4.6.2 Commonly applied staging systems
4.6.3 Commonly applied classification systems
5Advanced Clinicopathological
Integration [D]
The trainee is able to:
5.1 Discuss the relationship between histological
features, classification systems, grading systems,
staging systems and predicted biological
behaviour
5.2 Discuss the patient and tumour factors that
influence tumour and normal tissue (toxicity)
outcomes
5.3 Evaluate blood test results
5.3.1 Anaemia
5.3.2 Electrolyte disturbance
5.3.3 Liver enzyme abnormalities
5.3.4 Thromboembolic abnormalities
5.3.5 Tumour markers
5.4 Evaluate the optimal methods of obtaining a
diagnosis of malignancy [G]
5.4.1 Biopsy methods – advantages and
disadvantages for various types of cancer
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PHASE 2
5.5 Work with pathologists as part of the
multidisciplinary team
5.5.1 D
escribe the role of pathologists in the
cancer management team
5.5.2 C
ommunicate effectively with pathologists
regarding the pathological features that
may influence diagnosis and treatment
5.5.3 D
iscuss how to interpret a pathology
report including pathologic prognostic and
predictive factors
5.5.4 E valuate the advantages and
disadvantages of synoptic reporting
5.5.5 D
iscuss when second review of pathology
specimen may be appropriate
5.6 D
iscuss the difficulties and uncertainties of
pathological diagnosis
Page 38
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1Establishing a diagnosis and
management plan
As part of the process of arriving at and instituting an
optimal plan for individualised patient management, the
trainee is able to:
1.1 Assess the patient and the cancer
1.1.1 Obtain adequate information from the
patient (history and physical examination)
and relevant others to determine the
probable diagnosis, the extent of the
disease, other co-morbid conditions and
other physical factors influencing decision
making e.g. pregnancy
1.1.2 Identify and explore the patient’s issues,
concerns and beliefs within the scope of a
focussed consultation
1.1.3 Select and interpret investigations
1.2 D
emonstrate an understanding of the TNM
staging system and other commonly used
disease-specific staging systems. Demonstrate
knowledge of the specific TNM criteria used for
cancer sites deemed as major focus within the
MES Table (pg 42)
1.3 S ynthesise and justify treatment options based
on current evidence, multidisciplinary advice
and relevant patient-related factors including
treatment intent
1.4 D
iscuss with the patient (and others e.g. family)
the natural history of the disease, prognosis,
treatment options and recommendations, and
devise a mutually agreed management plan
(which may include situations where no anticancer treatment is involved)
1.5 E valuate patients for referral to other specialists
(e.g. palliative care physician), and allied health
professionals (e.g. dietician, clinical psychologist)
1.6 Adopt a holistic approach to care of the patient’s
physical, psychological and cultural needs
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
In relation to the process of delivery of treatment and
follow-up of patients undergoing management of cancer
(and other relevant diseases), the learning outcomes
pertaining to each management area are listed in
Sections 2 to 5.
2Where radiation therapy is part
of the management plan
The trainee is able to:
2.1 General
2.1.1 Describe the radiophysical and biological
advantages, disadvantages and limitations
of all radiation therapy modalities relative
to each other for clinical treatment
2.1.2 Describe the quality assurance and safety
issues of therapeutic radiation
2.1.3 Justify the intent of radiation treatment
(e.g. cure, local control, prolongation of
life, symptom palliation) and explain the
rationale of sequencing of the treatment in
relation to other treatment modalities
2.1.4 Arrange referrals prior to treatment (e.g.
dentist, audiology, sperm bank)
2.1.5 Select modality(ies) of treatment relevant
to the patient
2.1.6 Prescribe and supervise treatment
2.1.7 Describe the potential acute and late
radiation toxicity associated with any
given treatment plan
2.1.8 Explain, where relevant, how treatment
decisions have been modified in relation to
the pregnant patient
The trainee is able to:
2.2 External beam (kilovoltage and megavoltage)
2.2.1 Supervise the patient treatment planning
process, in particular to:
2.2.1.1 Justify appropriate patient
positioning including use of any
immobilisation, positioning or
shielding devices
2.2.1.2 Choose an appropriate mode of
simulation and where relevant use
contrast media and/or markers that
may aid in planning
2.2.1.3 Describe and use imaging modalities
that may be employed by treatment
planning systems, including
image fusion
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RADIATION ONCOLOGY
CENTRAL KNOWLEDGE AND
SKILLS SUMMARY (ROCKSS)
2.2.1.4 Review relevant histopathology,
surgical reports and imaging, and
use the information to devise an
appropriate GTV/CTV/PTV/ITV or
field size and identify relevant
organs at risk
2.2.1.5 Define the target volumes to receive
specific doses e.g. for intensitymodulated radiation therapy
2.2.1.6 Consider the likely treatment field
arrangement and the need for build
up material or beam modifiers
2.2.1.7 Communicate the above information
to the radiation therapists involved
in simulating and planning the
patient
2.2.2 Prescribe a course of radiation treatment
and in doing so:
2.2.2.1 Choose beam type and energy;
where relevant choose Focus Skin
Distance (FSD) and beam filter
2.2.2.2 Decide on reference dose, dose per
fraction, number of fractions, and
overall treatment time
2.2.2.3 Determine the optimal sequencing
and timing of external beam therapy
in relation to other treatments and
interventions, particularly surgery,
chemotherapy and brachytherapy
2.2.2.4 Specify tolerance dose of any organs
at risk
2.2.2.5 Select, justify and approve the
final treatment plan; central to this
process is the ability to critically
appraise treatment plans
2.2.3 Supervise a course of radiation treatment
including:
2.2.3.1 Verification of treatment e.g. attend
first treatment set-up, review portal
images, image-guided radiation
therapy
2.2.3.2 Review of patient during treatment;
management of acute toxicities
and radiobiological differences between
manual loading, LDR after-loading and
HDR after-loading methods
2.3.3 Explain, and demonstrate selection of,
the target volumes for brachytherapy
treatments
2.3.4 Explain the techniques of intracavitary,
surface and interstitial brachytherapy,
including quality assurance and safety
checks
2.3.5 List and justify the steps in preparation for
brachytherapy treatment, including patient
set-up, sedation if required, management
during the implantation period and
radiation protection issues
2.3.6 Explain, compare and contrast the
different methods of dose prescription for
brachytherapy
2.3.7 Select and justify the dose prescription
for brachytherapy treatments and dose
limitations to relevant normal tissues
2.3.8 Apply relevant ICRU reporting principles to
brachytherapy
2.3.9 Evaluate historical and contemporary
results of brachytherapy treatments in
terms of tumour control and toxicities
The trainee is able to:
2.4 Radio-isotope therapy
2.4.1 List the common clinical applications
of radio-isotope therapy and provide
evidence for their efficacy
2.4.2 Describe the techniques of radio-isotope
administration and explain the importance
of radiation protection for unsealed
sources
2.4.3 Select suitable patients for isotopes
including criteria for their safe use (e.g.
skeletal load and blood count thresholds
for Strontium-89 and Samarium-153)
2.4.4 Discuss the expected outcomes from
radioisotope therapy
2.4.5 Describe potential toxicities of isotope
treatment and their management
The trainee is able to:
2.3 Brachytherapy
2.3.1 List the clinical applications of
intracavitary, surface and interstitial
brachytherapy
2.3.2 D
escribe and explain the physical, logistic
Page 40
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
The trainee is able to:
3.1 E valuate the role of surgery in diagnosis
and staging
3.2 Describe the principles of cancer surgery
4.6 Demonstrate understanding and experience in
the management of patients undergoing systemic
therapy with, or without, concurrent radiation
therapy
4.7 Explain, where relevant, how treatment decisions
have been modified in relation to the pregnant
patient
3.3 List common complications of cancer surgery in
the curative and palliative settings
5Outcomes, continuing care and
palliative care
3.4 Evaluate appropriate surgical options and
understand the impact on individual patients
3.5 Describe the rationale of sequencing of surgery in
relation to other treatment modalities
The trainee is able to:
5.1 Quantify the expected benefits (e.g. overall
survival, local control, prolongation of life,
symptom control) and detriments (e.g. reduced
QoL) arising from the initial management plan
3.6 Evaluate the impact of surgical procedures on
radiation planning and delivery for individual
patients
3.7 Explain, where relevant, how treatment decisions
have been modified in relation to the pregnant
patient
4Where systemic therapy
(chemotherapy, hormonal therapy,
biological agents) may be part of
the management plan
The trainee is able to:
4.1 D
escribe the principles of systemic therapy
use and toxicity (acute and late effects) in the
curative and palliative setting
4.2 D
escribe common disease-specific systemic
therapeutic regimens used in the neoadjuvant,
concurrent, adjuvant and palliative setting
4.3 D
escribe the rationale of sequencing of systemic
therapy in relation to other treatment modalities
4.4 D
iscuss with the patient the role and implications
of concurrent systemic therapy and radiation
therapy in a management plan
4.5 E valuate the interaction between systemic
therapy and radiation in radiation therapy
planning and delivery for individual patients
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
5.2 Devise and justify a suitable follow-up program
after radiation therapy has been completed
5.3 Re-evaluate the patient’s condition and disease
status on an ongoing basis
5.4 Initiate further anti-cancer treatment as required
5.5 Quantify the anticipated outcome from further
treatment, including probabilities of salvage (i.e.
cure) or symptom relief
5.6 Anticipate potential late radiation-related
morbidities; diagnose and manage those
that occur
5.7 Select and monitor patients at higher risk for
subsequent malignancies
5.8 Select patients and relatives for assessment at
familial cancer clinics
5.9 Address issues of psychosocial support through
and beyond treatment, and identify patients at
high risk of major psychological morbidity
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3Where surgery may be part of the
management plan
Table of Medical Expert Supplement Topics
Category
Major Focus
Lesser Focus
Breast
Lung and
Mediastinum
Breast Cancer
Head and Neck
Mucosal Cancers
Salivary Gland Tumours
Skin
Non-melanomatous Skin Cancer
Melanoma
Kaposi’s Sarcoma
Male Reproductive
System
Prostate Cancer
Seminoma of the Testis
Non-Seminomatous Germ Cell Tumours of
the Testis
Penile Cancer
Female Reproductive
System
Cervical Cancer
Uterine Cancer
Ovarian Cancer
Vulval Cancer
Vaginal Cancer
Gestational Trophoblastic Disease
Urinary Tract
Bladder Cancer
Kidney Cancer
Cancer of the Ureter
Non-Small Cell Lung Cancer
Small Cell Lung Cancer
Superior Vena Caval Obstruction
Mesothelioma
Tumours of the Mediastinum
Gastrointestinal Tract Oesophageal Cancer
Biliary Tract & Gall Bladder Cancers
Hepatocellular Carcinoma
Gastrointestinal Stromal Tumours
Carcinoid Tumour
Colon Cancer
Liver Metastases
Gastric Carcinoma
Pancreatic Cancer
Rectal Cancer
Anal Cancer
Central Nervous
System
Adult Glioma
Meningioma
Pituitary Tumours
Medulloblastoma
Primitive Neuroectodermal Tumour
Cerebral Metastases
Malignant Spinal Cord Compression
Ependymoma
Pineal & Germ Cell Tumours
Acoustic Neuroma
Cerebral Arteriovenous Malformations
Haematology
Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Leukaemia
Multiple Myeloma
Musculoskeletal &
Connective Tissue
Paediatric
Endocrine
Metastatic Disease
Soft Tissue Sarcoma
Bone Metastases
Primary Tumours of the Bone
Aggressive Fibromatoses
Paediatric Cancers
Thyroid Cancer
Adrenal Tumours
Metastatic Carcinoma of Unknown Primary
Site
Metastases at sites not otherwise specified
above
Non-Malignant
Clinical Oncology
Non-Malignant diseases treated with
radiation therapy
Symptom Control
Quality of Life
It is recognised that this list of topics is not exhaustive and that the Radiation Oncologist may be rarely called upon to treat
other diseases, and in these situations would base their management plan on ROCKSS.
Page 42
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
BREAST
MAJOR FOCUS
Breast Cancer44
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 43
Breast Cancer
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Known genetic mutations and associations,
including BRCA1 and BRCA2
1.1.2 H
istological typing and grading of
breast cancer
1.1.3 M
olecular subtypes of breast cancer
(breast cancer intrinsic subtypes)
1.1.4 K
nown prognostic and predictive factors
for local recurrence and distant relapse
after treatment of pre-invasive (ductal
carcinoma-in-situ) and invasive breast
cancers
1.1.5 U
se of immunohistochemistry, in-situ
hybridisation assays and micro-array
predictive testing
1.1.6 The pathological findings of inflammatory
breast cancer (T4d)
1.1.7 The impact of margins of resection on the
risk of local recurrence
1.2 Anatomy
1.2.1 P otential alterations to lymphatic drainage
following surgery
1.2.2 Anatomy of the internal mammary chain,
axilla and the interpectoral
(“Rotter’s node”)
1.2.3 Union Internationale Contre le Cancer
(International Union Against Cancer UICC) staging including an understanding
of the definition and implication of
micrometastases and isolated tumour
cells (ITC)
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 E valuate routine diagnostic tests e.g.
mammogram and ultrasound
2.3.2 S elect patients for further staging
investigations e.g. breast MRI, CT scan,
Page 44
bone scan, and PET
2.3.3 Understand the limitations that
pregnancy imposes on maternal staging
investigations
2.3.4 Ascertain when a foetus can be
safely delivered
3Management
The trainee is able to:
3.1 General [D]
3.1.1 Discuss the impact of pregnancy (on both
mother and foetus) on the management
process including delaying or embarking
on therapy based on foetal age, tumour
stage and other prognostic features
3.1.2 Explain the special psychosocial issues
relating to the pregnant patient, including
the assessment of moral, religious and
ethical beliefs regarding termination
3.1.3 Advise patients regarding fertility
management and family planning in
relation to their cancer
3.1.4 Discuss the implications of genetic
mutations e.g. BRCA1, BRCA2 and p53
mutations on local therapy
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the indications for radiation
therapy following breast conservation
surgery or mastectomy
3.2.2 Discuss the management of regional nodes
3.2.3 Discuss the role of a breast boost
3.2.4 Discuss the role and modalities of partial
breast radiation
3.2.5 Discuss altered dose fractionation
regimens including their biological basis
3.2.6 Discuss integration of radiation with
systemic therapy.
3.2.7 Discuss the use and limitations of
predictive models of loco-regional
recurrence risk after mastectomy or breast
conservation including the integration of
biomarkers. (G)
3.3 Surgery [G]
3.3.1 Describe the indications for breast
conservation, re-excision and mastectomy
for early and locally advanced breast
cancer
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.3.2 D
iscuss the role of sentinel lymph node
biopsy and axillary dissection
3.3.3 D
escribe the types of mastectomy and
reconstructive procedures including
sequencing with radiation and systemic
therapy
3.4 Systemic Therapy [G]
3.4.1 D
iscuss the use and sequencing of
chemotherapy in early and advanced
breast cancer
3.4.2 U
nderstand the various “generations”
of chemotherapy including their risks
and benefits
3.4.3 D
iscuss the use and sequencing of
hormonal therapy in early and advanced
breast cancer
3.4.4 D
iscuss the different types of hormonal
therapy, including ovarian ablation,
and their relative advantages and
disadvantages
3.4.5 D
iscuss the use of targeted biological
therapies, including trastuzamab and
lapatinib, and sequencing with radiation
therapy
3.4.6 D
iscuss the use and limitations of
molecular profiling tools
3.4.7 D
iscuss the use and limitations of
predictive models for systemic therapy
the breast, heart, lungs and contralateral
breast.
4.2.2 The effect of radiation therapy on the
cosmetically augmented breast
4.2.3 The effect of radiation therapy on postmastectomy breast reconstruction
4.2.4 The impact on and risks to a foetus from
surgery, radiation therapy and systemic
therapy in the situation of the pregnant
patient, and according to gestational age
4.2.5 Factors that modify lymphodema risk
5 Screening and Prevention [G]
The trainee is able to:
5.1 Discuss the role of chemoprevention
5.2 Describe the role of prophylactic surgery
including prophylactic mastectomy and
prophylactic oophorectomy
5.3 Select appropriate patients for referral to
specialist genetic clinics
5.4 Discuss the role of breast cancer screening
3.5 Other Therapies [G]
3.5.1Discuss the use of bisphosphonates and
RANK Ligand inhibitors in the setting of
breast cancer
4 Outcomes [D]
The trainee is able to discuss:
4.1 Tumour
4.1.1 The risk of relapse and typical time-course
(including range) for relapse dependent on
risk factors for failure
4.1.2 An appropriate follow-up schedule,
including imaging and the role of the
specialist versus a general practicioner in
the process
4.2 Toxicity
4.2.1 The toxicity of radiation therapy on
cutaneous and subcutaneous tissues of
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 45
ROCKKS
AND MES
Page 46
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
LUNG AND MEDIASTINUM
MAJOR FOCUS
Non-Small Cell Lung Cancer48
Small Cell Lung Cancer49
Superior Vena Caval Obstruction 50
LESSER FOCUS
Mesothelioma50
Tumours of the Mediastinum51
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 47
Non-Small Cell Lung Cancer
(NSCLC)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Changing incidence of lung cancer
1.1.2 WHO histological classification of
malignant epithelial lung tumours
1.1.3 The 2011 IASLC/ATS/ERS revision of
the WHO classification system for
adenocarcinomas
1.1.4 R
elevance of epidermal growth factor
(EGF) receptor over expression
1.2 Anatomy
1.2.1 Nodal stations of the mediastinum
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 D
escribe the factors which influence
treatment choice (eg weight loss and
respiratory function)
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 S elect suitable tests and staging
investigations
2.3.1.1 Conventional radiology and
PET scanning
2.3.1.2 Invasive procedures e.g.
bronchoscopy, endobronchial
ultrasound, mediastinoscopy, and
video-assisted thoracoscopic surgery
(VATS)
2.3.1.3 R
espiratory function test and their
impact on treatment choice
3Management
The trainee is able to:
3.1 General [G]
3.1.1 D
iscuss the role of allied health in
optimising treatment outcomes (eg
dietitician assessment)
Page 48
3.2 Radiation Therapy [D and I]
3.2.1 Select patients for curative intent or
palliative intent radiation therapy
3.2.2 Describe the rationale and indications for
postoperative or preoperative radiation
therapy
3.2.3 Evaluate the use of elective nodal
irradiation
3.2.4 Evaluate the role of different dose and
fractionation schedules (e.g. CHART) for
potentially curative or palliative radiation
therapy
3.2.5 Describe the technique of thoracic
radiation therapy, including a discussion of
target volume definitions
3.2.6 Describe techniques which can optimise
tumour volume delineation
3.2.7 Describe methods for evaluating and
accounting for tumour motion.
3.2.8 Select patients for endobronchial
brachytherapy
3.3 Surgery [G]
3.3.1 Discuss the indications for and evaluate
surgical options including wedge resection,
lobectomy and pneumonectomy
3.3.2 Describe the indications for systematic
mediastinal node dissection
3.3.3 Describe the indications for bronchoscopic
laser resection and stents
3.4 Systemic Therapy [G]
3.4.1 Discuss the use of adjuvant chemotherapy,
following definitive local treatment
3.4.2 Discuss the use of neo-adjuvant
chemotherapy
3.4.3 Select patients for concurrent
chemo-radiation
3.4.4 Discuss the commonly employed
chemotherapy regimens used in
neoadjuvant, concurrent and adjuvant
settings.
3.5 Other Therapies [G]
3.5.1 Describe the clinical use of molecularly
targeted therapies.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4 Outcome [D]
4.2 Toxicity
4.2.1 Describe the acute and late toxicities of
radiation therapy and how to manage
them
4.2.2 Explain how and why toxicities
are affected by different radiation
fractionation protocols e.g. patients
on CHART
4.2.3 D
escribe the additional toxicity when using
concurrent systemic therapy
5 Screening and Prevention [G]
The trainee is able to:
5.1 D
escribe the impact of community-based
programs (especially smoking cessation) and
clinical trials to reduce the incidence of lung
cancer
5.2 Evaluate the evidence for lung cancer screening
Small Cell Lung Cancer (SCLC)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Veterans Affairs Lung Study Group (VALSG)
staging system and its advantages and
disadvantages compared with the TNM
staging system
1.1.2 Relationship of SCLC to other
neuroendocrine tumours
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Describe the presenting symptoms and
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Select suitable investigations to diagnose
and stage the disease
2.3.2 Assess relevant prognostic factors for
survival and suitability for radical or
combined modality treatment
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the use and timing of thoracic
radiation therapy in limited and extensive
presentations of SCLC
3.2.2 Evaluate the relative benefits of different
dose and fractionation schedules for the
treatment of thoracic disease
3.2.3 Describe the technique of thoracic
radiation therapy, including a discussion of
the clinical target volume
3.2.4 Discuss the role of prophylactic cranial
irradiation in limited and extensive
presentations of SCLC
3.2.5 Describe the technique of prophylactic
cranial irradiation, including a discussion
of dose
3.2.6 Discuss palliative radiation therapy in SCLC
3.3 Surgery [G]
3.3.1 Discuss the limited use of surgery in SCLC
3.4 Systemic Therapy [G]
3.4.1 Discuss the integration of concomitant
chemotherapy and radiation therapy and
the compatibility of the common regimens
with radiation.
3.5 Other Therapies [G]
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
Page 49
ROCKKS
AND MES
The trainee is able to:
4.1 Tumour
4.1.1 Describe the likelihood of different
symptoms (e.g. cough, haemoptysis)
responding to palliative radiation therapy
to the primary tumour
signs of SCLC, and contrast these
with NSCLC
4.1.1 C
ontrast radical (survival) and palliative
approaches (symptom control, quality of
life, and brain metastasis-free survival)
2.3.1 Select and evaluate the timing and method
of biopsy
3Management
4.2 Toxicity
4.2.1 D
iscuss the acute and late complications
of thoracic radiation therapy and how to
manage them
4.2.2 D
iscuss the sequelae of prophylactic
cranial irradiation
5 Screening and Prevention [G]
The trainee is able to discuss the:
5.1 B
enefits of smoking cessation as a preventive
measure and to increase therapeutic response in
established disease
Superior Vena Caval Obstruction
(SVCO)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 C
ommon and uncommon histologies
associated with presentation of SVCO;
including lung cancers, lymphoma,
thymoma and germ cell tumours
1.1.2 D
ifferences in presentation of primary
disease versus metastatic spread
1.2 Anatomy
1.2.1 Relationship of surrounding structures
1.2.2 B
ony landmarks relevant to the
mediastinal region
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 E licit symptoms of SVCO
2.1.2 E licit symptoms of underlying malignancy
2.2 Physical Examination
2.2.1 D
iscuss signs of SVCO and to distinguish
rapid versus slower development of SVCO
2.3 Investigation and Evaluation [S]
Page 50
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy[D and I]
3.2.1 Discuss options for patient positioning
e.g. the treatment of severely dyspnoeic
patients
3.2.2 Describe methods of delineation of the
target volume where CT is not possible
3.3 Surgery [G]
3.3.1 Evaluate the indications for stenting
3.3.2 Explain the role of open biopsy
3.4 Systemic Therapy [G]
3.4.1 Discuss the indications for initial
chemotherapy as an alternative to initial
radiation therapy
3.4.2 Describe the role of chemotherapy in
conjunction with radiation therapy in the
curative and palliative settings, including
consideration of sequencing and timing
3.5 Other Therapies [D]
3.5.1 Discuss the use of oxygen, corticosteroids
and analgesia as supportive measures
4 Outcomes [D]
4.1 Tumour
4.2 Toxicity
Mesothelioma
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The importance of asbestos in aetiology
1.1.2 Subtypes, classification and
immunohistochemistry
1.2 Anatomy
1.2.1 Extent of pleural lining in hemithorax
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Tumours of the Mediastinum
2.1 History
2.2 Physical Examination
Note: topics that overlap with this category are covered
in other sections e.g. lymphoma, germ cell tumour, and
carcinoid
2.3 Investigation and Evaluation
1 Oncology Sciences [D]
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the place of radiation therapy
in the definitive management of
mesothelioma
3.2.2 Discuss the place of radiation therapy in
the adjuvant setting, following extrapleural
pneumonectomy
3.2.3 Discuss the use of radiation therapy
in preventing or treating needle tract
recurrence after thoracoscopy/thoracotomy
3.2.4 Discuss the use of radiation therapy in the
palliative setting
3.3 Surgery [G]
3.3.1 Describe the indications for, and surgical
techniques of:
3.3.1.1 Pleurodesis
3.3.1.2 Pleurectomy
3.3.1.3 Extrapleural pneumonectomy
3 Outcomes [D]
The trainee is able to discuss the:
3.1 Tumour
3.1.1 Changing patterns of disease relapse with
improved local treatment
The trainee is able to describe the:
1.1 Pathology
1.1.1 Common histologies in relation to
anatomical location
1.1.2 Spectrum of thymus tumours: thymoma
through to thymic carcinoma
(WHO classification)
1.1.3 Masaoka staging system for thymic
epithelial tumours
1.2 Anatomy
1.2.1 Division of the mediastinum and the
structures within
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Recognise the association between
paraneoplastic disorders (eg myasthenia
gravis) and thymoma
2.2 Physical Examination
2.2.1 Describe the symptoms and signs occurring
as a result of compression of mediastinal
structures.
2.3 Investigation and Evaluation
2.3.1 Select suitable diagnostic tests: chest x-ray,
CT, mediastinoscopy, and MIBG
2.3.2 Assess suitability for treatment, including
assessing lung function
3.2 Toxicity
4 Screening and Prevention [G]
The trainee is able to discuss the:
4.1 Utility of surveillance imaging in the at-risk group
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the indications for radiation
therapy
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 51
ROCKKS
AND MES
2 Clinical assessment [D and I]
3.3 Surgery [G]
3.3.1 D
iscuss the role of surgery, especially
thymic tumours
3.3.2 D
escribe the importance of the extent
of resection
3.4 Systemic Therapy [G]
3.4.1 D
iscuss the role of chemotherapy in the
neoadjuvant, concurrent or adjuvant
setting.
3.4.2 D
iscuss the role of chemotherapy for
metastatic disease
3.5 Other Therapies [G]
3.5.1 D
iscuss the role of octreotide in the
management of thymic tumours
4 Outcomes [D]
The trainee is able to discuss the:
4.1 Tumour
4.1.1 Impact of local therapy on the symptoms
of paraneoplastic syndrome
4.1.2 The need for prolonged follow-up, to
detect late relapses.
4.2 Toxicity
4.2.1 Morbidity of surgery
Page 52
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
HEAD AND NECK
MAJOR FOCUS
Mucosal Cancers54
Salivary Gland Tumours54
Specific Head and Neck Cancer Sites
55
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 53
Mucosal Cancers and
Salivary Gland Tumours
The important common features of these tumours are
outlined below. Following the general headings are
specific features relating to individual sites.
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 M
acroscopic features of a tumour (i.e.
exophytic versus endophytic) and the
implications for choice of treatment
modality
1.1.2 C
ausal factors/pathogenesis especially the
role of HPV 16 and its impact on prognosis
1.1.3 Implications of EGFR over-expression in
mucosal squamous cell carcinoma (SCC)
1.1.4 Importance of field change, precursors,
risk factors and the incidence of multiple
primaries
1.2 Anatomy
1.2.1 P athway of each of the cranial nerves, and
demonstrate an understanding of how this
anatomy impacts on the various treatment
techniques used to treat head and neck
cancer
1.2.2 D
efine the location of the brachial plexus
on CT and MRI
1.2.3 L ymph node stations and levels including
an awareness of the typical subsites
which drain to each lymph node level and
laterality of drainage.
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 General
2.1.1 D
escribe the relevance of synchronous
primaries occurring in the aerodigestive
tract
2.2 History
2.2.1 E licit the history of referred pain
e.g. otalgia
2.3 Physical examination
2.3.1 Perform nasoendoscopy and indirect
laryngoscopy
Page 54
2.3.2 Elicit signs of cranial nerve palsies
2.3.3 Assess a patient for impending airway
obstruction
2.3.4 Elicit signs of trismus and understand its
significance
2.4 Investigation and evaluation
2.4.1 Discuss the limitations of CT imaging for
staging head and neck malignancies and
the role of MRI and PET imaging
2.4.2 Synthesise panendoscopy, biopsy and
operative reports including assessment
of factors (e.g. number and size of
involved nodes, presence of extracapsular
extension) that impact on radiation
therapy recommendation
2.4.3 Describe the importance of pre-treatment
dental assessment and select patients for
dental referral
3Management
The trainee is able to:
3.1 General [G]
3.1.1 Understand the importance of
pre-treatment multidisciplinary team
assessment, including dietician and speech
therapist
3.1.2 Understand the diagnostic workup of
metastatic SCC of unknown primary
origin involving the neck (eg the role of
PET, EUA and biopsy). Understand the
different management paths for each of
the possible mucosal primary sites and
the rationale for comprehensive RT (ie all
potential primary sites and bilateral neck
nodes) in unknown primary of presumed
mucosal origin.
3.2 Radiation Therapy [D and I]
3.2.1 Select patients for definitive radiation
therapy
3.2.2 Select patients for post-operative radiation
therapy
3.2.3 Discuss the indications for elective nodal
irradiation
3.2.4 Discuss the rationale and selection of
patients for altered fractionation schedules
3.2.5 List the indications for including the
tracheal stoma within the treatment field
3.2.6 Evaluate parotid-sparing techniques
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.2.7 S elect patients suitable for brachytherapy
3.2.8 D
iscuss the role and risks of re-irradiation
(including brachytherapy) for local
recurrence
3.3 Surgery [G]
3.3.1 D
iscuss the types of neck dissection
and the implications for post-operative
radiation therapy techniques
3.3.2 D
iscuss the use of a planned neck
dissection after radiation therapy
3.3.3 Discuss the role of salvage surgery
3.3.4 D
escribe the impact of definitive surgical
procedures on anatomical function, quality
of life and cosmesis
3.4 Systemic Therapy [G]
3.4.1 D
iscuss the evidence for combined chemoradiation in the definitive and adjuvant
settings
3.4.2 D
efine the risks associated with combined
chemo-radiation and discuss ways to
support a patient through chemo-radiation
to avoid breaks in treatment
3.5 Other Therapies [G]
3.5.1 D
iscuss the role of biological modifiers e.g.
EGFR inhibitors and anti-hypoxic agents
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Discuss the radiobiological concepts
underlying the effect of extending overall
treatment time on tumour control
4.1.2 Discuss the impact on tumour control (and
toxicity) of continued smoking during
treatment
4.2 Toxicity
4.2.1 Describe the potential acute and late
RT-related toxicities and the management
of these.
4.2.2 Manage mucositis with allied health team
4.2.3 S elect patients for Percutaneous
Endoscopic Gastrostomy (PEG) insertion
4.2.4 Describe the management of xerostomia
4.2.5 L ist the risk factors for development and
management of osteoradionecrosis of
the jaw
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
5 Screening and Prevention [G]
The trainee is able to discuss:
5.1 Anti-smoking advice aimed at individuals
and the community
ROCKKS
AND MES
Specific Head and Neck
cancer sites: [D]
A Nasal Cavity and Paranasal Sinuses
The trainee is able to:
A.1 Pathology
A.1.1 Describe the prognostic significance
and natural history of less common
histologies such as sinonasal
undifferentiated tumours, adenoid cystic
carcinomas, inverted papilllomas and
esthesioneuroblastoma
A.1.2 Assess and understand the prognostic
significance of intracranial extension
A.2 Anatomy
A.2.1 Identify and describe the paranasal
subsites.
A.3 Management
A.3.1 List the indications for orbital exenteration
A.3.2 Describe dental prostheses e.g. obturator
A.3.3 Describe ocular-sparing radiation
techniques
A.4 Outcomes
A.4.1 Minimise and manage acute and late
ocular toxicities
BNasopharynx
B.1 Pathology
B.1.1 L ist the endemic areas and discuss the
associated dietary and viral aetiological
factors
B.1.2 Describe the WHO classification system
B.1.3 D
escribe the natural history with regard
to nodal and distant metastases
B.1.4 D
escribe features and the natural history
of angiofibromas
B.2 Anatomy
B.2.1 D
escribe the boundaries of the
nasopharynx
Page 55
B.3 Management
B.3.1 D
iscuss the role of brachytherapy in
boosting the primary tumour and in the
setting of recurrence
D.3.3 D
iscuss the functional impact and quality
of life implications for partial and total
glossectomy
EHypopharynx
B.4 Outcomes
B.4.1 Assess the risk of and manage late
effects to the temporal lobe and hearing
apparatus
E.1 Anatomy
E.1.1 List the subsites of the hypopharynx and
describe the anatomical boundaries of the
pyriform fossa
CLarynx
C.1 Anatomy
C.1.1 D
escribe the subsites of the larynx and the
components of each
C.2 Physical examination
C.2.1 Assess for supra- and sub-glottic
extension and thyroid cartilage
involvement subite.
C.3 Management
C.3.1 Compare and contrast treatment outcomes
of radiation, surgery and endoscopic laser
resection; in particular for functional
outcome and cure
C.3.2 Describe the potential complications of
supraglottic laryngectomy with or without
adjuvant radiation
E.2 Physical Examination and Investigations
E.2.1 Assess the patient for involvement of
the posterior pharyngeal wall and for
retropharyngeal node involvement
E.3 Management
E.3.1 Radiation Therapy
E.3.1.1 Discuss the importance of neck and
shoulder positioning
E.3.1.2 Discuss the indications and the
treatment techniques available for
including the superior mediastinum
E.3.2 Surgery
E.3.2.1 List the indications for
pharyngolaryngectomy and the
surgical options for reconstruction
F Salivary Gland Tumours
D Oral Cavity and Oropharynx
D.1 Anatomy
D.1.1 L ist the subsites of the oral cavity and
oropharynx
D.1.2 D
escribe the vascular supply of the
tongue and the implications for surgical
management
D.2 Physical Examination and Investigations
D.2.1 Assess the patient for involvement of the
pharyngeal wall and for retropharyngeal
node involvement
D.3 Management
D.3.1 D
iscuss the treatment implications of
involvement of the mandible
D.3.2 C
ompare and contrast the functional and
cosmetic results of surgery versus the
morbidity of radiation therapy for early
oral cavity tumours
Page 56
F.1 Pathology
F.1.1 D
escribe the prognostic significance and
natural history of less common histologies
such as pleomorphic adenomas, Warthins
tumours, mucoepidermoid carcinomas,
acinic cell carcinomas and adenoid cystic
carcinomas
F.2 Management
F.2.1 D
iscuss the implications of perineural
invasion or adenoid cystic pathology on
radiation treatment fields
F.2.2 D
iscuss the positioning techniques and
beam arrangements needed to minimise
dose to the contralateral eye in parotid
treatment
F.2.3 C
ontrast the management of primary and
secondary tumours in the parotid
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
SKIN
MAJOR FOCUS
Non Melanomatous Skin Cancer
58
Melanoma59
LESSER FOCUS
Kaposi’s Sarcoma59
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 57
Non Melanomatous Skin Cancer
(including Merkel Cell Carcinoma)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Importance of Gorlin’s syndrome, albinism
and racial susceptibility
1.1.2 R
ole of UV exposure and topical
carcinogens
1.1.3 E ffect of immunosuppression e.g.
transplant patients
1.2 Anatomy
1.2.1 C
ranial nerve pathways that might be
affected by perineural spread
1.2.2 Lymph node drainage
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 R
ecognise the patient factors (age,
comorbidities) and tumour factors
(stage, site) which may impact on
treatment decision making
2.2 Physical Examination
2.2.1 R
ecognise the clinical appearance of BCC,
SCC, IEC and Merkel cell carcinoma
2.2.2 Accurately assess tumour extent
2.3 Investigation and Evaluation
2.3.1 S elect suitable means of obtaining
histological diagnosis e.g. excision versus
incisional biopsy/shave biopsy
2.3.2 D
iscuss indications and rationale for
imaging the primary tumour or draining
lymph nodes
3Management
The trainee is able to:
3.1 General
3.1.1 D
emonstrate a sound understanding of
surgical and non surgical treatments for
skin cancer [G]
Page 58
3.2 Radiation Therapy [D and I]
3.2.1 Evaluate the relative merits of definitive
treatment with radiation therapy versus
surgery
3.2.2 Select and explain the use of various
treatment modalities and techniques e.g.
electrons, superficial/orthovoltage photons,
and megavoltage photons
3.2.3 Identify indications for post-operative
radiation therapy to primary site
3.2.4 Identify indications for radiation therapy to
draining nodal regions
3.3 Surgery [G]
3.3.1 Discuss the indication for, and possible
complications of, the various skin surgical
techniques including split skin grafts, flap
repair, lymph node dissection and Moh’s
technique
3.4 Systemic Therapy [G]
3.4.1 Discuss the uses of chemotherapy in the
management of Merkel cell carcinoma
3.5 Other Therapies [G]
3.5.1 Explain the role of immunotherapy, Photo
dynamic Therapy, laser and cryotherapy
3.5.2 Discuss the role of topical agents
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Recognise the variable response rates of
different tumour types to ionizing radiation
4.2 Toxicity
4.2.1 Recognise factors that influence the
development of late effects, including the
expected cosmetic outcome
5 Screening and Prevention [G]
The trainee is able to:
5.1 Explain principles of prevention
5.1.1 Identifying people with genetic
predisposition
5.1.2 Individual and community education
on UV protection
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Growth patterns and histological subtypes
1.1.2 Natural history of non-cutaneous sites of
melanoma e.g. ocular, mucosal
1.2 Anatomy
1.2.1 Lymphatic drainage of regions of the skin
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Discuss relative benefits of PET, MRI and
CT in staging assessment
3.4 Systemic Therapy [G]
3.4.1 Describe the indications for, and possible
benefits of, regional chemotherapy
3.4.2 Discuss the indications for, and possible
benefits of, immunotherapy (e.g.
interferon) and molecularly targeted
biological therapies
3.5 Other therapy [G]
4 Outcomes [D]
4.1 Tumour
4.2 Toxicity
5 Screening and Prevention [G]
The trainee is able to:
5.1 Advise individuals and the community regarding
effective skin protection from UV radiation
Kaposi’s Sarcoma
3Management
1 Oncology Sciences [D]
The trainee is able to:
3.1 General [G]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Four epidemiological subtypes
1.1.2 Differentiation from angiosarcoma
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the use of post-operative radiation
therapy to the primary site and nodal
regions
3.2.2 Discuss the use of radiation therapy in
the management of locally advanced,
recurrent, in-transit, and metastatic
disease
3.3 Surgery [G]
3.3.1 Describe the importance of excision
margins
3.3.2 Describe the role of surgery in the
management of nodal disease, including
the place of sentinel node biopsy
3.3.3 Describe the role of surgery in the
management of locally recurrent, in-transit
and metastatic disease
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Elicit a history of risk factors for Kaposi’s
sarcoma
2.2 Physical Examination
Recognise the clinical appearance of KS and
the typical anatomical sites of origin
2.3 Investigation and Evaluation
Page 59
ROCKKS
AND MES
Melanoma
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 D
iscuss radiosensitivity, suitable range of
radiation doses, fractionation schedules
and techniques for treatment e.g.
superficial x-ray therapy (SXRT) and
electrons for solitary superficial lesions;
megavoltage photons for lesions covering
the majority of a limb
3.2.2 Discuss the effectiveness of re-treatment
3.3 Surgery [G]
3.3.1 D
escribe the limited role of surgery in
biopsy confirmation
3.4 Systemic Therapy [G]
3.4.1 D
iscuss the systemic treatment of lesions
refractory to radiation therapy
3.5 Other Therapies [G]
3.5.1 D
escribe other potentially effective
treatments including interferon α-2a given
subcutaneously or intra-lesionally, antiviral
treatments in HIV/AIDS patients, and
liposomal anthracyclines
4 Outcomes [D]
4.1 Tumour
4.1.1 R
ecognise the appearance of KS post
treatment (pigmentation commonly
retained)
4.2 Toxicity
4.2.1 B
e aware of increased mucosal toxicity
from radiotherapy in HIV related KS.
Page 60
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
MALE REPRODUCTIVE SYSTEM
MAJOR FOCUS
Prostate Cancer62
Seminoma Of The Testis63
LESSER FOCUS
Non-Seminomatous Germ Cell Tumours of Testis
64
Penile Cancer65
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 61
Prostate Cancer
3Management
1 Oncology Sciences [D]
The trainee is able to:
3.1 General
3.1.1 Discuss the approach of active surveillance,
including the rationale, patient selection, a
suitable follow-up program and the factors
influencing a decision to proceed with
definitive treatment [G]
3.1.2 Discuss appropriate treatment options for
low-, intermediate- and high risk prostate
cancer [D]
3.1.3 Define biochemical relapse
following surgery and
radiotherapy/brachytherapy [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 P SA: general structure, function and use
(including free to total ratio)
1.1.2 G
leason grading and scoring and the TNM
staging system
1.1.3 R
are non-adenocarcinoma subtypes
e.g. sarcoma, neuroendocrine tumours
1.1.4 R
elevance of defining so-called
“insignificant” prostate cancers
1.2 Anatomy
1.2.1 L ocation and relations of the apex and the
neurovascular bundle
1.2.2 N
on sequential lymphatic drainage
of the prostate
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Assess urinary function, including
obstructive symptoms and continence
including the use of standard scoring
systems e.g. IPSS
2.1.2 Assess erectile function including the use
of standardised scoring systems e.g. IEFS
2.2 Physical Examination
2.2.1 C
linically stage prostate cancer using
digital rectal examination
2.3 Investigation and Evaluation
2.3.1 S elect and evaluate relevant diagnostic
tests including CT scan, bone scan and MRI
2.3.2 D
escribe prognostic factors e.g. stage,
Gleason score, PSA at presentation, PSA
doubling time, volume of disease and
number of positive biopsies, presence of
perineural invasion
2.3.3 S tratify patients into low, intermediate or
high risk
Page 62
3.2 Radiation Therapy [D and I]
3.2.1 Discuss physiological and positional
variation in target position
3.2.2 Discuss the issues associated with elective
pelvic nodal radiation, dose escalation,
IMRT and IGRT including fiducial markers
and cone beam CT
3.2.3 Discuss issues regarding adjuvant/salvage
post prostatectomy EBRT including
indications and timing of treatment
3.2.4 Discuss the selection criteria, technique
and procedure for HDR and LDR
brachytherapy
3.2.5 Describe the use of external beam
radiotherapy and radiopharmaceuticals
(e.g. strontium-89,samarium) for palliation
3.3 Surgery [D]
3.3.1 Discuss the indications and toxicity
associated with prostatic biopsy, TURP,
prostatectomy and salvage surgery
after brachytherapy or external beam
radiotherapy
3.3.2 Describe surgical techniques used in
the palliative setting e.g. trans-urethral
resection of the prostate (TURP) and
ureteric stenting
3.4 Systemic Therapy [G]
3.4.1 Discuss systemic treatment options for
castrate resistant prostate cancer including
an awareness of mechanism of action and
optimal sequencing
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4 Outcomes [D]
Collaborative Group (IGCCCG)
and Marsden systems
1.1.3 Tumour markers associated with seminoma
and their significance
1.1.4 The relevance of maldescended testes
1.1.5 Pathological prognostic factors
1.2 Anatomy
1.2.1 The drainage of testicular lymphatics to
retroperitoneum, and circumstances in
which this is disrupted
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Elicit a history including prior pelvic
surgery, testosterone deficiency, fertility
status and the intention for future children
4.1 Tumour
4.1.1 Discuss the expected outcomes for
external beam radiotherapy and brachytherapy for low-, intermediate- and
high risk prostate cancer
2.2 Physical Examination
2.3 Investigation and Evaluation
4.2 Toxicity
4.2.1 Discuss incidence and management of late
rectal, urethral and bladder toxicity.
4.2.2 Discuss the management of erectile
dysfunction
The trainee is able to:
3.1 General [G]
5 Screening and Prevention [D]
The trainee is able to:
5.1 D
iscuss the role of serum PSA measurement and
digital rectal examination as screening tools for
the early identification of patients with prostate
Seminoma of the Testis
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 Pathological classification of testicular
tumours
1.1.2 The rationale for non-TNM staging systems
e.g. International Germ Cell Cancer
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3Management
3.2 Radiation Therapy [D and I]
3.2.1 Select patients suitable for adjuvant or
definitive radiation treatment to lymph
node groups (stages I and II) and palliative
treatment
3.2.2 Describe rationale for selecting para-aortic
or para-aortic plus pelvic (dog-leg) nodal
irradiation as well as an appropriate dosefractionation schedule
3.2.3 Discuss the potential and historical
indications for hemi-scrotal irradiation
3.2.4 Discuss the indications for radiation
therapy in the situation of postchemotherapy residual nodal disease
3.3 Surgery [G]
3.3.1 Discuss the approach and procedure of
radical inguinal orchidectomy
3.3.2 Discuss the risk of scrotal and nodal
recurrence resulting from trans-scrotal
incision and/or exploration
Page 63
ROCKKS
AND MES
3.5 Other Therapies
3.5.1 D
escribe the rationale, mechanism of
action and indications for the use of
androgen deprivation therapy in the
neoadjuvant, adjuvant and palliative
setting including a discussion of timing
and duration of therapy [D]
3.5.2 D
escribe the potential morbidity of
androgen deprivation therapy and
appropriate management strategies [D}
3.5.3 D
escribe the rationale, mechanism of
action of and timing of bisphosphonates
and denosumab in the setting of bone
metastases [D]
3.5.4 D
escribe, in simple terms, the role of other
local treatments such as cryotherapy and
high frequency US (HiFU) [G]
3.3.3 D
iscuss the limited role of retroperitoneal
node dissection
3.4 Systemic Therapy [G]
3.4.1 E valuate the evidence for adjuvant
chemotherapy for stage I disease
3.4.2 E valuate the place of chemotherapy versus
radiation therapy for stage II disease
3.5 Other Therapies [I]
3.5.1 S elect patients suitable for a surveillance
program and discuss the relative merits
and disadvantages of this approach
3.5.2 D
escribe a suitable follow-up program for
patients opting for surveillance
4 Outcomes [D]
The trainee is able to discuss:
4.1 Tumour
4.1.1 The 5-year relapse free rates for men
with stage one seminoma managed with
surveillance, radiotherapy and single agent
chemotherapy
4.1.2 The long term risk of a contralateral
testicular tumour
4.2 Toxicity
4.2.1 The risk, management and prevention
of infertility
4.2.2 The risk, management and prevention of
testosterone deficiency
4.2.3 The evidence for and against iatrogenic
carcinogenesis and cardiovascular
morbidity in relationship to testis
cancer therapy
4.2.4 The comparative toxicities of prophylactic
radiation therapy versus chemotherapy
stage I disease
5 Screening and Prevention [G]
The trainee is able to explain:
5.1 The rationale as to why population screening is
not generally advocated
Page 64
Non-Seminomatous Germ Cell
Tumours of Testis (NSGCT)
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 Pathological classification of testicular
tumours
1.1.2 Staging systems e.g. Royal Marsden
Hospital
1.1.3 The differences between NSGCTs and
seminomas in terms of histology, natural
history, mode of spread and biological
behaviour
1.1.4 In the case of mixed tumours, which
histology should be used to determine
therapy
1.1.5 Serum tumour markers associated with
NSGCT
1.2 Anatomy
1.2.1 The drainage of lymphatics to
retroperitoneum, and circumstances in
which this is disrupted
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Elicit clinical features (e.g. prior pelvic
surgery, scrotal involvement) impacting on
patterns of potential nodal spread
2.1.2 Describe the endocrine manifestations of
testicular tumours
2.2 Physical Examination
2.2.1 Describe the clinical presentation of
extra-gonadal germ cell tumours including
retroperitoneal, mediastinal and cerebral
manifestations
2.3 Investigation and Evaluation
2.3.1 Select and interpret investigations
including tumour markers, CT scans and
PET scanning
2.3.2 Demonstrate an understanding of
the International Germ Cell Cancer
Collaborative Group (IGCCCG) staging
system and the impact on treatment
options
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4 Outcomes [D]
The trainee is able to describe:
3.1 General [G]
3.1.1 The impact of therapy (including active
surveillance) on follow-up imaging choices
and schedules
3.1.2 A suitable “surveillance” program for men
under observation for low-risk, stage I
disease, and what constitutes a low-risk
group
3.1.3 The significance and natural history of a
diagnosis of teratoma at presentation and
in a residual mass post-chemotherapy
3.1.4 The management of reduced fertility
3.1.5 The clinical use of serum tumour markers
The trainee is able to:
4.1 Tumour
4.1.1 Recognise situations at presentation
and relapse which are still amenable
to potentially curative therapy despite
widespread metastatic disease
The trainee is able to discuss:
3.2 Radiation Therapy [D and I]
3.2.1 Indications for retroperitoneal nodal
irradiation; relative benefits versus
surveillance versus chemotherapy as initial
treatment
3.2.2 The use of radiation therapy following
chemotherapy; dissection versus nodal
irradiation
3.2.3 The use of radiation therapy to metastatic
sites (e.g. brain) in potentially curative and
palliative settings
The trainee is able to:
3.3 Surgery [G]
3.3.1 Outline the approach for inguinal
orchidectomy
3.3.2 Describe the utility of contralateral
testicular biopsy
3.3.3 Describe the indications for, and the
surgical approach to, retroperitoneal
lymph node dissection
The trainee is able to:
3.4 Systemic Therapy [G]
3.4.1 D
escribe first line chemotherapy options
3.4.2 E xplain the evidence for and against the
use of high-dose chemotherapy with stem
cell rescue in the initial management
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4.2 Toxicity
4.2.1 Describe the pathophysiology and
morbidity of bleomycin-induced
pulmonary fibrosis
5 Screening and Prevention [D]
The trainee is able to discuss:
5.1 The value of self examination of the testes
5.2 With patients the risk of second testis cancer
(seminoma or NSGCT) and to give an opinion
on the value of tumour marker testing for early
diagnosis
Penile Cancer
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The importance of risk factors e.g.
phimosis, presence of foreskin and HPV
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigations and Evaluation
2.3.1 Assess degree of urethral involvement
using information from urethroscopy/
cystoscopy report
2.3.2 Radiologically assess the inguinal regions
and pelvis for nodal involvement
Page 65
ROCKKS
AND MES
3Management
3Management
The trainee is able to:
3.1 General [G]
3.1.1 D
iscuss the choice of treatment in terms
of tumour control and the preservation of
sexual and urinary function
3.1.2 D
escribe the prognostic significance of
nodal involvement
3.2 Radiation Therapy [D and I]
3.2.1 D
iscuss the role of prophylactic nodal
irradiation following the surgical treatment
of the primary lesion
3.2.2 D
iscuss the relative benefits of radiation as
definitive treatment to the primary tumour
3.2.3 D
iscuss indications for brachytherapy for
penile preservation
3.3 Surgery [G]
3.3.1 E valuate the place of sentinel node biopsy
or superficial nodal dissection for clinically
node negative patients
3.4 Systemic Therapy [G]
3.4.1 E valuate the use of chemotherapy in
locally advanced disease treated with
curative radiation therapy
3.5 Other Therapies [G]
3.5.1 E valuate the potential role for various
non-surgical techniques for in-situ disease
e.g. topical 5-flurouracil, photodynamic
therapy, and laser treatment
4 Outcomes [D]
4.1 Tumour
4.2 Toxicity
Page 66
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
FEMALE REPRODUCTIVE SYSTEM
MAJOR FOCUS
Cervical Cancer68
Uterine Cancer69
LESSER FOCUS
Ovarian Cancer69
Vulval Cancer70
Vaginal Cancer71
Gestational Trophoblastic Disease72
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 67
Cervical Cancer
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 P athogenesis, including the role of HPV
subtypes
1.1.2 S ignificance of the natural history of
cervical intraepithelial neoplasia (CIN) 1-3
1.1.3 K
nowledge of rare types of cervical cancer
such as small cell/carcinosarcoma
1.1.4 The International Federation of
Gynaecologists and Obstetricians (FIGO)
staging system
1.2 Anatomy
1.2.1 Borders and contents of the parametrium
1.2.2 P otential alterations to lymphatic drainage
following surgery
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.2.1 P erform an EUA to clinically stage cervical
cancer [S]
2.3 Investigation and Evaluation
2.3.1 L ist the relative advantages and
disadvantages of the FIGO and TNM
staging systems for cervical cancer
2.3.2 L ist the prognostic factors that influence
local control and survival in cervical cancer
e.g. anaemia, nodal positivity
2.3.3 D
iscuss the relative benefits of various
imaging modalities e.g. CT, MRI, PET
3Management
The trainee is able to:
3.1 General [D]
3.1.1 D
iscuss pre-treatment measures that may
be performed to optimise outcomes from
treatment e.g. blood transfusion, ureteric
stents
Page 68
3.1.2 Discuss the impact on management
decisions in the situation of a pregnant
patient (see Breast page 44 for detailed
learning outcomes)
3.2 Radiation Therapy [D and I]
3.2.1 Discuss timing of external beam radiation
and brachytherapy
3.2.2 Discuss selection of brachytherapy
devices [S]
3.2.3 Discuss HDR versus LDR versus PDR
brachytherapy, including procedure, dose
and fractionation
3.2.4 Apply relevant ICRU reporting principles
to brachytherapy and discuss potential
limitations
3.2.5 Discuss the issues associated with
extended field radiation therapy
3.2.6 Discuss the role of IMRT in terms of
reduction of late effects to the small bowel
3.2.7 Discuss the use of radiation in the
postoperative setting
3.3 Surgery [G]
3.3.1 Evaluate patients for definitive surgery
3.3.2 Explain the different types of surgery,
including fertility-preserving surgery
3.3.3 Describe a management plan for cervical
cancer in a pregnant woman
3.3.4 Evaluate the role of surgery following
post-radiation recurrence
3.4 Systemic Therapy [G]
3.4.1 Discuss the rationale and select patients
for concurrent chemoradiation
3.4.2 Discuss the role of adjuvant chemotherapy
and its integration with radiation therapy
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.2 Toxicity
4.2.1 Identify and manage the endocrine and
sexual morbidities of treatment e.g.
vaginal effects, menopause, and altered
body image
4.2.2 Identify and manage late small bowel
toxicity
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
The trainee is able to:
5.1 D
iscuss cervical cancer screening programs e.g.
evidence, rationale, outcomes, and structure
5.2 D
escribe the evidence, rationale and structure of
the HPV vaccine program
Uterine Cancer
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 Type 1 and Type 2 endometrial cancer
(based on microscopic appearance, clinical
behaviour, and epidemiology)
1.1.2 Grading system used for endometrioid
tumours
1.1.3 Pathological features of uterine sarcomas
1.1.4 FIGO and TNM staging
1.2 Anatomy
1.2.1 Potential anatomical route of malignant
spread transperitoneally
1.2.2 Borders and contents of parametrium
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Recognise commonly associated comorbidities (hypertension, obesity, diabetes
mellitus, and previous pelvic radiation
therapy) and their impact on management
2.2 Physical Examination
2.2.1 Perform a pelvic examination in women
under anaesthetic or as an outpatient,
including obtaining cervical smears
3Management
recurrence following pelvic surgery and the
indications for post-operative
radiation therapy
3.2.2 Detail the indications for definitive
radiation therapy including where surgery
is inappropriate
3.2.3 Describe the indications for brachytherapy
in the management of uterine cancer
3.2.4 Describe the radiobiological and physical
aspects of brachytherapy – LDR, HDR, and
PDR afterloading equipment
3.2.5 Perform brachytherapy insertions using
vaginal ovoids and vaginal applicators
3.3 Surgery [G]
3.3.1 Describe the general techniques for
surgical resection (total abdominal
hysterectomy and bilateral salpingooophorectomy – TAHBSO)
3.3.2 Describe modifications to surgical
procedures – extrafascial/radical
hysterectomy
3.3.3 Describe the indications for surgical
staging and components of the procedure
(exploration, cytology, TAHBSO, omental
biopsy and selective lymphadenectomy)
3.4 Systemic Therapy [G]
3.4.1 Discuss the role of chemotherapy (eg as an
alternative to adjuvant radiation or given
concurrently with radiation therapy)
3.5 Other Therapies [D]
3.5.1 Describe the use of hormones in uterine
cancer (provera and tamoxifen)
4 Outcomes [D]
4.1 Tumour
4.2 Toxicity
Ovarian Cancer
The trainee is able to:
3.1 General [G]
1 Oncology Sciences [D]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the prognostic factors for
The trainee is able to describe the:
1.1 Pathology
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5 Screening and Prevention [G]
1.1.1 Importance of BRCA 1 and 2 mutations
1.1.2 N
atural history of ovarian carcinoma,
borderline tumours, and germ cell tumours
4 Outcomes [D]
4.1 Tumour
1.2 Anatomy
1.2.1 D
escribe the route of transperitoneal
spread
4.2 Toxicity
2 Clinical Assessment [D and I]
The trainee is able to:
5.1 Evaluate the screening options in BRCA 1
and 2 carriers
The trainee is able to:
2.1 History
5 Screening and Prevention [G]
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 S elect and interpret suitable tests for
diagnosis and staging, including Ca125
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 D
iscuss the use of radiation therapy in
ovarian cancer
3.2.2 D
emonstrate an awareness of the
controversies surrounding the use of
whole abdominal radiation therapy
3.2.2.1 D
escribe the fields that constitute
whole abdominal radiation therapy
3.2.2.2 D
iscuss doses and normal tissue
constraints
3.3 Surgery [G]
3.3.1 D
escribe benefits of surgical staging and
second-look laparotomy
3.3.2 D
escribe advantages and disadvantages of
palliative surgical procedures
3.4 Systemic Therapy [G]
3.4.1 D
iscuss the use of chemotherapy in
ovarian cancer
3.4.2 S elect appropriate patients for adjuvant
chemotherapy (for either intravenous and/
or intraperitoneal chemotherapy)
5.2 Discuss the advantages and disadvantages of
prophylactic oophorectomy in BRCA 1 and 2
carriers
Vulval Cancer
1 Oncology Sciences [D]
The trainee is able to:
1.1 Pathology
1.1.1 Discuss the natural history of vulvar
intraepithelial neoplasia (VIN)
1.2 Anatomy
1.2.1 Describe the lymphatic drainage of
the vulva
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.2.1 Perform a clinical examination (under
anaesthetic if required [S])
2.3 Investigation and Evaluation
2.3.1 List the surgical and non-surgical
prognostic factors that influence local
control and survival in vulval cancer, e.g.
depth of invasion, lymphovascular space
invasion, nodal status, excision margins
3Management
The trainee is able to:
3.1 General [G]
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.3 Surgery [G]
3.3.1 E xplain the different types of surgery
(wide local excision, hemi-vulvectomy, and
vulvectomy)
3.3.2 S elect appropriate patients for sentinel
node biopsy or inguinal lymph node
dissection (unilateral versus bilateral) [D]
3.4 Systemic Therapy [G]
3.4.1 E valuate the use of concurrent
chemotherapy during radiation therapy for
vulval cancers
4 Outcomes [D]
The trainee is able to describe:
4.1 Tumour
4.2 Toxicity
4.2.1 Discuss the conditions that may lead to a
break during radiation therapy and their
management
4.2.2 The effect treatment has on sexual
function (vaginal effects, menopause, and
altered body image) and the available
management options
4.2.3 Lymphodema risks and management
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Vaginal Cancer
1 Oncology Sciences [D]
The trainee is able to:
1.1 Pathology
1.1.1 Discuss muliticentricity and clinical
importance
1.2 Anatomy
1.2.1 Describe the differences in lymphatic
drainage of the upper 2/3 and lower 1/3 of
the vagina
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination [S]
2.2.1 Perform an EUA to stage vaginal cancer
using the FIGO clinical staging system
2.3 Investigation and Evaluation
2.3.1 Describe the prognostic factors that
influence local control and survival in
vaginal cancer
2.3.2 Diagnose the presence of a rectovaginal or
vesicovaginal fistula
2.3.3 Synthesise information regarding the
tumour’s involvement of and proximity to
local structures and the psychosocial needs
of the patient, to arrive at a management
approach
3Management
3.1 General [G]
The trainee is able to describe:
3.2 Radiation Therapy [D and I]
3.2.1 The use of intracavitary and interstitial
brachytherapy in the definitive and
adjuvant treatment setting
The trainee is able to describe:
3.3 Surgery [G]
3.3.1 Definitive surgical techniques
3.3.2 The surgical management of fistulae
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3.2 Radiation Therapy [D and I]
3.2.1 C
ompare and contrast surgery versus
definitive radiation therapy for early stage
disease
3.2.2 S elect appropriate patients for adjuvant
radiation therapy to the primary tumour
and to the inguinal and pelvic lymph nodes
3.2.3 L ist the relative advantages and
disadvantages of the different treatment
techniques (photons, photons and
electrons, and partial transmission blocks)
used to treat the vulva and inguinal lymph
nodes in continuity
3.2.4 D
iscuss controversies surrounding elective
treatment of inguinal lymph nodes, with
either surgery or radiation therapy
3.2.5 D
iscuss controversies surrounding central
shielding of the vulva during elective
treatment of inguinal and pelvic lymph
nodes
The trainee is able to discuss:
3.4 Systemic Therapy [G]
3.4.1 The indications for concurrent, platinumbased chemotherapy
The trainee is able to discuss:
3.5 Other therapies [G]
3.5.1 The use of intra-vaginal chemotherapy or
immune modifiers for Stage 0 disease
4 Outcomes [D]
The trainee is able to describe:
4.1 Tumour
4.1.1 A management plan for local and/or
distant recurrence depending on the
previous treatment approach
4.2 Toxicity
4.2.1 The effect that treatment may have
on sexual function (vaginal effects,
menopause, and altered body image) and
the management of these toxicities
Gestational Trophoblastic Disease
(GTD)
1 Oncology Sciences [D]
The trainee is able to:
1.1 Pathology
1.1.1 D
iscuss and define the heterogeneous
group of lesions arising from abnormal
proliferation of trophoblastic epithelium of
the placenta
1.1.1.1 Benign trophoblastic lesions
1.1.1.2 Hydatidiform mole (partial, complete
and invasive)
1.1.1.3 Gestational trophoblastic neoplasia:
choriocarcinoma and placental site
trophoblastic tumour
1.1.2 D
escribe the pathogenesis of GTD i.e. from
foetal tissue
1.1.3 Describe the significance of beta-HCG
1.1.4 D
iscuss the pathology and natural history
of malignant GTD after a non-molar
pregnancy
1.2 Anatomy
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2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Describe the post-partum symptoms that
warrant investigation
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Discuss routine HCG monitoring postpartum and the levels of HCG seen in
presence of GTD
2.3.2 Discuss the use of investigations to assess
uterine contents and to look for metastatic
disease
2.3.3 Aware of the NIH classification of GTD, and
WHO prognostic index score for GTD
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Evaluate the use of radiation therapy
in the treatment of GTD (especially in
the setting of high risk, poor prognostic
metastatic GTD)
3.3 Surgery [G]
3.3.1 Discuss the indications for surgery
3.4 Systemic Therapy [G]
3.4.1 Discuss the indications for chemotherapy
and the specific agents used
3.5 Other Therapies [G]
4 Outcome [D]
The trainee is able to demonstrate understanding of:
4.1 Tumour
4.1.1 The importance of extent of disease at
presentation, age, interval between the
gestational event and persistent disease
and serum beta-HCG levels
4.2 Toxicity
4.2.1 Issues related to contraception and future
pregnancy during and following treatment
for GTD
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
URINARY TRACT
MAJOR FOCUS
Bladder Cancer74
LESSER FOCUS
Kidney and Ureter Cancer75
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 73
Bladder Cancer
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The concept and relevance of urothelial
field change
1.2 Anatomy
1.2.1 R
are variations e.g. hypotonic bladder,
diverticuli, cystocoeles
2 Clinical Assessment [D and I]
The trainee is able to describe the importance of:
2.1 History
2.1.1 P revious intravesical therapy
2.1.2 Irritable bladder symptoms
2.1.3 P re-treatment bladder capacity
and function
2.2 Physical Examination
The trainee is able to:
2.3 Investigation and Evaluation
2.3.1 E valuate the results of EUA, cystoscopy,
bimanual palpation and TURB with bladder
mapping and “random” biopsies
2.3.2 E xplain the importance of extent of CIS
and presence of hydronephrosis
3Management
3.1 General [G]
The trainee is able to:
3.2 Radiation Therapy [D and I]
3.2.1 S elect patients for bladder-conserving
therapy
3.2.2 D
escribe situations where partial bladder
irradiation may be used as definitive
radiation post-TURB or as boost after
whole bladder treated for first phase
3.2.3 D
iscuss the controversies associated with
elective pelvic nodal irradiation
3.2.4 E valuate the utility of radiation therapy
in treating high-risk, Grade 3 superficial
disease
Page 74
3.2.5 Describe historical data concerning the use
of radiation therapy in the pre- and postoperative settings
3.2.6 Discuss the rationale and techniques
available for adaptive radiotherapy,
3.2.7 Discuss the different palliative
fractionation schedules
The trainee is able to describe:
3.3 Surgery [G]
3.3.1 Discuss the use of of TURBT for
superficial TCC/CiS
3.3.2 List the indications for partial cystectomy
3.3.3 List the indications for radical cystectomy
3.3.4 Describe the procedure of radical
cystectomy in general terms (for males and
females) and options for urinary diversion
3.3.5 Discuss the importance of complete/
maximal TURBT when organ-conserving
approach employed
3.3.6 Evaluate the role of completion/salvage
cystectomy following persistence or
recurrence of muscle-invasive TCC after
radiation treatment
The trainee is able to describe:
3.4 Systemic Therapy [G]
3.4.1 The use of intravesical Bacillus CalmetteGuerin (BCG) and chemotherapy for
superficial disease
3.4.2 The relative benefits of concurrent chemoirradiation[D]
3.4.3 The current status of neo-adjuvant and
adjuvant chemotherapy
3.4.4 The benefits and limitations of palliative
chemotherapy
3.5 Other Therapies [G]
4 Outcomes [D]
The trainee is able to describe the:
4.1 Tumour
4.1.1 Importance of regular follow-up with
urine cytology and cystoscopy following
treatment of superficial disease
4.1.2 Risk of recurrence with superficial TCC/CIS
following bladder conserving therapy and
its further management
4.1.3 Recommended follow-up schedule for
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4.2 Toxicity
4.2.1 M
orbidities and impact on quality of life
of surgical procedures, including urinary
diversion
Kidney and Ureter Cancer
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Highly variable natural history of renal cell
carcinoma and immunological influences
that may affect this
1.1.2 “Field change” concept relating TCC of the
renal pelvis, ureter and bladder
1.2 Anatomy
1.2.1 Relevance of the horseshoe kidney
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Recognise the role of sequential CT scan
assessment of size and appearance of
renal lesions in predicting the diagnosis of
renal cell carcinoma, need for intervention
and risk of metastasis
2.3.2 Understand the limited role of needle
or incisional biopsy and the risk of
haemorrhage
2.3.3 Outline the use of ureteroscopy in
evaluation of TCC of the ureter
3.2 Radiation Therapy [D and I]
3.2.1 Describe the indications for radiation
therapy to the renal bed following
nephrectomy
3.2.2 Discuss the variations in radiation therapy
given for metastatic renal cell carcinoma
depending on clinical presentation e.g.
solitary metastases and long disease-free
interval
3.3 Surgery [G]
3.3.1 Describe the primary role of surgery
(radical nephrectomy – open and
laparoscopic) in the management of renal
cell carcinoma and TCC renal pelvis
3.3.2 Describe the role of (nephro)ureterectomy
for TCC of the ureter
3.3.3 Discuss the indications for nephrectomy in
a patient with metastatic disease
3.3.4 Describe the use of ureteric stenting
3.4 Systemic Therapy [G]
3.4.1 Describe the use of immunological agents
e.g. interferon, interleukin, and molecularly
targeted agents eg VEGF TK inhibitors
3.5 Other Therapies [G]
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Describe the highly variable life expectancy
and behaviour of renal cell carcinoma with
and without treatment
4.2 Toxicity
3Management
The trainee is able to:
3.1 General [G]
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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AND MES
patients having bladder-conservation
approach for muscle-invasive TCC,
including the rationale, timing of biopsies
and salvage operation if required
Page 76
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
GASTROINTESTINAL TRACT
MAJOR FOCUS
Oesophageal Cancer78
Gastric Carcinoma78
Pancreatic Cancer79
Rectal Cancer80
Anal Cancer81
LESSER FOCUS
Biliary Tract and Gall Bladder Cancers
82
Hepatocellular Carcinoma83
Gastrointestinal Stromal Tumours84
Carcinoid Tumour84
Colon Cancer85
Liver Metastases86
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 77
Oesophageal Cancer
1 Oncology Sciences [D]
3.2.3 The use of radiation therapy to the
primary oesophageal tumour as palliative
treatment for dysphagia
The trainee is able to:
1.1 Pathology
1.1.1 C
ompare and contrast the epidemiology,
etiologic factors, and pathobiology of
adenocarcinoma and squamous cell
carcinoma of the oesophagus
1.1.2 D
iscuss the rising incidence of
adenocarinoma
1.1.3 D
iscuss the association with synchronous
head and neck primaries
1.1.4 L ist the common and uncommon
histologies, including sarcoma, lymphoma,
mucosal melanoma
3.3 Surgery [G]
3.3.1 The indications for definitive surgery with
aim of cure
3.3.2 The importance of preservation of function
3.3.3 The common surgical procedures for
attempted cure or palliation
1.2 Anatomy
1.2.1 D
escribe the lymphatic drainage of the
upper, mid and distal oesophagus
2 Clinical Assessment [D and I]
The trainee can demonstrate :
4.1 Tumour
4.1.1 A knowledge of meta-analysis
data evaluating preoperative
chemoradiotherapy and preoperative
chemotherapy and the expected treatment
outcomes
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 D
iscuss the limitations of staging
investigations e.g. difficulty in assessment
of depth of tumour invasion, and the role
of endoscopic USS and PET
3.4 Systemic Therapy [G]
3.4.1 The use of chemotherapy alone or in
combination with radiation, with the aim
of cure, or palliation
3.4.2 The indications and relative benefits of
combining chemotherapy with surgery
3.5 Other Therapies [G]
4 Outcomes [D]
4.2 Toxicity
Gastric Carcinoma
1 Oncology Sciences [D]
3Management
The trainee is able to describe:
3.1 General [G]
3.1.1 The controversies regarding Gastrooesophageal tumours and their
management.
3.2 Radiation Therapy [D and I]
3.2.1 The indications and relative benefits of
combining radiation therapy with surgery
ie preoperative and postoperative
3.2.2 The indications for the use of radiation
therapy as definitive treatment, alone or
with systemic therapy
Page 78
The trainee is able to describe the:
1.1 Pathology
1.1.1 WHO classification system of gastric
tumours
1.1.2 Diffuse type and e-cadherin association
1.1.3 Other histologies: primary lymphoma,
gastrointestinal stromal tumours (GIST)
1.2 Anatomy
1.2.1 The lymphatic drainage of stomach
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4 Outcomes [D]
The trainee is able to:
2.1 History
2.1.1 Describe the relative importance of:
2.1.1.1 L ocalising symptoms e.g.
haematemesis, gastric outlet
obstruction
2.1.1.2 C
onstitutional symptoms e.g. weight
loss and performance status
The trainee is able to discuss:
4.1 Tumour
The trainee is able to:
5.1 Evaluate the effectiveness of the Japanese
screening program
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Demonstrate an understanding of the
uses of various staging investigations e.g.
endoscopy, CT scan, PET
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the indications for radiation
therapy (± chemotherapy) preoperatively
and postoperatively
3.2.2 Discuss the use of radiation therapy for
palliation of inoperable local disease
3.3 Surgery [G]
3.3.1 Describe the indications for definitive
surgical treatment
3.3.2 Discuss the different gastric and nodal
resections and implications for staging
3.4 Systemic Therapy [G]
3.4.1 Discuss the use of pre- and post-operative
chemotherapy
3.4.2 Debate the pros and cons of postoperative
chemoradiation and perioperative
chemotherapy
3.4.3 Knowledge of the use of Herceptin in
metastatic gastric cancer
3.5 Other Therapies [G]
3.5.1 Describe the potential application of
evolving therapies e.g. EGFR inhibitors
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4.2 Toxicity
4.2.1 Treatment related toxicity in particular that
of postoperative chemoradiation
5 Screening and Prevention [G]
Pancreatic Cancer
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The differences between exocrine and
endocrine tumours and subtypes
1.1.2 Molecular pathogenesis of pancreatic
cancer
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Describe variations in presentation and
distinguish from other causes of jaundice
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Select and evaluate relevant investigations,
including EUS and biopsy
3Management
3.1 General [G]
The trainee is able to discuss the:
3.2 Radiation Therapy [D and I]
3.2.1 Controversies in the use of radiation
therapy (definitive and adjuvant), and
variations in practice
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2 Clinical Assessment [D and I]
The trainee is able to describe:
3.3 Surgery [G]
3.3.1 The indications for
pancreaticoduodenectomy
(Whipple’s procedure)
3.3.2 The indications for, and complications of,
stenting
The trainee is able to discuss the:
3.4 Systemic Therapy [G]
3.4.1 U
se of chemotherapy as adjuvant
treatment
3.4.2 P ros- and cons- of chemoradiation
vs chemotherapy alone as definitive
treatment for unresectable locally
advanced pancreatic cancer
3.4.3 Indications for the use of chemotherapy
alone as palliative therapy
4 Outcomes [D]
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.2.1 Perform a rectal assessment of the primary
cancer and describe the tumour location,
extent of stenosis, length of tumour,
tethering and involvement of adjacent
organs.
2.3 Investigation and Evaluation
2.3.1 Evaluate the different staging
investigations including sigmoidoscopy
and biopsy, colonoscopy, EUA, MRI, CT,
and PET
2.3.2 Assess a patient’s fitness for curative
therapy
3Management
The trainee is able to:
4.1 Tumour
4.1.1 D
escribe the expected rates of palliation in
relation to specific symptoms
4.1.2 D
escribe the expected median survival
rates for surgery, chemoradiation and
chemotherapy alone
4.2 Toxicity
4.2.1 Identify and manage malabsorption
syndrome
Rectal Cancer
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 C
olorectal carcinogenesis – morphological,
molecular and genetic changes and genetic
testing
1.1.2 The Dukes’, MAC and AJCC (TNM)
staging systems
1.1.3 Role and significance of microsatellite
testing
1.2 Anatomy
1.2.1 The rectosigmoid junction and the
mesorectal fascia
Page 80
The trainee is able to:
3.1 General [G]
3.1.1 Discuss treatment options for stage l, ll, lll
disease
3.1.2 Select patients for preoperative radiation
therapy
3.1.3 Discuss treatment options for patients with
simultaneous local and metastatic disease
3.1.4 Discuss treatment options for local
recurrence
3.1.5 Discuss management of rectal cancer in
elderly patients
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the advantages and disadvantages
of pre- and post-operative radiotherapy
3.2.2 Discuss the evidence for and against
short-course and long-course pre-operative
radiation therapy
3.2.3 Explain the benefits of radiation therapy in
palliative treatment
3.3 Surgery [G]
3.3.1 Describe common surgical approaches and
their indications
3.3.2 Describe surgical field for total mesorectal
excision
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.3.3 D
iscuss the role of palliative surgery e.g.
diversion, stent
3.3.4 D
iscuss the role of resection of solitary
liver metastasis
3.4 Systemic Therapy [G]
3.4.1 D
iscuss selection of patients for adjuvant
and palliative chemotherapy
3.4.2 D
escribe common adjuvant and palliative
chemotherapy protocols
3.4.3 D
iscuss the rationale for concurrent
chemoradiation and list the commonly
used regimens
3.4.4 D
iscuss the role of biological agents
3.5 Other Therapies [G]
3.5.1 D
iscuss the different treatment options
used in the management of liver
metastases e.g.RFA, SBRT, chemoembolisation, radioactive microspheres
3.5.2 Discuss the management of polyps
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Discuss a follow up program after
treatment of rectal cancer
4.2 Toxicity
4.2.1 Discuss management of acute side effects
during chemoradiation
4.2.2 Discuss measures to anticipate and
manage late effects of radiation therapy
e.g. fertility, sexual dysfunction, early
menopause, altered bowel functions
5 Screening and Prevention [G]
The trainee is able to:
5.1 D
iscuss screening programs for colorectal cancer
in the general population and in high-risk groups
5.2 E xplain the relative merits of various screening
tools: stool-testing, sigmoidoscopy, and
colonoscopy
5.3 Explain the function of familial cancer clinics
5.4 C
ounsel patients and their families regarding risk
reduction in colorectal cancer
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Anal Cancer
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The importance of human papilloma virus
(HPV), HIV, and immunosuppression
1.2 Anatomy
1.2.1 The lymphatic drainage of the anal canal
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.2.1 Perform a digital anorectal examination
and assess the involvement of adjacent
organs
2.2.2 Assess sphincter function
2.3 Investigation and Evaluation
2.3.1 Discuss staging for anal cancer with
biopsy, EUA, CT, PET, endorectal
ultrasound and MRI
2.3.2 Interpret CT and MRI scans
2.3.3 Describe the investigation of suspected
malignant lymphadenopathy e.g. enlarged
inguinal nodes
2.3.4 Recognise the importance of
gynaecological assessment in
female patients
3Management
The trainee is able to:
3.1 General [G]
3.1.1 Describe treatment options for stage l, ll, lll
and lV disease
3.1.2 Discuss the management of patients with
HIV
3.1.3 Discuss the management of AIN
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the role of prophylactic nodal
irradiation
3.2.2 Describe the different radiation therapy
techniques eg conformal vs IMRT
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AND MES
including relevant doses for the primary
tumour and prophylactic nodal regions
3.2.3 D
iscuss the advantages and disadvantages
of split course techniques
3.2.4 D
iscuss the rationale for concurrent
chemotherapy, and the common
chemotherapeutic agents that are used
3.2.5 D
iscuss salvage radiotherapy for isolated
nodal recurrence
3.2.6 D
iscuss the use of interstitial
brachytherapy
3.3 Surgery [G]
3.3.1 Appreciate the principles of surgery
where it is used in treating early disease;
the importance of margins and the
preservation of sphincter function
3.3.2 D
escribe the role of defunctioning
colostomy for locally advanced disease
3.3.3 D
iscuss surgical salvage for persistent or
recurrent local disease
3.3.4 D
iscuss surgical salvage for nodal
recurrence
3.4 Systemic Therapy [G]
3.4.1 D
iscuss the benefits and increased
toxicities associated with chemotherapy
delivered concurrently with radiation
therapy
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 D
escribe a follow-up programme
for patients treated with definitive
chemoradiation.
4.1.2 D
iscuss the role of biopsy and other
investigations in follow-up after definitive
chemoradiation
4.2 Toxicity
4.2.1 D
iscuss management of acute effects
during chemoradiation
4.2.2 E valuate anal dysfunction and the role of
defunctioning colostomy
4.2.3 D
iscuss measures to anticipate and
manage late effects of radiation therapy
e.g. fertility, sexual dysfunction, early
menopause, altered bowel functions
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4.2.4 Appreciate how toxicity might be modified
by HIV infection
Biliary Tract and
Gall Bladder Cancers
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Diffusely invasive pattern of
adenocarcinoma
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Be aware of the role of ERCP and imaging
modalities designed to assess operability
2.3.2 Describe the limitations of tissue biopsy
and the use of endoscopic USS guided
biopsy
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the circumstances when external
beam radiation therapy would be used
definitively
3.2.2 Describe the varied roles, techniques
and doses of brachytherapy i.e. boost in
definitive treatment, and as a bile duct
implant to prevent stenosis/restenosis [S]
3.2.3 Discuss potential benefits of concurrent
chemoradiotherapy and the agents used
3.3 Surgery [G]
3.3.1 Describe the role of surgery, including the
indications and techniques for stenting
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.4 Systemic Therapy [G]
3.5 Other Therapies [G]
4 Outcomes [D]
4.1 Tumour
4.2 Toxicity
Hepatocellular Carcinoma (HCC)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Differential diagnosis for a solitary liver
lesion
1.1.2 Viral aetiology and impact of vaccination
1.2 Anatomy
1.2.1 Effect of respiratory motion
2 Clinical Assessment [D and I]
The trainee is able to describe the importance of:
2.1 History
2.1.1 Performance status and co-morbidities
2.1.2 Previous treatment e.g. chemotherapy,
and RFA
2.1.3 Extent of extrahepatic tumour burden
2.1.4 C
o-existing liver disease and its impact
on prognosis
2.2 Physical Examination
The trainee is able to describe the:
2.3 Investigation and Evaluation
2.3.1 R
elative benefits of CT, US, MR and
PET imaging
3Management
The trainee is able to:
3.1 General [G]
3.2.2 Describe the indications and technique for
radical, high-dose focal radiation therapy
including stereotactic body radiotherapy
(HFRT)[G and S]
3.2.3 Describe radiation therapy in
conjunction with transcatheter arterial
chemoembolisation (TACE) [G]
3.3 Surgery [G]
3.3.1 Describe indications for surgical resection
3.3.2 Describe the role of liver transplantation
3.4 Systemic Therapy [G]
3.4.1 Describe systemic administration versus
hepatic artery administration
3.4.2 Describe potential benefits of concurrent
chemo-radiation with hepatic artery
chemotherapy
3.5 Other Therapies [G]
3.5.1 Discuss evidence supporting use of
molecularly targeted agents in treatment
of unresectable disease
3.5.2 Discuss radiofrequency ablation (RFA)
3.5.3 Discuss radionuclides such as yttrium-90
microspheres (Sirtex spheres) or iodinelabelled lipiodol administered via hepatic
artery
4 Outcomes [D]
The trainee is able to describe:
4.1 Tumour
4.1.1 Response, local control and survival rates
with radical and palliative treatments
including palliative whole liver radiation
therapy
4.2 Toxicity
5 Screening and Prevention [G]
The trainee is able to discuss:
5.1 Screening for HCC
3.2 Radiation Therapy [D and I]
3.2.1 Describe the indications and technique for
palliative radiation therapy
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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Gastrointestinal Stromal Tumours
(GIST)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 C
-kit proto-oncogene mutation
Differentiation between sarcomaand GIST
1.1.2 Pattern of recurrence
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to describe the:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 P rognostic features: site, size, mitotic rate,
extent, imaging characteristics
3Management
4.1.1 Unreliability of survival data for
this disease prior to 2000 due to
misclassification of these tumours
4.2 Toxicity
Carcinoid Tumour
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The importance of malignant carcinoid
syndrome
1.1.2 The association with other familial
or genetic disorders, such as multiple
endocrine neoplasia type 1 (MEN 1) and
Peutz-Jeghers syndrome
1.1.3 The importance of mitotic count/Ki67 in
assessing different grades of carcinoid
tumours
1.2 Anatomy
1.2.1 Presentations in non-gastrointestinal tract
sites (lungs, mediastinum, thymus liver,
pancreas, bronchus, and ovaries)
The trainee is able to:
3.1 General [G]
2 Clinical Assessment [D and I]
3.2 Radiation Therapy [D and I]
The trainee is able to:
2.1 History
3.3 Surgery [G]
3.4 Systemic Therapy [G]
3.4.1 D
escribe mechanism of action of imatinib
mesylate
3.4.2 D
iscuss the role and action of other
molecularly targeted agents for imatinib
resistance
3.5 Other Therapies [G]
3.5.1 B
e aware of use of radiofrequency
ablation and embolisation techniques for
unresectable liver metastases
2.2 Physical Examination
2.3 Investigation and Evaluation [G]
2.3.1 Evaluate the use of special diagnostic tests
2.3.1.1 Biogenic amines and metabolite
measurements
2.3.1.2 Scintigraphy with MIBG and
octreotide scanning
2.3.1.3 Radiotracers (Indium-111-labelled
DTPA, Dota-octreotate (Gatate) PET)
3Management
4 Outcomes [D]
The trainee is able to discuss:
3.1 General [G]
The trainee is able to discuss the:
4.1 Tumour
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3.2 Radiation Therapy [D and I]
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.4 Systemic Therapy [G]
3.5 Other Therapies [G]
3.5.1 S omatostatin analogues (octreotide) for
systemic and targeted treatment
3.5.2 Interferon alpha
3.5.3 Hepatic arterial embolisation
4 Outcomes [D]
The trainee is able to describe:
4.1 Tumour
4.2 Toxicity
4.2.1 Carcinoid crisis
Colon Cancer
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 Colorectal carcinogenesis – morphological,
molecular and genetic changes and genetic
testing
1.1.2 The Dukes’, MAC and AJCC (TNM) staging
systems
1.2 Anatomy
1.2.1 The relationship of the colon to the
peritoneum and retroperitoneum in its
different segments
2 Clinical Assessment [D and I]
The trainee is able to evaluate:
2.1 History
2.1.1 The significance of family history
3Management
3.1 General [G]
The trainee is able to describe:
3.2 Radiation Therapy [D and I]
3.2.1 The situations where radiation therapy
may be used as an adjunct to surgery
The trainee is able to outline the procedures of and
describe the indications for:
3.3 Surgery [G]
3.3.1 Colonoscopic polypectomy
3.3.2 Partial colonic resection
3.3.3 Total colectomy in high risk patients
(familial adenomatosis polyposis (FAP) or
ulcerative colitis with invasive cancer)
3.3.4 Metastatectomy e.g. hepatic resection
for liver metastases; pulmonary
metastatectomy in highly selected cases
The trainee is able to demonstrate understanding of:
3.4 Systemic Therapy [G]
3.4.1 The role of combination chemotherapy in
the adjuvant and palliative setting
3.4.2 The use and mechanisms of action of
molecularly targeted therapies including
VEGF inhibitors e.g. bevacizumab and
EGFR inhibitors (including dependence on
k-Ras status)
3.5 Other Therapies [G]
4 Outcomes [D]
4.1 Tumour
4.2 Toxicity
5 Screening and Prevention [G]
The trainee is able to:
5.1 Identify family members at risk of colon cancer
and refer them for genetic counseling
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Relevant diagnostic tests e.g. colonoscopy,
CT scans, blood tests including
chorioembryonic antigen (CEA)
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
5.2 Demonstrate awareness that the patient may be
the index case in a familial syndrome
5.3 Describe the rationale for the general
population screening program
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3.3 Surgery [G]
3.3.1 The indications for surgery with curative
intent
3.3.2 The palliative value of de-bulking surgery
Liver Metastases
1 Oncology Sciences [D]
3.5 Other Therapies [G]
3.5.1 Evaluate other therapeutic options e.g.
arterial embolisation, cryotherapy, radiofrequency ablation
The trainee is able to describe the:
1.1 Pathology
1.1.1 C
ommon and uncommon primary sites
associated with liver metastases
1.1.2 M
echanisms of metastasis to the liver
1.2 Anatomy
1.2.1 P ortal circulation and the preference
of gastrointestinal tract tumours to
metastasise to the liver
1.2.2 D
ivision of the liver into lobes and subsegments
3.4 Systemic Therapy [G]
4 Outcomes [D]
4.1 Tumour
4.2 Toxicity
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 S elect and evaluate the relevant diagnostic
tests e.g. US and CT abdomen, liver biopsy,
MRI
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 D
iscuss situations where treatment with
curative intent may be considered e.g.
small, isolated metastasis in medically
inoperable patient
3.2.2 S elect and plan patients for palliative liver
irradiation [I] including high dose focal
liver radiotherapy [S]
3.2.3 D
iscuss the limited role of radio-isotope
therapy e.g. Yttrium microspheres [G]
3.3 Surgery [G]
3.3.1 D
escribe the indications for partial liver
resection with curative intent
Page 86
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
CENTRAL NERVOUS SYSTEM
MAJOR FOCUS
Adult Gliomas88
Meningioma89
Pituitary Tumours89
Medulloblastoma And Primitive
Neuroectodermal Tumours90
Cerebral Metastases91
Malignant Spinal Cord Compression 92
LESSER FOCUS
Ependymoma, Pineal and Germ Cell Tumours
93
Acoustic Neuroma 94
Cerebral Arteriovenous Malformations 95
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 87
Adult Gliomas
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The WHO classification system of primary
brain tumours according to histology
1.1.2 The molecular genetics of formation of
astrocytoma, transition to malignant
glioma and response to treatment
1.2 Anatomy
1.2.1 N
euro-anatomy in terms of the functional
consequences of lesion location and
relationships with other critical CNS
structures
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 E licit symptoms of raised intracranial
pressure
2.2 Physical Examination
2.2.1 Elicit signs of raised intracranial pressure
2.3 Investigation and Evaluation
2.3.1 S elect and interpret appropriate
investigations e.g. CT, MRI, MRS and PET
2.3.2 Assess prognostic factors for clinical
outcome (MRC and Radiation Therapy
Oncology Group (RTOG) prognostic groups
and EORTC nomograms) and explain how
these aid treatment decision making
may alleviate symptoms and optimise
quality of life
3.1.3 Discuss the management of raised
intracranial pressure
3.2 Radiation Therapy [D and I]
3.2.1 Select patients with high grade glioma
for treatment with the aim of improving
survival
3.2.2 Discuss the use of hypofractionated
schedules in selected high grade glioma
patients
3.2.3 Describe potential indications for
specialised radiation therapy techniques
e.g. stereotactic radiosurgery, fractionated
stereotactic radiation therapy, and
radioactive implantation
3.2.4 Discuss situations in which re-irradiation
may be implemented in patients with
progressive disease
3.3 Surgery [G]
3.3.1 Describe the indications for surgery and
the factors that influence the extent of
resection e.g. tumour site and imaging
3.3.2 Describe indications for other surgical
procedures such as stereotactic biopsy and
CSF shunting
3.3.3 Recognise situations where palliative
surgery may be employed
3.4 Systemic Therapy [G]
3.4.1 Explain how agents may be integrated
with radiation therapy, in particular
glioblastoma muliforme [D]
3.4.2 Recognise the potential role of emerging
systemic agents e.g. biological therapies
3Management
The trainee is able to:
3.1 General [D]
3.1.1 E xplain the advantages and disadvantages
of observation versus immediate therapy in
patients with low grade gliomas; describe
features that influence the timing of an
intervention
3.1.2 R
ecognise the role of supportive care
alone for selected patients with high grade
glioma and the palliative measures that
Page 88
3.5 Other Therapies [D]
3.5.1 Describe the use of corticosteroids
in managing the symptoms of raised
intracranial pressure
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Interpret diagnostic investigations such
as CT or MRI after radiation therapy,
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
4.2 Toxicity
4.2.1 D
escribe the importance of late effects of
radiation therapy in the management of
patients with low grade glioma
Meningioma
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 WHO classification system
1.1.2 Explain the clinical significance of different
pathological grades of meningioma
1.2 Anatomy
1.2.1 Common anatomical sites at which
meningiomas arise and related critical
structures
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Elicit clinical symptoms and describe focal
deficits caused by meningiomas in specific
locations
2.2 Physical Examination
2.3 Investigation and Evaluation
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss radiation therapy in definitive,
adjuvant and recurrent settings
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.2.2 Discuss the indications for stereotactic
radiation therapy
3.3 Surgery [G]
3.3.1 Discuss the utility of observation in
patients with asymptomatic meningioma
3.3.2 Discuss the circumstances for maximal
surgical resection
3.3.3 Describe situations where complete
surgical resection is difficult, in particular,
skull base and parasagittal meningiomas
3.4 Systemic Therapy [G]
3.4.1 Demonstrate an awareness of
experimental treatments such as
temozolomide, bevacizumab and
hydroxyurea
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Discuss the likelihood of local control
with surgery alone (complete resection,
incomplete resection), surgery and
adjuvant radiation therapy, and radiation
therapy alone
4.2 Toxicity
4.2.1 Describe potential long-term toxicities
associated with radiation therapy and
surgery
Pituitary Tumours
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Differentiation between secretory and
nonsecretory tumours
1.1.2 Differential diagnosis for a pituitary
tumour (adult and paediatric)
1.2 Anatomy
1.2.1 Describe the structure of the
pituitary gland
1.2.2 Discuss the importance of adjacent
structures
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ROCKKS
AND MES
including differentiation of recurrence
from necrosis
4.1.2 D
escribe the concepts of pseudoprogression and pseudo-response in the
follow up of high-grade glioma, especially
glioblastoma, and the implications for
response assessment (RANO response
criteria vs. the MacDonald criteria)
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 E licit the typical presenting features for the
different pathological subtypes, including
malignant tumours
2.2 Physical Examination
2.2.1 Assess the visual pathways to determine
their possible involvement by tumour
2.3 Investigation and Evaluation
2.3.1 D
escribe the macroscopic growth
and neuro-endocrine effects of the
tumour using a combination of clinical
examination, blood tests and neuroimaging, including involvement of the
cavernous sinus(es) and optic chiasm
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 O
utline indications for radiation therapy,
including pituitary carcinomas
3.2.2 E valuate the suitability of individual
patients for stereotactic radiosurgery
3.3 Surgery [G]
3.3.1 R
ecognise indications for urgent surgical
decompression
3.3.2 L ist the contraindications to transsphenoidal surgery
3.4 Other Therapies [G]
3.4.1 D
iscuss the appropriate use of medical
management options (e.g. bromocriptine)
for pituitary adenomas
4 Outcomes [D]
The trainee is able to:
4.1 Tumour:
4.2 Toxicity
4.2.1 Identify patients for whom post-treatment
Page 90
visual and endocrine assessment is
appropriate
4.2.2 Identify and refer patients with radiation
induced hypopituitarism
5 Screening and Prevention [D]
The trainee is able to refer:
5.1 Patients with relevant family history for genetic
counselling
Medulloblastoma and Primitive
Neuroectodermal Tumours (PNET)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Sporadic and familial occurrence
of medulloblastoma and primitive
neuroectodermal tumours (including
Turcot’s and Golin’s syndrome)
1.2 Anatomy
1.2.1 Structures in and adjacent to the cerebrum,
cerebellum, brainstem, spinal cord, spinal
canal and dural reflections
1.2.2 Anatomical extent of the cererbro-spinal
fluid spaces, including the optic nerves,
meninges, spine and sacrum
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.2.1 Perform a neurological examination
to assess mental state, cranial nerves,
cerebellar function, motor and sensory
function
2.3 Investigation and Evaluation [G and S]
2.3.1 Describe relative benefits of lumbar
puncture, CT, MRI brain and spine
2.3.2 Assess prognostic factors for outcome,
including age and histology
2.3.3 Explain how prognostic factor groupings
aid treatment decision-making
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Cerebral Metastases
The trainee is able to:
3.1 General [G]
1 Oncology Sciences [D]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the relationship between radiation
dose, fractionation and treatment outcome
3.2.2 Describe strategies for regions at risk of
underdosage e.g. the cribiform plate
3.2.3 Explain junction techniques of co-planar
and non co-planar beams for craniospinal
irradiation
3.2.4 Discuss radiation techniques employed
to reduce acute and late side effects with
particular reference to the paediatric
patient.
3.3 Surgery [G]
3.3.1 Communicate with neurosurgical
colleagues regarding optimal management
of individual patients
3.3.2 Explain the advantages and disadvantages
of surgical intervention
3.4 Systemic Therapy [G]
3.4.1 Explain how, and which, drugs are
commonly integrated with radiation
therapy
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.2 Toxicity
4.2.1 Explain clinical consequences of radiation
damage to the brain, brainstem, and
growing tissues
4.2.2 Select and refer patients for rehabilitation
5 Screening and Prevention [G]
The trainee is able to:
5.1 R
ecognise a family history typical of Turcot’s and
Gorlin’s syndrome
5.2 E xplain the screening procedures for patients
with Turcot’s syndrome
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
The trainee is able to describe:
1.1 Pathology
1.1.1 Common primary sites associated with
brain metastases
1.1.2 Pathophysiology of brain metastases and
leptomeningeal metastases
1.2 Anatomy
1.2.1 The relationship of site(s) of brain
involvement to symptoms
2 Clinical Assessment [D and I]
The trainee is able to evaluate:
2.1 History
2.2 Examination
2.3 Investigation and Evaluation
2.3.1 The role of MRI in defining the extent of
disease and assessing eligibility for surgery.
2.3.2 The extent of systemic disease and its
impact on treatment recommendations
3Management
The trainee is able to:
3.1 General [G]
3.1.1 Discuss variations in management relating
to the primary tumour type (including
carcinoma of unknown primary), extent of
brain metastases, and extent of systemic
disease
3.1.2 Recognise situations where supportive
care alone is most appropriate
3.2 Radiation Therapy [D and I]
3.2.1 Evaluate the use of external beam
radiation therapy in patients with
solitary brain metastasis (with or without
surgery/radiosurgery) and multiple brain
metastases
3.2.2 Evaluate the indications for, and
techniques of, stereotactic radiation
therapy /radiosurgery
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3Management
3.3 Surgery [G]
3.3.1 D
escribe surgical options for diagnosis e.g.
stereotactic biopsy, open brain biopsy, total
or partial resection of metastases
3.3.2 U
nderstand the contribution of surgery to
the management of solitary and multiple
brain metastases
3.3.3 R
ecognise clinical situations for which
urgent decompression surgery is required
2 Clinical Assessment [D and I]
3.4 Systemic Therapy [G]
3.4.1 D
iscuss the concept of the brain as a
sanctuary site in certain clinical situations
2.2 Physical Examination
2.2.1 Elicit signs of early and more
advanced MSCC
3.5 Other Therapies [I]
3.5.1 P rescribe steroids, analgesia and
anticonvulsants as required
3.5.2 Involve palliative care services
2.3 Investigation and Evaluation
2.3.1 Select suitable diagnostic tests and
investigations for:
2.3.1.1 Situations where diagnosis of
malignancy is known
2.3.1.2 Situations where there is no previous
diagnosis of malignancy
2.3.1.3 Clarification of full extent of disease
2.3.2 Describe the importance of whole
spine MRI
2.3.3 Describe patient and tumour factors
influencing the approach to, and outcomes
of treatment – including available models
aimed at predicting patient outcomes
4 Outcomes [D]
4.1 Tumour
4.1.1 B
e able to estimate survival based on
known prognostic factors
4.2 Toxicity
Malignant Spinal Cord
Compression (MSCC)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 C
lassification systems for the causes of
cord compression including neoplastic
(primary and secondary) and nonmalignant causes
1.1.2 P athophysiology of the clinical
manifestations of cord compression
including cord oedema and cord infarction
1.1.3 Acute and late radiation therapy changes
in the spinal cord and research relating to
spinal cord recovery
1.2 Anatomy
1.2.1 Implications of the position of the tumour
within the vertebra e.g. body versus
posterior elements and implications for
surgical decompression
Page 92
The trainee is able to:
2.1 History
2.1.1 Describe the chronology of symptoms
associated with MSCC
2.1.2 Recognise and justify the emergency status
of established MSCC and importance of
impending MSCC
3Management
The trainee is able to:
3.1 General [D]
3.1.1 Distinguish malignant spinal cord
compression from cauda equina
compression in terms of diagnosis and
treatment
3.1.2 Describe general supportive measures such
as analgesia, physiotherapy, bladder and
bowel care
3.1.3 Describe the purpose, timing and dosage
of steroid therapy
3.2 Radiation Therapy [D and I]
3.2.1 Discuss radiation therapy in MSCC
management (alone and post-operative)
3.2.2 Recognise special cases of potentially
curable or long-term controllable disease
including plasmacytoma and lymphoma
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.2.3 D
iscuss the role of higher dose
radiotherapy in patients with
oligometastatic disease and good
prognosis
3.3 Surgery [G]
3.3.1 Evaluate the use of surgery in diagnosis
3.3.2 D
iscuss the indications for biopsy,
laminectomy and vertebrectomy and/or
stabilisation procedures
3.4 Systemic Therapy [G]
3.4.1 D
iscuss the limited use of chemotherapy
in MSCC as an alternative to radiation
therapy or surgery e.g. lymphoma,
paediatric tumours
3.5 Other Therapies [G]
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Describe expected outcomes and goals of
treatment
4.1.2 Explain options if there is neurological
deterioration following initial therapy
4.1.3 Integrate other components of palliative
care including rehabilitation where
appropriate
4.2 Toxicity
4.2.1 Identify patient, tumour and treatment
considerations for radiation therapy retreatment
5 Screening and Prevention [G]
The trainee is able to:
5.1 E ducate patients at higher risk for developing
MSCC about early warning symptoms and signs
Ependymoma, Pineal
and Germ Cell Tumours
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The histological classification of
ependymoma (WHO grading system) and
the most common sites of involvement in
the CNS
1.1.2 The histological classification of pineal
gland tumours (WHO classification).
1.1.3 The histological classification of
intracranial germ cell tumours (WHO
classification system) and the common
sites of involvement in the CNS
1.2 Anatomy
1.2.1 The anatomical extent of the cerebrospinal fluid space
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.2.1 Perform a neurological examination to
assess mental state, the cranial nerves, and
cerebellar, motor and sensory function
2.3 Investigation and Evaluation
2.3.1 Select and interpret appropriate
investigations such as lumbar puncture, CT,
MRI of the brain and spine, and PET
2.3.2 Understand the significance of tumour
markers and how to use them
2.3.3 Define prognostic factor grouping for
a particular patient for the purposes of
treatment decision making
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Explain the indications for localised and
craniospinal irradiation
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3.2.2 E xplain the relationship between radiation
dose, fractionation, control rates and the
risk of complications
3.2.3 D
emarcate the CSF spaces and develop
strategies for regions at risk of under
dosage, such as the cribriform plate
3.2.4 E xplain junction techniques of co-planar
and non co-planar beams for craniospinal
irradiation
3.3 Surgery [G]
3.3.1 C
ommunicate with neurosurgeons
regarding the optimal management of
individual patients
3.3.2 L ist the advantages and disadvantages of
surgical intervention
1.2.2 Anatomical pathways and functions of
cranial nerves
2 Clinical Assessment [D and I]
2.1 History
The trainee is able to perform:
2.2 Physical Examination
2.2.1 A neurological examination to assess
mental state, cranial nerves V, VII, VIII,
cerebellar function, motor and sensory
function
2.3 Investigation and Evaluation
3Management
3.4 Systemic Therapy [G]
3.4.1 E xplain how agents may be integrated
with radiation therapy
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 E xplain the special definition of local
control i.e. lack of progression
4.1.2 E xplain risk of radiation-induced
malignancy
4.2 Toxicity
4.2.1 E xplain clinical consequences of radiation
damage to the brain, brainstem, and
growing tissues
4.2.2 Select and refer patients for rehabilitation
Acoustic Neuroma (AN)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Sporadic and familial occurrence of AN
1.2 Anatomy
1.2.1 S tructures in, and adjacent to, cerebellopontine angle and inner ear
1.2.1.1 Identify these structures on CT and
MRI scans (transverse, sagittal and
coronal slices)
Page 94
The trainee is able to:
3.1 General [G]
3.1.1 Evaluate patients for active treatment
versus observation
3.2 Radiation Therapy [D and I]
3.2.1 Explain the concept and rationale of
stereotactic radiosurgery
3.2.2 Select patients for stereotactic versus
conventional external beam therapy
3.2.3 Explain the relationships between
radiation dose, fractionation (single vs.
fractionated), incidence of control of AN
and risk of complications
3.3 Surgery [G]
3.3.1 Communicate with neurosurgeon/ENT
surgeon regarding optimal management of
individual patients
3.3.2 List the advantages and disadvantages of
surgical intervention
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Explain the special definition of local
control i.e. lack of progression
4.1.2 Explain risk of radiation-induced
malignancy
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Cerebral Arteriovenous
Malformations (AVMs)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Natural history of AVMs in relation to the
risk of haemorrhage
1.1.2 Gross and microscopic structure of AVMs,
including nidus and associated afferent
and efferent vessels
1.1.3 Pathogenesis of luminal obliteration
following radiation therapy
1.2 Anatomy
1.2.1 Cerebral vasculature and sketch a diagram
or schema
1.2.2 Correlation of areas of brain parenchyma
to vasculature
3.2 Radiation Therapy [D and I]
3.2.1 The concepts behind, and rationale for,
stereotactic radiosurgery
3.2.2 The relationships between radiation dose,
incidence of AVM ablation and risk of
complications
3.3 Surgery [G]
3.2.1 The principles of, and indications for,
treatment of AVMs with a surgical
approach
4 Outcomes [D]
The trainee is able to describe:
4.1 Tumour
4.1.1 The time course of ablation following
radiosurgery
4.2 Toxicity
4.2.1 Clinical consequences of radiation necrosis
or cerebral oedema of specific areas of the
brain
4.2.2 The risk of radiation-induced malignancy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation [G]
2.3.1 Discuss the importance of MRI and
angiogram findings, with respect to
treatment options and toxicity of
treatment
3Management
The trainee is able to demonstrate an understanding of:
3.1 General [G]
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AND MES
4.2Toxicity
4.2.1 E xplain clinical consequences of radiation
damage to the brainstem, and cranial
nerves V - VIII
4.2.2 R
efer patients with radiation-induced
cranial nerve injury for surgical
management
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
HAEMATOLOGY
MAJOR FOCUS
Hodgkin Lymphoma98
Non-Hodgkin Lymphoma 99
LESSER FOCUS
Leukaemia100
Multiple Myeloma100
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 97
Hodgkin Lymphoma (HL)
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 WHO classification system
1.1.2 P athobiology and molecular pathology
particularly where these relate to diagnosis
1.1.3 Infectious aetiopathogenesis
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Identify B symptoms and alcohol
intolerance
2.2 Physical Examination
2.2.1Perform a thorough examination of the
lymphoreticular system.
2.3 Investigation and Evaluation
2.3.1 Describe appropriate staging investigations
including the role of PET
2.3.2 S tratify patients according to
contemporary prognostic groupings
2.3.3 D
escribe the Cotswolds staging
classification i.e. modified Ann Arbor
3.2 Radiation Therapy [D and I]
3.2.1 Detail contemporary combined modality
therapy and the historical changes in the
role of radiation therapy in the curative
treatment of HL
3.2.2 Describe involved field and involved nodal
radiation, including the planning principles
of post-chemotherapy radiation
3.2.3 Understand geometric uncertainties as
they apply to image fusion
3.2.4 Describe the role and key planning
principles of other radiation therapy
techniques e.g. mantle field, subtotal
nodal irradiation, total nodal irradiation,
extended field, and total body irradiation
(TBI)
3.2.5 Determine the role of salvage radiation
therapy for chemotherapy treatment
failures
3.2.6 Describe the role of radiotherapy following
salvage chemotherapy and autograft
3.3 Surgery [G]
3.3.1 Describe the historic role of staging
laparotomy in the context of the natural
history of HL
3.4 Systemic Therapy [G]
3.4.1 Discuss the role of chemotherapy, and the
common regimens used, in the curative
and palliative settings
3.4.2 Discuss the use of high-dose chemotherapy
3Management
The trainee is able to:
3.1 General [D]
3.1.1 D
istinguish the utility of fine needle biopsy
versus core biopsy versus excision biopsy
3.1.2 D
iscuss the impact of pregnancy on
management decisions, including the
significance of gestational stage and
special psychosocial issues (see Breast
page 44 for detailed learning outcomes)
3.1.3 Advise patients regarding fertility
management and family planning in
relation to their cancer
3.1.4 E xplain the clinical significance of
pathological subtypes of HL and how they
affect treatment choice
Page 98
3.5 Other Therapies [G]
3.5.1 Discuss the role of bone marrow transplant
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.2 Toxicity
4.2.1 Discuss how late effects (including
secondary malignancy) influence the
evolution of treatment strategies
4.2.2 Describe follow-up of patients specifically
with regard to monitoring for late effects
and their management
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The rationale for classification schemes i.e.
WHO classification
1.1.2 Pathobiology and molecular pathology
particularly where these relate to diagnosis
including cytogenetics
1.1.3 Features distinguishing special sites i.e.
orbital lymphoma, testicular lymphoma,
MALT-type (extra-nodal marginal zone)
lymphoma, primary bone lymphoma,
primary cutaneous lymphoma (PBCL/PTCL),
primary CNS lymphoma, and HIV-related
lymphoma
1.1.4 Infectious aetio-pathology
1.2 Anatomy
1.2.1 Lymph node regions as related to Ann
Arbor staging system
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Elicit a history and risk profile for
immunosuppression e.g. HIV/AIDS
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Evaluate molecular and cytogenetic studies
indicating B or T-cell origin
2.3.2 Describe appropriate staging investigations
(including PET, bone marrow biopsy)
2.3.3 Stratify patients according to
contemporary prognostic groupings
3.2 Radiation Therapy [D and I]
3.2.1 Describe involved field radiation therapy
including the planning principles of the
post-chemotherapy radiation field
3.2.2 Describe treatment principles for
extranodal lymphomas
3.2.3 Describe the indications and techniques for
applying fields extending beyond “involved
field” radiation therapy, including subtotal
nodal irradiation, total nodal irradiation
and TBI
3.2.4 Understand geometric uncertainties as
they apply to image fusion
3.2.5 Describe the role of radiotherapy following
salvage chemotherapy and autograft
3.3 Surgery [G]
3.3.1 Discuss the role of surgery in diagnostic
biopsy and definitive treatment of NHL e.g.
MALT-type (extra-nodal marginal zone)
lymphoma and primary CNS lymphoma
3.4 Systemic Therapy [G]
3.4.1 Discuss the roles of chemotherapy and
radiation therapy in low grade NHL
3.4.2 List commonly used chemotherapy agents
and regimens (current and historical)
3.4.3 Evaluate the use of high-dose
chemotherapy and bone marrow
transplant
3.4.4 Discuss the role of molecularly targeted
agents and radioimmunotherapy
3.5 Other Therapies [G]
3.5.1 Discuss the role of other forms of
treatment eg triple therapy for H. pylori
related gastric MALT-type (extra-nodal
marginal zone) lymphoma, corticosteroids
3.5.2 Discuss CNS prophylaxis
4 Outcomes [D]
3Management
The trainee is able to:
3.1 General [G]
3.1.1 Discuss the impact of pregnancy on
management decisions, including the
significance of gestational stage and
special psychosocial issues (see Breast
page 44 for detailed learning outcomes)
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
The trainee is able to describe the:
4.1 Tumour
4.2 Toxicity
4.2.1 Discuss how late effects (including
secondary malignancy) influence the
evolution of treatment strategies
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AND MES
Non-Hodgkin Lymphoma (NHL)
4.2.2 D
escribe follow-up of patients specifically
with regard to monitoring for late
effects and their management
3.2.2 Explain the practical considerations of the
above techniques
3.2.3 Describe the use of radiotherapy for
granulocytic sarcoma [chloroma]
5 Screening and Prevention [G]
The trainee is able to:
5.1 E xplain the role of H. pylori screening and
eradication in MALT-type (extra-nodal marginal
zone) lymphoma
Leukaemia
1 Oncology Sciences [D]
3.3 Surgery [G]
3.4 Systemic Therapy [G]
3.5 Other Therapies [G]
3.5.1 Discuss the evolving role of biological
therapies e.g. imatinib, dasatinib in chronic
lymphoid leukaemia (CML)
4 Outcomes [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Genetic abnormalities
1.1.2 Infective precursors
1.1.3 M
utagenic therapies associated with
development of leukaemia
The trainee is able to:
4.1 Tumour
4.1.1 Discuss the importance of close follow-up
and the measurement of minimum residual
disease
1.2 Anatomy
4.2 Toxicity
2 Clinical Assessment [D and I]
Multiple Myeloma
The trainee is able to:
2.1 History
1 Oncology Sciences [D]
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 E valuate relevant diagnostic tests,
including molecular and cytogenetic
studies e.g. indicating Ph+ disease
2.3.2 D
escribe significance of minimal residual
disease and the duration of disease
remission
The trainee is able to describe the:
1.1 Pathology
1.1.1 Differences between Monoclonal
Gammopathy of Undetermined
Significance (MGUS), solitary
plasmacytoma in both osseus and
extraosseus sites and multiple myeloma
1.1.2 Discuss the wide variation in clinical
presentation of plasma cell neoplasms
1.2 Anatomy
3Management
2 Clinical Assessment [D and I]
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 D
escribe uses of radiation therapy,
including indications for cranial,
craniospinal or total body irradiation in
both myeloablative and non myeloablative
transplants and total marrow irradiation
Page 100
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigations and Evaluations
2.3.1 Select and evaluate diagnostic tests
including serum IgG and IgA, creatinine,
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
calcium, urinary protein excretion, and
radiology (skeletal survey, CT, and MRI)
ROCKKS
AND MES
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the differences in PTV and
prescription for solitary plasmacytoma
compared to multiple myeloma
3.2.2 Discuss the use of hemi-body radiation
therapy
3.3 Surgery [G]
3.3.1 Discuss the indications for spinal surgery
3.4 Systemic Therapy [G]
3.4.1 Discuss the use of chemotherapy as the
primary treatment modality, including
the most effective regimens, timing of
interventions with systemic therapies
3.5 Other Therapies [G]
3.5.1 Describe the use of bisphosphonates in
multiple myeloma
3.5.2 Describe the evolving role of
immunotherapy and currently used
biological agents
3.5.3 Describe the role of transplantation
4 Outcomes [D]
The trainee demonstrates knowledge of:
4.1 Tumour
4.1.1 The measurement of response to systemic
therapies
4.1.2 The impact of site of plasmacytoma on risk
of progression to multiple myeloma
4.2 Toxicity
5 Screening and Prevention [G]
The trainee demonstrates knowledge of:
5.1 The importance of regular monitoring of patients
with solitary plasmacytoma
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
MUSCULOSKELETAL AND CONNECTIVE TISSUE
MAJOR FOCUS
Soft Tissue Sarcoma104
Bone Metastases105
LESSER FOCUS
Primary Tumours Of The Bone106
Aggressive Fibromatosis106
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 103
Soft Tissue Sarcoma
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The spectrum of malignancy from benign
to malignant and the differential diagnosis
between these entities
1.1.2 The main histological subgroups
of sarcomas and their specific
immunohistochemical features and
chromosome abnormalities
1.1.3 The AJCC staging system
1.1.4 P redisposing factors (eg genetic
predisposition)
1.2 Anatomy
1.2.1 The location of major neurovascular
bundles and fascial planes in relation to
muscle “compartments”
2 Clinical Assessment [D and I]
The trainee is able to :
2.1 History
2.1.1 E licit symptoms arising from tumour
compression of surrounding structures
2.2 Physical Examination
2.2.1 Assess the extent of the tumour and its
relationship to surrounding structures
(eg fixity, relationship to neurovascular
structures)
2.2.2 Assess any functional deficit caused by the
tumour or treatment
2.3 Investigation and Evaluation
2.3.1 D
iscuss optimal biopsy techniques and the
considerations behind the placement of
surgical scars
2.3.2 E valuate staging investigations including
CT, MRI/MRA, bone scan, and PET
3.2 Radiation Therapy [D and I]
3.2.1 The role of radiation therapy in curative
(including definitive, pre- and postoperative, and salvage) and palliative
situations
3.2.2 The advantages and disadvantages
of preoperative versus postoperative
radiation therapy
3.2.3 Special considerations when defining the
planning target volume, specifically:
3.2.3.1 Patient set-up for the treatment of
various limb compartments
3.2.3.2 Indications for elective nodal
irradiation
3.2.3.3 Individualised use of bolus, including
rationale
3.3.4 The role of intra-operative radiation
treatment, brachytherapy and IMRT
3.3 Surgery [G]
3.3.1 The role and indications for surgery
in biopsy, local excision, and
compartmentectomy versus amputation
3.3.2 The importance of wide surgical margins
3.3.3 The potential morbidity and impact on
quality of life following surgery
3.4 Systemic Therapy [G]
3.4.1 The role of systemic therapy in the curative
and palliative settings
3.5 Other Therapies [G]
4 Outcomes [D]
The trainee is able to:
4.1 Tumour
4.1.1 Describe the prognostic factors for distant,
local recurrence and survival
4.2 Toxicity
4.2.1 Measure functional outcome following
treatment and contribute to planning a
suitable rehabilitation program
3Management
The trainee is able to describe:
3.1 General [G]
3.1.1 The importance of multidisciplinary
evaluation and management
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1 Oncology Sciences [D]
The trainee is able to:
1.1 Pathology
1.1.1 List common and less common primary
sites
1.1.2 Recognise the appearance and natural
history of metastases according to primary
site
1.1.3 Describe the mechanisms of bone
metastasis
1.2 Anatomy
1.2.1 Appreciate anatomical implications for the
position of metastases e.g. neck of femur,
adjacent nerves
1.2.2 Describe the typical distribution of bone
metastases within the skeleton and the
reasons for this e.g. prostate cancer and
the vertebral bodies and pelvis
2
Clinical Assessment [D and I]
The trainee is able to
2.1 History
2.1.1 Describe different types of bone pain e.g.
neuropathic
2.1.2 Describe measures and scales of the
severity of pain
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Select suitable investigations for suspected
bony metastases
2.3.2 Describe the mechanism by which bone
scans detect lesions and recognise
diseases where a bone scan may not show
bone metastases e.g. myeloma
2.3.3 Understand the principles of pathological
diagnosis if bone metastases are the first
presentation of cancer
3Management
The trainee is able to:
3.1 General [D]
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.1.1 Demonstrate an understanding of
treatment intent and likely outcomes
3.1.2 Integrate methods of symptom
management of bone metastases with
other components of palliative care
3.1.3 Select patients at higher risk for spinal
cord compression and educate them
accordingly
3.1.4 Demonstrate knowledge of the prevention
of pathological fractures
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the role of single vs multi fraction
treatment schedules for uncomplicated
bone metastases
3.2.2 Discuss the emerging role of high dose
stereotactic radiation in the setting of
oligometastatic disease and re-irradiation
ie spinal metastases.
3.2.3 Discuss the role of hemibody radiotherapy
3.2.4 Identify patients for re-irradiation
3.2.5 Quantify fracture risk and subsequent
impact on dose/fractionation
3.3 Surgery [G]
3.3.1 Describe the role of surgery in diagnosis
3.3.2 Describe the role of surgery in the
prevention and treatment of pathological
fracture
3.4 Systemic Therapy [G]
3.4.1 Describe the potential benefit and use of
radioisotope therapy
3.5 Other Therapies [D and I]
3.5.1 Demonstrate an ability to manage bone
pain with pharmacological agents
3.5.2 Demonstrate an understanding of the
mechanism of action, indications for and
evidence for use of bisphosphonates and
RANK ligand inhibitors
4
Outcomes [D]
4.1 Tumour
4.2 Toxicity
4.2.1 Describe the phenomenon of acute bone
pain flare following radiotherapy
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AND MES
Bone Metastases
Primary Tumours of the Bone
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Bi-modal age distribution
1.1.2 S ites of various tumours in relation to the
epiphysis
1.1.3 Classification of tumours
1.1.4 D
ifferences in mode of spread for different
tumours e.g. aneurysmal bone tumour vs.
osteosarcoma
1.2 Anatomy
1.2.1 Importance of neurovascular supply and
lymphatics
2 Clinical Assessment [D and I]
The trainee is able to discuss the:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
2.3.1 Importance of pathology review
2.3.2 Use of CT, MRI, bone and PET scans
2.3.3 P lain radiographic appearances e.g.
starburst, onion-skin
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Select patients for radiation therapy
3.3 Surgery [G]
3.3.1 D
escribe indications for (considering
advantages and disadvantages) limb
conservation and amputation
3.5 Other Therapies [G]
3.5.1 Discuss the indications for embolisation
4 Outcomes [D]
The trainee is able to describe:
4.1 Tumour
4.2 Toxicity
4.2.1 Functional and cosmetic outcomes
4.2.2 Specific issues for paediatric patients e.g.
growth potential, second malignancy
Aggressive Fibromatosis
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 The relationship to soft tissue trauma (e.g.
surgery), familial adenomatous polyposis
of colon, and Gardner’s syndrome
1.2 Anatomy
1.2.1 The most common anatomical sites of
disease
2 Clinical Assessment [D and I]
The trainee is able to elicit:
2.1 History
2.1.1 The functional impact of disease and
treatments
The trainee is able to perform:
2.2 Physical Examination
2.2.1 A functional assessment of disease and
impact of therapy
The trainee is able to discuss:
2.3 Investigation and Evaluation
2.3.1 The importance of margin status
2.3.2 The place of CT, large volume MRI
(assessment of multifocality)
3.4 Systemic Therapy [G]
3.4.1 E valuate use of neo-adjuvant
chemotherapy
3.4.2 D
escribe uses of intra-arterial
chemotherapy
Page 106
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3Management
3.1 General [G]
ROCKKS
AND MES
The trainee is able to describe:
3.2 Radiation Therapy [D and I]
3.2.1 Indications for adjuvant and definitive
settings
3.2.2 The role of observation in situations where
post-operative margins are involved
3.2.3 The importance of large margins on CTV,
especially longitudinally
The trainee is able to discuss:
3.3 Surgery [G]
3.3.1 The indications for biopsy and local
excision
3.3.2 The importance of wide resection margins
The trainee is able to discuss:
3.4 Other Therapies [G]
3.4.1 Reported responses to other therapies e.g.
tamoxifen, steroids, non-steroidal antiinflammatory drugs, imatinib (Glivec)
4 Outcomes [D]
The trainee is able to discuss expected outcomes of
treatment relating to:
4.1 Tumour
4.2 Toxicity
4.2.1 Potential functional and cosmetic
morbidity of surgery
4.2.2 Morbidity of adjuvant or definitive
radiation therapy, especially in the
paediatric population
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
PAEDIATRICS
LESSER FOCUS
Paediatric Cancers110
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 109
Paediatric Cancers
1 Oncology Sciences [D]
The spectrum of paediatric cancer is unique because it is
not defined by histological entity but by age (generally
accepted as <16 years).
The trainee is able to describe:
1.1 Pathology
1.1.1 The RB gene, and the syndromes
associated with Wilms’ tumours
1.1.2 Variations in differentiation of “small
round blue cell tumours”, and differences
in natural history and modes of spread
Although paediatric patients and tumours are infrequently
seen in a Radiation Oncology practice, the fundamental
reasons for all trainees achieving a good level of
knowledge in this area are:
1. S o that trainees develop an appreciation of
managing malignancy in the developing child,
focusing on the long-term consequences of
treatment choices, in particular “survivorship”
2. S o that trainees consider issues related to
delegated consent
It should be appreciated that both survivorship and
consent issues also occur in adult oncology but are usually
of a lesser focus.
The management of children with differing cancers
follows a basic pattern of minimising radiation with its
potent long-term consequences whilst maintaining or
improving cure. This is well illustrated by the changes in
the management of Acute Lymphocytic Leukeamia (ALL)
and Hodgkin’s Lymphoma, particularly when contrasted
with the adult setting.
The specific malignancies that trainees should have most
detailed knowledge of are:
• “Developmental” Malignancies:
Retinoblastoma; Neuroblastoma; Wilms’ tumour
• Haematological Malignancies: ALL; Hodgkin’s
Lymphoma
• Musculoskeletal Malignancies:
Rhabdomyosarcoma; Ewing’s Sarcoma;
Osteosarcoma;
• CNS Malignancies: Medulloblastoma;
Ependymoma; Brain Stem Glioma; Other Gliomas;
CNS Germ Cell Tumours
At the end of this section, following the general headings,
are key learning objectives relating to each of these
malignancies. In addition, the trainee is advised to refer to
other relevant MES.
Page 110
1.2 Anatomy
1.2.1 Anatomical variations from adult e.g.
skeleton
2 Clinical Assessment [D]
The trainee is able to describe the importance of:
2.1 History
2.1.1 Familial cancers
2.1.2 Developmental status in management
decisions
2.1.3 Second malignancies
2.2 Physical Examination
The trainee is able to evaluate relevant diagnostic tests,
specifically:
2.3 Investigation and Evaluation
2.3.1 Understand the role of CNS evaluation
in ALL, parameningeal RMS, and CNS
tumours
2.3.2 Understand the roles of MRI and PET in
staging sarcomas and brain tumours
2.3.3 Understand the impact of treatment
on fertility, tissue growth, and
neuropsychological development
2.3.4 Describe the relevant prognostic factors
and risk groupings
3Management
3.1 General [G]
The trainee is able to describe:
3.2 Radiation Therapy [D]
3.2.1 Immobilisation of children and infants,
including anaesthesia
3.2.2 Considerations for planning target volume
3.2.3 Importance of tolerance of organs at risk
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3.2.4 S tandard doses and fractionation
schedules
3.2.5 D
ose escalation and altered fractionation
3.2.6 U
se of special techniques – IMRT,
brachytherapy, stereotactic, TBI
3.2.7 Use of radiation for palliation
The trainee is able to describe the:
3.3 Surgery [G]
3.3.1 R
ole and extent of surgery, as part of
overall management
The trainee is able to:
3.4 Systemic Therapy [G]
3.4.1 D
escribe the role, and timing, of
chemotherapy in conjunction with other
treatments
3.4.2 D
emonstrate knowledge of the common
drugs used for the specific malignancies
listed
The trainee is able to describe the:
3.5 Other Therapies [G]
3.5.1 U
se of agents such as retinoic acid
in neuroblastoma, and steroids in
haematological and CNS malignancies
4 Outcomes [D]
In reference to the following specific tumour histologies,
the trainee is able to describe the significance of:
6.1 Retinoblastoma
6.1.1 The RB gene and the impact of Knudson’s
“two-hit hypothesis” in understanding
carcinogenesis
6.1.2 The implications of optic nerve and/or
scleral involvement
6.2 Neuroblastoma
6.2.1 Embryonic neural crest cell maturation and
consequent limitations of infant screening
6.2.2 The impact of N-Myc amplification and the
use of biological markers to guide therapy
6.2.3 The use of MIBG for staging and therapy
6.3 Wilms’
6.3.1 Differences between the SIOP and National
Wilms’ Tumour Study (NWTS) approach to
management
6.3.2 “Favourable” versus “unfavourable”
histology
6.4 Acute Lymphocytic Leukaemia
6.4.1 Defining children in the “high-risk”
category
6.4.2 CNS preventive therapy including CSI
4.1 Tumour
The trainee is able to discuss the risks, management and
prevention of:
4.2 Toxicity
4.2.1 Acute and late morbidity of radiation and
other treatment, in particular, growth
and developmental issues (including
neuropsychological), fertility and second
malignancy
4.2.2 The above treatment toxicities with the
patient and family
5 Screening and Prevention [G]
The trainee is able to describe:
5.1 The use of genetic testing, and involvement of
the familial cancer service
6 Tumour Specific Points
5.2 The rationale for long-term follow-up and “late
effects clinics”
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
6.5 Hodgkin’s Lymphoma
6.5.1 PET in defining involved fields
6.5.2 Issues specific to adolescent patients
6.6 Rhabdomyosarcoma (RMS)
6.6.1 Nodal spread
6.6.2 So-called “favourable” sites of RMS
6.6.3 Sequencing therapy for parameningeal
RMS
6.6.4 Differences in European (SIOP) and North
American (COG) management approaches
6.7 Ewing’s Sarcoma
6.7.1 Distinguishing this disease from PNET
6.7.2 Associated chromosomal abnormalities
6.8 Osteosarcoma
6.8.1 The association with the RB gene
6.8.2 Isolated metastases e.g. to lung and
management thereof
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AND MES
6.9 Medulloblastoma
6.9.1 Gene expression profiles and prognosis
6.9.2 H
igh and average risk categories and
influence on management
6.9.3 H
ydrocephalus and relationship to
neurocognitive function
6.10 Ependymoma
6.10.1 Gene expression profiles and prognosis
6.10.2 B
aby brain study outcomes and
controversy surrounding benefit of
radiation therapy
6.10.3 C
hoice of local versus craniospinal
irradiation
6.11 Brain Stem Glioma
6.11.1 The classical diffuse infiltrating pontine
tumour in paediatric setting
6.11.2 R
isks of obtaining histological
confirmation
6.11.3 This diagnosis in relation to urgency of
treatment
6.11.4 Temozolamide as part of treatment
regimen
6.12 Other Gliomas
6.12.1 The option of observation for NF-1 and
visual pathway gliomas
6.12.2 J uvenile pilocystic astrocytoma (JPA) in
relation to timing and dose of radiation
therapy
6.12.3 H
igh grade gliomas and management
issues in the paediatric setting LiFraumeni syndrome in connection with
gliomas
6.13 Intracranial Germ Cell Tumours
6.13.1 D
ifferentiating lesions from other
suprasellar pathologies
6.13.2 H
istorical “test” dose radiation therapy
(to confirm germ cell origin)
6.13.3 E mploying whole ventricle treatment in
comparison with CSI
6.13.4 S ystemic therapy options and their
sequencing with radiation therapy
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
ENDOCRINE
MAJOR FOCUS
Thyroid Cancer114
LESSER FOCUS
Adrenal Tumours114
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 113
Thyroid Cancer
1 Oncology Sciences [D]
The trainee demonstrates knowledge of the:
1.1 Pathology
1.1.1 C
ompare and contrast the epidemiology,
risk factors, presentation, histology and
the biological behaviour of the different
pathological subtypes (papillary carcinoma,
follicular carcinoma, medullary carcinoma,
and anaplastic carcinoma)
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to elicit:
2.1 History
2.1.1 P rognostic determinants, in particular age
groups
2.2 Physical Examination
The trainee is able to select and interpret diagnostic tests
and staging investigations including:
2.3 Investigations and Evaluations
2.3.1 B
lood investigations e.g. thyroid function
tests, thyroglobulin, and calcitonin
2.3.2 Imaging e.g. radionuclide scan and CT
3Management
The trainee is able to:
3.1 General [G]
3.1.1 D
escribe different treatment approaches
for different pathological subtypes of
thyroid cancer
3.1.2 D
iscuss the impact on treatment decisions
in the situation of the pregnant patient
(refer to Breast page 44 for detail of
learning outcomes)
3.2 Radiation Therapy [D and I]
3.2.1 D
iscuss the use of radioactive iodine and
involvement of the endocrinologist in
papillary and follicular carcinoma
3.2.2 D
escribe external-beam radiation therapy
techniques
Page 114
3.3 Surgery [G]
3.3.1 Describe surgical techniques for the relief
or prevention of respiratory obstruction
3.3.2 Discuss the indications for total
thyroidectomy versus partial thyroidectomy
3.3.3 Describe the role of neck dissection
3.4 Systemic Therapy [G]
3.4.1 Acknowledge the limited role of
conventional cytotoxic chemotherapy and
discuss the role for targeted therapies
4 Outcomes [D]
The trainee demonstrates knowledge of the:
4.1 Tumour
4.1.1 Differences in prognosis for the different
pathological subtypes of thyroid cancer
4.2 Toxicity
4.2.1 Toxicity of radiation therapy treatment,
radioactive iodine and surgery
4.2.2 Use of medical therapy for hormone
deficiency [G]
5 Screening and Prevention [G]
The trainee demonstrates knowledge of the:
5.1 Situations where prophylactic thyroidectomy and
screening for phaeochromocytoma in MEN II
families would be recommended
Adrenal Tumours
1 Oncology Sciences [D]
The trainee is able to describe the:
1.1 Pathology
1.1.1 Importance of MEN (multiple endocrine
neoplasia) syndromes
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
2.2.1 Describe the following clinical syndromes:
2.2.1.1 C
ushing’s syndrome
2.2.1.2 C
onn’s syndrome
ROCKKS
AND MES
2.3 Investigation and Evaluation
2.3.1 Interpret blood and urine tests to assess
the adrenal status
2.3.2 Describe the radiological features of
benign and malignant tumours
2.3.3 Discuss the importance of nodal
involvement and inferior vena cava (IVC)
involvement
3Management
The trainee is able to:
3.1 General [G]
3.1.1 Discuss the management of electrolyte and
hormone imbalances
3.1.2 Discuss the control of blood pressure
3.2 Radiation Therapy [D and I]
3.2.1 Discuss the indications for adjuvant
radiation therapy
3.2.2 Discuss the use of radiation for palliation
3.3 Surgery [G]
3.3.1 Describe the utility of surgery in early
stage disease and palliation
3.4 Systemic Therapy [G]
4 Outcomes [D]
4.1 Tumour
4.2 Toxicity
5 Screening and Prevention [G]
The trainee is able to:
5.1 Identify families at risk of MEN and refer
appropriately for genetic counselling
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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AND MES
MEDICAL EXPERT
Medical Expert Supplement
METASTATIC DISEASE
MAJOR FOCUS
Metastatic Carcinoma of Unknown Primary Site
118
LESSER FOCUS
Metastases at Sites Not Otherwise Specified
118
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 117
Metastatic Carcinoma of
Unknown Primary Site
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 C
ommon patterns of lymphatic and
haematogenous spread
1.1.2 C
ytological, histological and
immunohistochemical features that assist
in determining the primary site
1.1.3 The role of tumour markers
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 E licit clinical features that may aid in
identification of the likely primary
2.2 Physical Examination
2.2.1 Identify where specialised examination
techniques may be required e.g.
nasendoscopy
2.3 Investigation and Evaluation
2.3.1 S elect and interpret appropriate
investigations, including biopsy techniques,
aimed at identification of subtypes
of malignancy e.g. carcinoma versus
lymphoma: adenocarcinoma versus
squamous cell carcinoma
2.3.2 E xplain the importance of histological
confirmation of malignancy
3Management
The trainee is able to discuss:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 The need, on rare occasions, to commence
treatment prior to the completion of a
full diagnostic work-up, even potentially
without histological confirmation
e.g. spinal cord compression, airway
compromise
Page 118
3.2.2 Situations where radiation therapy
management of an occult primary may
be undertaken with curative intent e.g.
squamous cell carcinoma metastatic to
parotid gland or cervical lymph nodes:
adenocarcinoma metastatic to axillary
lymph nodes
3.3 Surgery [G]
3.4 Systemic Therapy [G]
4 Outcomes [D]
The trainee is able to describe:
4.1 Tumour
4.1.1 The differing prognoses dependent on the
probable primary
4.2 Toxicity
Metastases at Sites Not
Otherwise Specified
The rationale for this as a separate topic is to
emphasise the principles of palliation employing nonpharmacological modalities. Note that management of
metastases is also dealt with in the tumour site topics and
in separate bone, brain and liver metastases sections.
1 Oncology Sciences [D]
The trainee is able to describe:
1.1 Pathology
1.1.1 Unusual patterns of metastatic spread that
prompt need for histological confirmation
e.g. isolated lung tumour in the setting
of an otherwise low-risk previous breast
cancer; cerebral tumours following
previous prostate cancer
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.1.1 Recognise clinical features that assist in
assessing performance status
2.2 Physical Examination
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ROCKKS
AND MES
2.3 Investigation and Evaluation
2.3.1 Select and interpret appropriate
investigations including biopsy techniques
to confirm the presence of disease,
histology and define disease extent
2.3.2 Explain the importance of histological
confirmation of metastases in certain
situations (as above)
3Management
The trainee is able to:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 Recognise the impact of Eastern
Cooperative Oncology Group (ECOG)
performance status, weight loss, histology,
and volume of disease on radiation
schedules
3.3 Surgery [G]
3.3.1 Identify situations where metastectomy
may be appropriate
3.3.2 Evaluate palliative surgical interventions
e.g. stenting
3.4 Systemic Therapy [G]
3.4.1 List agents, regimens and modes of
delivery that are most efficacious for
palliation, according to histology and site
of metastatic spread
3.4.2 Liaise with medical oncology team
regarding appropriate sequencing of
therapy
4 Outcomes [D]
The trainee is able to discuss:
4.1 Tumour
4.1.1 The likelihood of particular symptoms
responding to local palliative therapy
4.1.2 The differing prognoses dependent on
the cancer type, disease-free-interval, site
of metastases and how this influences
therapy and follow-up
4.2 Toxicity
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
NON-MALIGNANT
LESSER FOCUS
Non-Malignant Diseases Treated With Radiation Therapy 122
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 121
Non-Malignant Diseases treated
with Radiation Therapy
It is expected that the following benign diseases are
studied in detail –
• heterotopic bone ossification (HBO)
• keloid scarring
• pterygium
• Grave’s ophthalmopathy (hyperthyroid eye disease)
Some non-malignant conditions that fit within a siteoriented supplement will be covered elsewhere e.g.
pituitary adenoma, acoustic neuroma and non-malignant
tumours of bone.
There are a number of other non-malignant conditions
where radiation is occasionally used. It is not expected
that these are studied in detail.
1 Oncology Sciences [D]
3.3 Surgery [G]
3.4 Systemic Therapy [G]
3.5 Other Therapies [G]
3.5.1 Alternative options for management and
their effectiveness e.g. non-steroidal antiinflammatory agents in HBO; steroids for
keloid scars and Grave’s ophthalmopathy
4 Outcomes [D]
The trainee is able to discuss the:
4.1 Non-malignant disease
4.1.1 Benefits of various treatments
4.2 Toxicity
4.2.1 Incidence, histopathology, natural
history and features of radiation-induced
malignancies
The trainee is able to discuss:
1.1 Pathology
1.1.1 B
enign conditions that have historically
been treated with radiation therapy e.g.
ankylosing spondylitis, Peronie’s disease,
synovitis
1.1.2 P athophysiology of benign processes that
are treated with radiation therapy
1.2 Anatomy
2 Clinical Assessment [D and I]
The trainee is able to:
2.1 History
2.2 Physical Examination
2.3 Investigation and Evaluation
3Management
The trainee is able to discuss:
3.1 General [G]
3.2 Radiation Therapy [D and I]
3.2.1 The timing of radiation therapy in relation
to surgery
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ROCKKS
AND MES
MEDICAL EXPERT
Medical Expert Supplement
CLINICAL ONCOLOGY
MAJOR FOCUS
Symptom Control124
Quality Of Life 125
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 123
Symptom Control
2 Management [D and I]
Cancer pain
1 Clinical Assessment [D and I]
2.1 Understand that the cause of dyspnoea is often
multifactorial and that treatment is dictated by
the suspected cause
1.2 D
escribe the location of dermatomes
2.2 Pharmacological management
2.2.1 Assess suitability for and prescribe
medication to treat dyspnoea e.g.
steroids, opiates, anticoagulation and
benzodiazapines
1.3 Assess the patient and select or review
investigations in order to determine the likely
causes and severity of the pain
2.3 Non-Pharmacological management
2.3.1 Assess suitability for blood transfusion,
pleural tap, pleurodesis, and paracentesis
The trainee is able to:
1.1 D
iscuss the causes of cancer pain i.e. somatic,
visceral, neuropathic and psychological [G]
2 Management [D and I]
Nausea and Vomiting
1 Clinical Assessment [D and I]
2.1 U
nderstand that a multidisciplinary approach is
often required to achieve adequate analgesia
2.2 Pharmacological management
2.2.1 P rescribe non-opiate and common opiate
analgesics; choose the most appropriate
drug and route of administration
2.2.2 Anticipate and manage potential side
effects of common analgesics e.g.
constipation, nausea
2.2.3 D
escribe the role of adjuvant analgesics
e.g. steroids, anti-epileptics, antidepressants, bisphosphonates
2.2.4 Assess response to a chosen analgesic
regimen and select patients for referral to
a palliative care or pain specialist
2.3 Non-Pharmacological management [G]
2.3.1 D
escribe common anaesthetic and
palliative surgical procedures that may be
used to control pain
Dyspnoea
1 Clinical Assessment [D and I]
The trainee is able to:
1.1 Discuss the causes of cancer-related and
treatment-related nausea and vomiting
1.2 Assess the patient and select or review
investigations to determine the likely cause and
severity of nausea or vomiting
2 Management [D and I]
2.1 Understand the multi-factorial nature of nausea
and vomiting
2.2 Pharmacological management
2.2.1 Assess suitability for, and prescribe,
appropriate medication e.g.
hydroxytryptamine receptor blockers (5HT3), dopamine antagonists, haloperidol,
steroids and aperients
2.3 Non-pharmacological management
2.3.1 Select patients for palliative surgical
procedures to treat uncontrolled nausea
and vomiting
The trainee is able to:
1.1 Discuss the causes of cancer-related dyspnoea
1.2 Assess the patient and select or review
investigations in order to determine the likely
cause(s) and severity of the dyspnoea
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1 Clinical Assessment [D]
The trainee is able to:
1.1 L ist the risk factors for cancer patients
developing depression or anxiety
1.2 D
iscuss the difficulties associated with diagnosis
of depression in the cancer patient
1.3 D
escribe the cognitive symptoms of depression
that aid in diagnosis
Quality of Life (HR-QoL)
The purpose of this section is to emphasise the
importance of addressing health-related quality of
life (HR-QoL) during the assessment of patients,
communication with patients and their carers and during
the formulation of a suitable management plan. In
addition, an understanding of the importance of choosing
appropriate quality of life end points and employing
suitable measurement tools to assess these endpoints,
both as part of clinical trials as well as in the evaluation
of “standard” treatment programs, is fundamental to the
optimal practice of oncology.
2 Management [D and I]
Specifically, the trainee is able to describe and discuss:
1 Principles of Quality of Life [G]
2.1 U
nderstand that depression and anxiety in the
cancer patient is best managed by a combination
of drugs, supportive psychotherapy and
cognitive-behavioural techniques
1.1 Working definitions for health-related HR-QoL
1.2 The potential influence that HR-QoL factors may
have on treatment related decision-making by
patients, carers and doctors
1.3 How consideration of short-term versus longterm quality of life may differ with treatment
intent and patient factors - e.g. significant acute
side effects causing a temporary deterioration
in HR-QoL may be acceptable in the potentially
curative treatment of a young man with
metastatic testis cancer but not in an elderly
patient with co-morbidities and very low chance
of cure
1 Clinical Assessment [D]
The trainee is able to:
1.1 D
escribe the symptoms and signs associated with
hypercalcaemia
1.4 The approach to discussion of the impact of
radiation therapy and other interventions /
therapies on HR-QoL
1.5 The particular relevance of HR-QoL issues when
balancing the possibilities of active treatment
against no treatment in the palliative and
terminal phases of disease
2.2 S elect patients for referral for psychiatric
assessment
2.3 Pharmacological management [G]
2.3.1 List commonly used anti-depressants and
understand that in the setting of advanced
disease, the selection of drug is dependent
on the type of depressive symptoms,
intercurrent medical problems and the
drug side effect profiles
Hypercalcaemia
1.2 Assess hydration and renal function
2 Management [D and I]
2.1 S elect patients for, and prescribe, appropriate
rehydration and bisphosphonate therapy
2.2 Evaluate response to therapy
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
2 Measurement of Quality of Life [G]
2.1 One or two commonly used instruments for the
measurement of aspects of HR-QoL in oncology
and the basic format and scope of each of
these e.g. SF-36 (a global HR-QOL measure for
use in patients with any disease, the European
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AND MES
Depression and Anxiety
Organisation for the Research and Treatment
of Cancer (EORTC) QLQ-C30 (a global measure
of HR-QOL in all cancer patients), QLQ-BR23 (a
breast cancer specific module), , hospital anxiety
and depression scale (HADS) or other
2.2 The basic process for the development and
evaluation of HR-QoL instruments, including
validation and analysis of data (in simple terms)
2.3 K
ey HR-QoL concepts that are relevant to
consider in varying clinical contexts such as when
measuring the efficacy of a given treatment or
in the setting of clinical trial development. eg.
Perceptions of body image after breast cancer
treatments, or sexual function in prostate cancer
2.4 The meaning of health-related HR-QoL
“domains” in HR-QoL measurement
2.5 The concept and examples of “trade-offs”
pertaining to Oncology
2.6 The concept of “utility” of treatment options
2.7 The meaning of HR-QoL-adjusted life years
(QALYs) and how these may be employed in
comparison of treatment regimens
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
LEARNING
OPPORTUNITIES
MEDICAL EXPERT
Learning Opportunities
It is essential that this Medical Expert Supplement (MES) be used in conjunction
with the ROCKSS document (page 39). MES direct the trainee to areas of
study that are in some way particular or unique to the topic in question.
In contrast, the ROCKSS competencies form the core requirements
for all topics, regardless of tumour site or clinical scenario.
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Page 127
MEDICAL EXPERT LEARNING
OPPORTUNITIES
1New patients seen as inpatients
or outpatients
3.3 Prepare treatment summaries
3.4 Obtain feedback on referrals to other health
professionals
3.5 Receive appraisal of performance by radiation
therapists, physicists, medical oncologists and
nurses
The trainee may, under consultant supervision:
1.1 Assess new patients
1.2 D
iscuss treatment recommendations with patient
and family
1.3 Review tests and referrals
1.4 S ubmit a specific dose and fractionation schedule
1.5 O
btain feedback on presentation of patients
at MDT
1.6 Reflect on new patients seen and treatment
planned
1.7 Dictate letters and reports
2 Follow up patients
The trainee may, under consultant supervision:
2.1 Assess patients under active follow up
2.2 C
onduct an audit of documentary record of
findings
2.3 C
onduct an audit of recommended treatments for
symptom control and toxicity
2.4 Counsel a patient and family
2.5 C
onduct an audit of referrals to other specialists
and health professionals
3 Treatment review
The trainee may, under consultant supervision:
3.1 Assess patients during course of radiation
therapy and manage toxicities
3.2 C
onduct an audit of documentation of diagnosis
and management of acute toxicities
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4 Inpatient Care
The trainee may, under consultant supervision:
4.1 Assess patients and make decisions regarding
management
4.2 Discuss treatment recommendations with patient
and family
4.3 Review tests results
4.4 Reflect on patients seen and treatment planned
4.5 Review, and seek feedback on, documentation of
patient care
4.6 Present patients on ward rounds, and receive
feedback
4.7 Conduct an audit of patient care or discharge
planning
5Radiation Therapy Planning
and Treatment
The trainee may, under consultant supervision:
5.1 Submit a provisional radiation therapy treatment
prescription
5.2 Contour structures, and receive feedback
5.3 Critically appraise treatment plans
5.4 Reflect on radiation therapy treatment plans
5.5 Participate in simulator sessions, including using
planning software
5.6 Participate in physics tutorials regarding
treatment techniques and quality assurance
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
5.7 Review treatment verification
5.8 Complete a planning module
5.9 Outline response to set-up errors
5.10 O
bserve and discuss specific methods in
brachytherapy e.g. gynaecological, prostate
6.14 Complete a rotation within medical oncology
and palliative care
LEARNING
OPPORTUNITIES
6 Other learning opportunities
The trainee may:
6.1 Engage in self-directed study e.g. reading
6.2 D
iscuss oncology issues with a Radiation
Oncologist
6.3 P articipate in departmental and state-wide
tutorials
6.4 Participate in hospital grand rounds
6.5 E ngage in on-line and other computer-based
learning activities e.g. attend a literature
searching course, learn to use reference manager
soft-ware, undertake a Cochrane Library users
course
6.6 Participate in journal clubs
6.7 Participate in MDT meetings
6.8 P articipate in special meetings e.g. examination
preparation courses, paediatric course, scientific
meetings
6.9 Supervise and teach attached junior medical staff,
medical students, nurses and radiation therapists
6.10 C
onduct a literature review or internet search,
relating to patients seen or for research
6.11 S pend rostered time on treatment machines
6.12 S pend rostered time in planning with radiation
therapists and physicists
6.13 O
bserve surgical and interventional procedures
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COMMUNICATOR
COMMUNICATOR
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Role 2: Communicator
The Radiation Oncologist:
• Establishes a professional relationship with the patient and their family, and is sensitive to their illness, social
situation and cultural background
• Is expert in eliciting and synthesising relevant history and patient preferences by directed questioning and
effective listening
• Discusses information with patients, their families and their health care team, using appropriate language
• Maintains ethical and effective verbal and written communication with other practitioners, in all roles
1 Patients and significant others
The trainee is able to:
1.1 Learning Outcomes
1.1.1 Obtain adequate information from the
patient to formulate a history, diagnosis
and management plan
1.1.2 Identify and explore the patient’s issues
and concerns within the scope of a
focussed consultation
1.1.3 Discuss with the patient and relatives/
carers the implications of the patient’s
cancer, the stage of the disease,
the prognosis, treatment options,
complications and supportive care in a
clear, honest and empathetic manner
1.1.4 Explain and manage issues that
arise from diagnostic or therapeutic
uncertainty
1.1.5 Recognise and respect the differing
needs of patients for a variety of
levels of information and degrees of
participation in management decisions
1.1.6 Provide an environment in which the
patient can ask questions and seek
guidance about other treatments
1.1.7 Ascertain the patient’s and carer’s
understanding of the information
provided
1.1.8 Explain details of radiation therapy
planning and the treatment process (e.g.
physical isolation during treatment)
1.1.9 Recognise and manage patient anxiety
1.1.10 Obtain informed consent and document
information on which consent is based
1.1.11 Demonstrate specific communication
skills required to deal with emotional
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
reactions of patients and families e.g.
denial, anger
1.1.12 Satisfy privacy and confidentiality
requirements as they pertain to the
individual
1.1.13 Demonstrate awareness of, and
communication skills to deal effectively
with, patients from culturally and
linguistically diverse backgrounds
1.1.14 Discuss with the patient and significant
others the implications of familial
cancer clinics and genetic testing
The trainee may:
1.2 Learning Opportunities
1.2.1 Conduct a consultation with a patient and
their family, and receive feedback from an
observer
1.2.2 Counsel a palliative patient and their
family regarding prognosis, and receive
feedback from an observer
1.2.3 Reflect on a patient interview where
informed consent for treatment or
participation in a clinical trial was
obtained
1.2.4 Participate in family conferences
1.2.5 Complete formal communication skills
training, especially in the areas of breaking
bad news, dealing with uncertainty and
preparing a patient for potentially injurious
interventions
1.2.6 Complete a course on working with
interpreters
1.2.7 Participate in tutorials and role plays on
end of life issues
1.2.8 Discuss with a clinical psychologist
common problems for cancer patients
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COMMUNICATOR
Role Statement
e.g. dealing with uncertainty, anxiety,
claustrophobia, panic disorder
1.2.9 Attend teaching sessions on cultural
variations in beliefs about, and responses
to, illness and death
2 Other health professionals
3.1.2 Use language appropriate to the audience
and the topic
The trainee may:
3.2 Learning Opportunities
3.2.1 Speak to community or patient groups
about aspects of cancer care, and receive
feedback
The trainee is able to:
2.1 Learning Outcomes
2.1.1 P resent the patient’s problems succinctly
and accurately to colleagues, listen to
other health professionals’ opinions and
contribute to consensus decisions
2.1.2 E xplain how radiation therapy fits into the
overall management plan, including the
potential benefits and side effects
2.1.3 S eek advice from clinical colleagues where
their expertise may contribute to a better
outcome
2.1.4 C
ommunicate with other professional
groups (e.g. radiation therapists, physicists,
managers, administrators) to achieve
optimal patient care
The trainee may:
2.2 Learning Opportunities
2.2.1 B
e appraised by radiation therapists,
physicists, medical oncologists and nurses
2.2.2 P resent patients at multidisciplinary team
meetings and reflect on outcomes, and
discuss these with colleagues
2.2.3 P resent at educational meetings and
obtain feedback
2.2.4 P resent cases to a clinical supervisor and
receive feedback
2.2.5 S upervise and teach medical students,
nurses and radiation therapists
2.2.6 D
ictate letters and reports for review by a
clinical supervisor
3 The community
The trainee is able to:
3.1 Learning Outcomes
3.1.1 Talk with a range of community groups e.g.
patient support groups, interest groups,
school students, medical students, and the
media
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COLLABORATOR
COLLABORATOR
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Role 3: Collaborator
Role Statement
The Radiation Oncologist:
• Establishes and maintains interpersonal co-operative relationships with patients
• Establishes and maintains interpersonal co-operative relationships with other healthcare providers
• Facilitates optimal patient care both in the out-patient and inpatient setting
• Participates in research and educational activities
The trainee is able to:
1.1 Learning Outcomes
1.1.1 Work with the patient and others to find
common goals
1.1.2 Co-ordinate services
1.1.3 Support cancer patients and their families
The trainee may:
1.2 Learning Opportunities
1.2.1 Observe and discuss senior colleagues’
interactions with patients
1.2.2 Attend other interdisciplinary cancerrelated consultations (e.g. psychology
services)
1.2.3 Conduct family conferences
1.2.4 Participate in cultural awareness training
1.2.5 Compile a list of local support services
1.2.6 Attend and participate in cancer support
groups
2 Other health professionals
The trainee is able to:
2.1 Learning Outcomes
2.1.1 Seek colleagues’ opinions, both formally
and informally
2.1.2 Respond constructively to feedback
2.1.3 Co-ordinate care with general practitioners
2.1.4 Develop and implement clinical guidelines
The trainee may:
2.2 Learning Opportunities
2.2.1 Participate in formal and informal
performance appraisal
2.2.2 Participate in a mentoring program
2.2.3 Develop a management and follow-up
plan with a general practitioner
2.2.4 Read current intra-departmental guidelines
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
2.2.5 Participate in review and implementation
of new guidelines
3 Multidisciplinary patient care
The trainee is able to:
3.1 Learning Outcomes
3.1.1 Co-ordinate services
3.1.2 Inform other specialties of the role of
radiation therapy
3.1.3 Explore treatment alternatives
3.1.4 Work with other specialties and allied
health staff to arrive at an optimal patientfocused management program
3.1.5 Develop and implement evidence-based
guidelines
The trainee may:
3.2 Learning Opportunities
3.2.1 Participate in and organise team meetings
3.2.2 Work with other medical and allied health
staff to ensure optimal case management
3.2.3 Present at team meetings
3.2.4 Discuss management options in a
multidisciplinary setting
3.2.5 Review and synthesise new evidence for
presentation
3.2.6 Participate in the development of
guidelines
4 Research and clinical trials groups
The trainee is able to:
4.1 Learning Outcomes
4.1.1 Contribute to the design, conduct and
analysis of research activities
4.1.2 Support and participate in local and
multicentre studies and trials
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COLLABORATOR
1 Patient and significant others
The trainee may:
4.2 Learning Opportunities
4.2.1 C
omplete the training research
requirement
4.2.2 Recruit to clinical trials
4.2.3 Attend clinical trials meetings e.g. TROG
Scientific Meeting
4.2.4 P articipate in the collection of clinical trial
data
4.2.5 P resent their own research for the Varian
prize
5 Education stakeholders
The trainee is able to:
5.1 Learning Outcomes
5.1.1 E ngage constructively with other
education stakeholders to provide teaching
in Oncology
5.1.2 P articipate in RANZCR meetings and
activities
The trainee may:
5.2 Learning Opportunities
5.2.1 Attend review meetings of local teaching
programs
5.2.2 D
esign teaching content, based on the
requirements of universities
5.2.3 O
rganise and prepare trainee teaching
programs
5.2.4 Act as a Trainee Representative on local
and RANZCR committees
6 Health managers
The trainee is able to:
6.1 Learning Outcomes
6.1.1 Work with health managers and colleagues
to ensure the best use of available
resources
The trainee may:
6.2 Learning Opportunities
6.2.1 D
raw up a trainee roster for cover and
educational activities
6.2.2 P articipate in departmental management
committees
6.2.3 C
ollect and present information relating
to resource management to inform
departmental policy
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MANAGER
MANAGER
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Role 4: Manager
Role Statement
The Radiation Oncologist:
• Optimises decisions regarding individual patient care in the context of finite health care resources
• Provides leadership in healthcare organisations
• Ensures effective work practices through staffing and the development of policies and procedures based on
appropriate use of information systems
1Resources
The trainee is able to:
1.1 Learning Outcomes
1.1.1 Describe budgetary considerations in
an established Radiation Oncology
department
1.1.2 Consider resource limits when ordering
investigations for individual patients
1.1.3 Evaluate and explore alternative methods
of patient investigation and treatment on
behalf of the department
1.1.4 Evaluate the use of clinical guidelines to
assist patient care
1.1.5 Manage waiting times, including the
prioritisation of patients for evaluation and
treatment
1.1.6 Demonstrate an understanding of quality
assurance and accreditation activities
within a Radiation Oncology department
1.1.7 Collect activity data to inform decisions
regarding service provision e.g. when to
build a new department
1.1.8 Describe issues to consider in the
establishment and maintenance of
databases
1.1.9 Describe the process and costs involved
in establishing a new Radiation Oncology
department
The trainee may:
1.2 Learning Opportunities
1.2.1 Participate in departmental staff and
business meetings
1.2.2 Order appropriate and optimally
sequenced investigations for a patient
1.2.3 Assign waiting time priorities according to
departmental protocols
1.2.4 Attend a time management course
1.2.5 Attend a business management course
3Technologies
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
1.2.6 Participate in quality assurance and
accreditation activities of the department
1.2.7 Review jurisdictional and national cancer
strategies
1.2.8 Participate in departmental activity data
collection and review
The trainee is able to:
2.1 Learning Outcomes
2.1.1 Display skills in conflict resolution
2.1.2 Display skills in the management of
trainees
2.1.3 Display leadership skills
2.1.4 Chair clinical and non-clinical meetings
The trainee may:
2.2 Learning Opportunities
2.2.1 Attend training sessions on conflict
resolution
2.2.2 Manage trainee rosters
2.2.3 Be active in taking up leadership
opportunities e.g. Trainee Representative
on RANZCR committees
2.2.4 Participate in performance management
e.g. assessor in multi-source feedback
activities
2.2.5 Participate in staff selection committees
The trainee is able to:
3.1 Learning Outcomes
3.1.1 Actively participate in the assessment,
development, installation and application
of new technologies
3.1.2 Describe the features of electronic
information systems as applied to
Radiation Oncology
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MANAGER
2People
3.1.3 D
emonstrate understanding of data
storage options and discuss advantages
and limitations
The trainee may:
3.2 Learning Opportunities
3.2.1 Attend discussions, and join committees,
regarding new technologies
3.2.2 Teach colleagues to use new technologies
3.2.3 Attend information technology teaching
sessions
3.2.4 Investigate the information system
operating in their own training department
3.2.5 U
ndergo training in the use of electronic
records and retrieval of results
3.2.6 Visit other centres to investigate their use
of new technologies
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HEALTH
ADVOCATE
HEALTH ADVOCATE
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Role 5: Health Advocate
Role Statement
The Radiation Oncologist:
• Applies expertise and influence, whether individually or as part of a group, to improve cancer services on behalf of
individual patients, groups of people with cancer and the community at large
1 Patient and Significant Others
The trainee is able to:
1.1 Learning Outcomes
1.1.1 Advocate for the patient in a
multidisciplinary clinic
1.1.2 Recognise, and help overcome, barriers to
treatment
1.1.3 Be aware of, and facilitate access to,
support services and resources
1.1.4 Demonstrate awareness of the processes
for securing resources for patient care
1.1.5 Promote patient safety
1.1.6 Demonstrate knowledge of potential
mismatches between evidence and
regulations controlling drugs and other
treatments
2.1.3 Discuss cancer-related public health policy
e.g. community screening programs
2.1.4 Contribute to public fora e.g. media, public
debates
The trainee may:
2.2 Learning Opportunities
2.2.1 Speak at support group meetings and
public forums
2.2.2 Join a cancer organisation
2.2.3 Volunteer to participate in cancer
organisation activities, including fundraising events
HEALTH
ADVOCATE
The trainee may:
1.2 Learning Opportunities
1.2.1 Attend, and present at, multidisciplinary
clinics
1.2.2 Attend hospital and departmental
orientation sessions
1.2.3 Attend Occupational Health and Safety
meetings
1.2.4 Read hospital and departmental safety
protocols
1.2.5 Identify personnel responsible for safety
and patient representation in the local
setting
2 The Community
The trainee is able to:
2.1 Learning Outcomes
2.1.1 Access cancer-related community
organisations e.g. Cancer Council,
government, cancer institutes
2.1.2 Speak to community groups e.g. cancer
support groups, Apex, schools
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SCHOLAR
SCHOLAR
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Role 6: Scholar
Role Statement
1 Students and Trainees
The trainee is able to:
1.1 Learning Outcomes
1.1.1 Mentor students and other trainees
1.1.2 Participate in departmental academic
programs and teaching sessions
1.1.3 Assist other trainees in examination
preparation
1.1.4 Provide and obtain feedback on all areas
of performance
The trainee may:
1.2 Learning Opportunities
1.2.1 Lead teaching sessions for students,
trainees and other staff
1.2.2 Supervise teaching programs
1.2.3 Present educational topics to peers and
senior medical staff
1.2.4 Read medical literature
1.2.5 Participate in journal clubs
1.2.6 Act as a mock examiner and provide
feedback
1.2.7 Give advice regarding examination
preparation and technique
2 Critical Appraisal and Statistics
The trainee is able to:
2.1 Learning Outcomes
2.1.1 Explain common research terminology
e.g. hypotheses, endpoints, outcomes,
incidence, prevalence, biases
2.1.2Contrast types of research design e.g.
controlled clinical trials, case-control
studies, historical and concurrent
controls, blind and double-blind studies
2.1.3 Discuss the advantages and
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
disadvantages of randomised controlled
clinical trials
2.1.4 Define phases [I - III] of clinical trials
2.1.5 Define and describe the importance of
different outcome measures e.g. overall
survival, disease-free survival, time to
progression, quality of life
2.1.6 Evaluate different methods of calculating
survival
2.1.7 Discuss levels of significance, types of
errors and power calculations
2.1.8 Discuss the relative benefits of various
statistical methods and tests e.g.
Chi-squared, logistic regression
2.1.9 Explain study limitations and how they
may affect conclusions/outcomes
2.1.10 Describe key principles of meta-analyses
and systematic reviews
2.1.11 Define and describe levels of evidence
2.1.12 Demonstrate awareness of the
importance of ethics in human
experimentation, as defined by National
Health and Medical Research Council
(NHMRC) national statement and the
Helsinki declaration
2.1.13 Critically appraise published literature
and other research-related documents
2.1.14 Demonstrate familiarity with guidelines
for the reporting of research studies
2.1.15 Demonstrate knowledge of principles of
peer-review process
The trainee may:
2.2 Learning Opportunities
2.2.1 Attend a course on critical appraisal
2.2.2 Attend local journal club meetings
2.2.3 Read the information on critical
appraisal and basic statistics that is
provided on the RANZCR website
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SCHOLAR
The Radiation Oncologist:
• Engages in life-long learning with the goal of continuously improving his or her mastery of the discipline
• Contributes to the collection, analysis and interpretation of data that relate to health care quality and outcomes
• Critically evaluates scientific literature and research
• Integrates emerging evidence into clinical practice
• Participates in the education of peers, trainees, other health care providers, and community bodies
• Actively participates in advancing knowledge in the clinical and laboratory settings
2.2.4 R
eview statistical methodology of a
scientific article
2.2.5 Analyse and present analysis, verbally or in
writing, of their research results
2.2.6 U
ndertake units of relevant post-graduate
study in statistics and critical appraisal
e.g. as part of M Clinical Epidemiology or
similar
3 Role Model
The trainee is able to:
3.1 Learning Outcomes
3.1.1 D
emonstrate enthusiasm in teaching and
learning roles
3.1.2 R
ecognise and apply novel methods,
approaches and attitudes to teaching
The trainee may:
3.2 Learning Opportunities
3.2.1 C
omplete a formal course or workshop in
clinical teaching
3.2.2 F ormulate a feedback system for personal
educational activities
3.2.3 S tudy educational methodology
3.2.4 P articipate in the development of
educational changes within the RANZCR
3.2.5 C
ontribute to the development of an
e-learning module
4 Research Activities
The trainee is able to:
4.1 Learning Outcomes
4.1.1 Actively participate in all aspects of clinical
trials
4.1.2 E ncourage and mentor other trainees in
research
4.1.3 D
emonstrate skills required for research,
which must include those related to
clinical research and may include those
related to laboratory research
4.1.4 P ursue accurate data collection of clinical
outcomes as a basis for future research
initiatives
The trainee may:
4.2 Learning Opportunities
4.2.1 Attend a course on trial development e.g.
ACCORD workshop
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4.2.2 Attend a course on scientific writing,
referencing or searching the medical
literature
4.2.3 Visit a radiobiology laboratory
4.2.4 Develop laboratory skills and knowledge
4.2.5 Attend research meetings
4.2.6 Conduct research projects
4.2.7 Write and submit a scientific paper
4.2.8 Present research findings at meetings
4.2.9 Discuss trial participation with patients
4.2.10 Complete clinical research forms and
database entry
4.2.11 Undertake training on database design
4.2.12 Join a research organisation e.g. TROG
(TransTasman Radiation Oncology Group)
4.2.13 Observe an ethics or scientific committee
process/meeting
4.2.14 Contribute to writing an ethics
submission for research
4.2.15 Undertake units of relevant postgraduate study relating to research
methodology or other research-focussed
topic
5 Lifelong Learning
The trainee is able to:
5.1 Learning Outcomes
5.1.1 Develop and explore special areas of
interest e.g. tumour sites, research,
education
5.1.2 Maintain continuing professional
development standards
5.1.3 Discuss current literature and practice
5.1.4 Identify gaps in knowledge and take action
to redress these
The trainee may:
5.2 Learning Opportunities
5.2.1 Read documents associated with the
RANZCR Continuing Professional
Development Framework
5.2.2 Attend educational and research meetings
5.2.3 Identify and access important oncology
journals and other resources for learning
5.2.4 Enrol for study or courses in areas of
special interest
5.2.5 Identify and collect sentinel papers
5.2.6 Participate in local and national
audit programs
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PROFESSIONAL
PROFESSIONAL
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Role 7: Professional
Role Statement
The Radiation Oncologist:
• Delivers the highest level of patient care with integrity, honesty and compassion
• Exhibits exemplary personal and interpersonal behaviour, and practices ethically
• Practices with diligence and active concern for the progress of the profession, while continuing to improve
mastery of the discipline
1 Ethical Behaviour
The trainee is able to:
1.1 Learning Outcomes
1.1.1 Respect patient and family sensitivities
and concerns
1.1.2 Respond appropriately to situations
that might compromise the wellbeing of
others, including impaired performance of
colleagues
1.1.3 Work to promote equitable and
compassionate health care
1.1.4 Comply with national standards for
research ethics
1.1.5 Respect confidentiality and privacy
1.1.6 Act with sensitivity to patients from
differing cultural backgrounds
1.1.7 Respect intellectual property rights and
take a strong stand against plagiarism
2 Continuity of Care
The trainee is able to:
2.1 Learning Outcomes
2.1.1 Contribute actively to ongoing patient care
2.1.2 Ensure appropriate follow-up of patients
The trainee may:
2.2 Learning Opportunities
2.2.1 Make contact with other health
professionals e.g. general practitioner,
surgeon
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3 Medico-legal Responsibilities
The trainee is able to:
3.1 Learning Outcomes
3.1.1 Understand and comply with the legal
requirements relating to:
− Informed consent, including relevant
patient charters such as Patient Code of
Rights (NZ) or Australian Commission
on Safety and Quality in Health Care
(ACSQHC) National Patient Charter of
Rights
− End of life care
− Statutory notification e.g. new cancer,
communicable diseases
− Impaired colleagues
− Radiation safety issues
− Employment
− Occupational Health and Safety
− Privacy and confidentiality
The trainee may:
3.2 Learning Opportunities
3.2.1 Obtain informed consent in the clinical
setting e.g. radiation therapy treatments
and clinical trials
3.2.2 Discuss, document and implement end of
life management and advanced health
directives
3.2.3 Enter data into patient information
systems
3.2.4 Read radiation exposure protocols
3.2.5 Attend radiation safety training courses
3.2.6 Meet with radiation safety personnel
3.2.7 Attend Occupational Health and
Safety briefings
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PROFESSIONAL
The trainee may:
1.2 Learning Opportunities
1.2.1 Write, or review, an ethics submission
1.2.2 Participate in a human ethics committee
1.2.3 Attend a bioethics course
1.2.4 Read NHMRC standards
1.2.5 Attend cultural awareness training
2.2.2 Attend, and present at, multidisciplinary
clinics
2.2.3 Review and manage late side effects
2.2.4 Establish follow-up procedures
4 Colleagues and Patients
6 Risk Management
The trainee is able to:
4.1 Learning Outcomes
4.1.1 R
ecognise conflicting values and opinions,
and develop skills to accommodate these
differences
4.1.2 U
nderstand and apply principles of duty
of care
4.1.3 R
espect confidentiality of all
communications, both formal and informal,
between patients, carers and colleagues
4.1.4Understand and disclose any conflict
of interest
The trainee is able to:
6.1 Learning Outcomes
6.1.1 Demonstrate good record keeping
6.1.2 Participate in quality assurance programs
The trainee may:
4.2 Learning Opportunities
4.2.1 Identify role models
4.2.2 Participate in a mentoring program
4.2.3 Develop stress management strategies
4.2.4 Attend a workshop on stress management
4.2.5 Debrief on complex cases with colleagues
4.2.6 D
eclare a conflict of interest at business
meetings, trials, or ethics committees
The trainee is able to:
7.1 Learning Outcomes
7.1.1 Demonstrate effective time management
7.1.2 Work within their own capacity and have
methods of stress management
7.1.3 Follow through on commitments
7.1.4 Set priorities
7.1.5 Adhere to department dress code
7.1.6 Avoid use of substances that impair
performance
The trainee may:
6.2 Learning Opportunities
6.2.1 Demonstrate open disclosure
6.2.2 Attend morbidity and mortality meetings
6.2.3 Participate in quality assurance studies
7 Personal Management
5 Role Model
The trainee is able to:
5.1 Learning Outcomes
5.1.1 Act as a positive role model for students
and registrars
5.1.2 D
emonstrate to colleagues and patients
an awareness and understanding of recent
developments related to the profession
5.1.3 Implement RANZCR goals and objectives
by active participation in its affairs and
by contributing to public debate on issues
related to the profession
The trainee may:
7.2 Learning Opportunities
7.2.1 Participate in performance management
7.2.2 Display punctuality
7.2.3 Read the code of conduct of the local
institution, Area Health Service and the
profession
7.2.4 Attend time and behaviour management
courses
The trainee may:
5.2 Learning Opportunities
5.2.1 N
ominate as Trainee Representative on
RANZCR Committees
5.2.2 Mentor junior medical staff and students
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The assessments are described according to the Phase
of the program during which they are undertaken, some
being specific to one phase or another and several being
utilised over the entire program. The requirements and
instructions should be sought from the electronic versions
of assessment materials found on the College website at
http://www.ranzcr.edu.au/radiation-oncology/training-inradiation-oncology .
Assessments over the entire program
Mini-CEX
Mini-CEX is an abbreviation for Mini-Clinical Evaluation
Exercise. The mini-CEX is an adaptation of the Clinical
Evaluation Exercise previously used by the American
Board of Internal Medicine. The mini-CEX’s use as a
tool for evaluating medical trainees is now widespread
internationally.
Use of the mini-CEX involves an assessor (in this case,
a supervising Radiation Oncologist) observing a clinical
encounter between a trainee and a patient, rating the
performance of the trainee on a number of dimensions
including interviewing skills, physical examination,
professionalism and humanistic qualities, counselling
skills, clinical judgment, organisational ability, and
with overall score for clinical competence. The rating
is performed on a simple 9-point scale. The clinical
encounter is designed to take 15 to 20 minutes depending
on the complexity of the case. Not all dimensions need
to be addressed in each mini-CEX episode, but it is
recommended that at least one mini-CEX per year include
observation of and feedback on a physical examination of
a patient. The assessor provides feedback to the trainee at
the end of the encounter.
The reliability of the mini-CEX rests on the trainee being
observed on several occasions over a period of time
by multiple assessors and having serial assessments.
This has been demonstrated to be a reliable measure of
performance in patient interactions, particularly aptitude
in the communicator role. Results are generalisable to
the trainee’s everyday clinical practice, provided that
sufficient numbers of mini-CEXs are undertaken. Its
value as a formative assessment is dependent on the
assessor providing prompt feedback to the trainee after
the conclusion of the encounter. For this to be optimally
effective, assessors require some structured training in
provision of trainee feedback.
© 2014 RANZCR. Radiation Oncology Training Program Curriculum
Trainees are required to complete one mini-CEX
approximately every 3 months. Over the course of their
training, trainees must achieve a satisfactory result for
each individual component of the mini-CEX on at least
one, and preferably several, occasions. Additional miniCEXs over the minimum requirement, as desired by the
trainee or recommended by the DoT, can be completed.
Clinical Supervisor Assessments (CSAs)
At the end of each clinical term/rotation or every 6
months (whichever is the more frequent), the trainee
will meet with the Clinical Supervisor, who has provided
most of the supervision for that term to complete the
Clinical Supervisor Assessment. This simple rating form
is completed by the Clinical Supervisor and contains
a number of items under each of the CanMEDS roles,
allowing for elaboration on areas of a trainee’s strengths
and weaknesses. This becomes the basis of discussion
between the Clinical Supervisor and trainee on their
performance and progress during that term/rotation.
The record of the CSA must be signed by both the Clinical
Supervisor and the trainee, and submitted into the Trainee
Information Management System (TIMS), where the CSA
can be viewed by their DoT.
Director of Training (DOT) Assessments
Every 6 months, the trainee should meet with their
DoT to complete the DoT assessment. This assessment
is predominantly a collation of other assessments
undertaken in the previous 6 months and includes a
review of these.. The simple rating form is completed by
the DoT and contains a number of
items under each of the CanMEDS roles, allowing
for elaboration on areas of a trainee’s strengths and
weaknesses. This form then becomes the basis for a
structured discussion, and provides an opportunity for the
DoT to give feedback on progress and guidance for further
learning.
The record of the DoT Assessment must be signed by both
the DoT and the trainee, and submitted into TIMS.
These interviews may also serve to identify problems
with a particular training term or a trainee having other
difficulties within training, including failure to adequately
progress. Refer to the RANZCR Trainee in Difficulty Policy
(Radiation Oncology) for further information as required.
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ASSESSMENTS
Description of Assessments
Trainee Assessment of Training Site (TATS)
Phase 1 only assessments
It is important that training sites are monitored in order
to demonstrate that aspects of training are delivered
safely and effectively. Although this issue of training site
performance will be addressed in a variety of ways, one of
the most valuable methods is to canvas trainee opinions.
Foundation Modules & Clinical Assignments
The Trainee Assessment of Training Sites (TATS) is
submitted electronically through TIMS. The information
is then de-identified, collated, analysed and a report
generated. To ensure that trainee feedback on training
sites is submitted and is done so in an ongoing manner,
records of acknowledgement of submissions are a Training
Program requirement.
Multi-Source Feedback Assessment (MSF)
The use of multi-source feedback tools is common in
many areas and sectors of the workplace today. Many
medical schools and specialist Colleges around the world
use MSF tools to assist in the assessment of, and feedback
on, capabilities within the areas of communicator,
collaborator, professional and manager.
The MSF involves asking a group of 12 -15 people to
complete a simple, nine question assessment where the
assessor rates the trainee for each dimension on a 9-point
scale ranging from unsatisfactory to above expected
performance. There is also a section for free-response
comments about the trainee’s performance on the job.
The assessors are drawn from four groups of co-workers:
other senior clinicians, allied health professionals (e.g.
radiation therapists, nurses and physicists) administrative
or clerical staff, and other trainees. A self-assessment is
also conducted.
The responses are submitted through TIMS, the results
de-identified, collated, analysed, and a report generated
by the RANZCR. The report is available to the DoT and
the trainee via TIMS, and a discussion of the report is
encouraged . The MSF and resultant report provides a
valuable opportunity to give ifeedback on a range of
professional skills and attributes.
Trainees are required to complete one MSF per year, or
more as directed by their DoT if reports are considered
unsatisfactory.
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The Foundation Modules (designed for the first 6 months
or so of training), and the Clinical Assignments (CAs)
are aimed at promoting an organised approach to the
learning of the Oncology Sciences of Anatomy, Pathology,
Radiation and Cancer Biology and Radiation Oncology
Physics. It is expected that the Foundation Modules will
help teach some underlying principles, after which the
CAs will help lead the trainee through the more clinicallylinked and complex sections of the Phase 1 curriculum.
Although there is some logical progression through the
curriculum topics, it is not intended that the CAs include
all content that is required to be learned or that they
necessarily deal with content in exactly the same order
as the curriculum records it. The CAs are designed to be
completed at regular intervals during Phase 1, and are
valuable aid in preparation for the Phase 1 Examination.
The CAs consist of a series of questions or activities
dealing with the Oncology Science subjects. In some
instances, the integration of material from various
subjects are included to enhance the understanding of
links between the material.
Trainees are expected to use self-directed learning
techniques and resources to assist them in completing
the CAs. In addition, tutorials and other clinical teaching
activities at the training site will assist the trainee to
complete the CAs. Seeking feedback and guidance from
DoTs, Clinical Supervisors and other professionals in the
training centre is an important part of CA completion.
Clinical Supervisors are provided with Feedback Guides to
assist them in giving useful feedback to trainees on their
CA work.
Foundation Modules must be completed and feedback
sought and given, but formal submission of these is not
required. Trainees are required to complete and formally
submit to the College, five (5) CAs in Phase 1. The CAs will
be updated and modified over time to enhance their value
for learning, but any of the versions of CAs 1 - 5 may be
completed, as long as they are substantially different
from each other. If trainees do not complete a CA to a
satisfactory standard, they will be required to discuss and/
or resubmit the CA (or the sections which were assessed
as unsatisfactory) until a satisfactory result is achieved,
with the DoT and/or Clinical Supervisor reviewing the
CA being the final arbiter. This process need not be very
© 2014 RANZCR. Radiation Oncology Training Program Curriculum
Phase 1 Practical Oncology Experiences
Trainees are expected to meet certain requirements in
relation to logged, practical sessions spent with members
of other disciplines including other non-Radiation
Oncology cancer specialists. These are designed to
promote understanding of the full spectrum of cancer
management expertise, many aspects of which may not
be experienced within the usual day-to-day activities of a
Radiation Oncology trainee.
In Phase 1, these activities will include a period or
sessions attached to the radiation therapists and
physicists in planning and treatment, and to radiologists
for learning of anatomy.
Some reflection on the part of the trainee in relation to
learning objectives met by these practical experiences will
form part of the assessment. Suggested goals for these
experiences and some questions trainees may find helpful
to ask (in addition to the related Learning Objectives
in the curriculum) are provided in the Assessment
Instructions located on the website at http://www.ranzcr.
edu.au/training/resources/current-trainees/resourcesfor-radiation-oncology-trainees/assessments-radiationoncology.
Phase 1 Examination
The Phase 1 Examination will consist of two written
papers, examining the Oncology Science subjects.
Questions will test knowledge in these subjects but
also synthesis and integration of this knowledge. The
subjects will be weighted as follows: Anatomy, Radiation
Physics and Cancer and Radiation Biology 30% each and
Pathology 10%.
The results of the Phase 1 Examination will be included in
the trainees profile in TIMS. Trainees are required to pass
this examination before progressing to Phase 2.
Phase 2 only assessments
Case Reports
The Case Reports are intended to act as a Log Book of
clinical activity, and provide a directly relevant, systematic
record of patient cases and management, particularly
© 2014 RANZCR. Radiation Oncology Training Program Curriculum
in the area of radiation therapy planning and treatment
and also for specialized radiation and other oncology
techniques and experiences. Full details, requirements,
templates, instructions and additional Learning Outcomes
are provided in the Assessment Instructions located on
the College website at -http://www.ranzcr.edu.au/training/
resources/current-trainees/resources-for-radiationoncology-trainees/assessments-radiation-oncology
Trainees are required to complete a minimum of 30 case
reports prior to sitting their Phase 2 Examination. These
will contain elements relating to clinical presentation,
decision-making and radiation technique. Attempts should
be made to spread the reports across the MES in the
“major focus” and “lesser focus” topics.
There is no maximum number for Case Reports to be
completed by the trainee. It is anticipated that trainees
may choose to complete many more brief reports on
interesting or common scenarios to aid and document
their learning, especially in relation to technical treatment
issues, in the same way a case Log Book might be used.
Furthermore, it will likely be helpful for trainees to start
documenting specific cases early in the course of their
training and, depending on progress, undertake some
Case Reports (a maximum of 5 of the 30 if only 30 overall
completed) in the latter part of Phase 1.
Statistical Methods, evidence Appraisal and
Research for Trainees (SMART) Program
1.
Research Requirement
The research requirement aims to foster an interest
in research, establish an understanding of research
methodology, ensure participation in research as an
integral component of Radiation Oncology training and
subsequent specialist practice, and encourage trainees to
contribute to the oncology literature.
Trainees are required to undertake a piece of original
research and to prepare a manuscript for submission.
The manuscript must be submitted to JMIRO or another
peer-reviewed journal. Acceptance to the peer-review
process will serve to satisfy the requirement. Trainees will
be required to provide proof of acceptance to peer review
before applying to sit the Phase 2 examinations.
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ASSESSMENTS
formal if the trainee is felt to have achieved most of the
important outcomes.
2.
SMART Points Accrual
To satisfy the accrual of SMART points assessment
requirement, trainees will be required to attain a
minimum of 20 SMART points by taking part in a selection
of activities which provide learning opportunities
to address learning outcomes within the Scholar,
Collaborator & Communicator roles of the curriculum.
Trainees can begin collecting points as soon as they
enter the training program. 20 SMART points will need
to be collected and evidence of submission (in the form
of a brief form and/or certificate of completion) must be
received by the College to satisfy the requirement and
allow application to sit the Phase 2 examination.
Ten (10) points can be earned by attendance at one (of
two) of the annual joint TROG/FRO SMART workshops
to be run in conjunction with the TROG ASM each year.
Attaining 10 points through this activity is strongly
recommended, but not mandatory.
Phase 2 Examination
The Phase 2 Examination will comprise written and oral
(viva) components covering all aspects of Pathology,
Clinical Oncology and Radiation Therapy, including
diagnosis, management and technical aspects of planning
and delivery of radiation therapy.
There are 4 written papers in the above subjects.
The viva examinations include a radiation therapy
Planning Examination (using photographic prompts), 8
clinical ‘short’ cases (some with actual patients and some
with clinical prompts), and a Pathology viva. One of the
clinical ‘short’ cases will assess physical examination skills
alone.
Full eligibility criteria for sitting the Phase 2 Examination
are published on the College website at
http://www.ranzcr.edu.au/radiationoncology/
traininginradiationoncology
Trainees are required to pass the Phase 2 Examination
before being eligible to proceed to Fellowship.
The requirements of the Phase 2 examination are detailed
further on the RANZCR website at http://www.ranzcr.edu.
au/radiation-oncology/training-in-radiation-oncology.
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© 2014 RANZCR. Radiation Oncology Training Program Curriculum
Assessing the CanMEDS Roles
The following table details how the variety of assessment tools used within the training program may relate to the
spectrum of the CanMEDS roles.
CanMEDS Roles
3
3
3
DOT Assessment
3
3
3
Practical Oncology
Experience
3
3
3
Clinical Supervisor
Assessment
3
3
3
MSF
3
Professional
Mini-CEX
Scholar
3
Health Advocate
Communicator
3
Manager
Medical Expert
Clinical Assignments
Collaborator
Evidence
3
3
3
3
3
3
3
3
3
3
3
3
3
Examinations
3
3
Case Reports
3
3
3
Research Requirement
3
3
SMART points accrual
3
3
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
3
3
3
3
3
3
3
3
3
3
3
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ASSESSMENTS
3
TATTs
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Glossary
AIDS
Acquired Immunodeficiency Syndrome
AJCC
American Joint Cancer Collaborative
ALARA
As Low As Reasonably Achievable
ALL
Acute Lymphoblastic Leukaemia
AN
Acoustic Neuroma
AVMs
Cerebral Arteriovenous Malformations
BRCA
Breast Cancer (Genes 1 And 2)
CanMEDS
Canadian Medical Education Directives For Specialists
CHART
Continuous Hyperfractionated Accelerated Radiation Therapy
CIS
Carcinoma-In-Situ
CNS
Central Nervous System
COG
Children’s Oncology Group
CSF
Cerebrospinal Fluid
CSI
Craniospinal Irradiation
CT
Computed Tomography
CTV
Clinical Target Volume
D
A Detailed level of knowledge, and ability to apply this knowledge in clinical settings, is required
DNA
Deoxyribonucleic Acid
DoT
Director of Training
EGFR
Epithelial Growth Factor Receptor
ERCP
Endoscopic Retrograde Cholangiopancreatogram
EUA
Examination Under Anaethesia
FIGO
International Federation of Gynaecology And Obstetrics
G
A more General level of knowledge, and minimal application of this knowledge, is required
GIST
Gastrointestinal Stromal Tumours
GTV
Gross Tumour Volume
HBO
Heterotopic Bone Ossification
HCC
Hepatocellular Carcinoma
HCG
Human Coreogonadotrophin
HDR
High Dose-Rate
HIV
Human Immunodeficiency Virus
HL
Hodgkin Lymphoma
HPV
Human Papilloma Virus
I
Ability to perform the specified activity essentially Independently
IAEA
International Atomic Energy Agency
ICRP
International Commission on Radiological Protection
ICRU
International Commission on Radiation Units and Measurements
IMRT
Intensity-Modulated Radiation Therapy
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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ITV
Integral Tumour Volume
kV
Kilovoltage
LDR
Low Dose-Rate
LET
Linear Energy Transfer
MAC
Modified Astler Coller
MALT
Mucosa-Associated Lymphoid Tissue
MDT
Multidisciplinary Team
MEN
Multiple Endocrine Neoplasia
MES
Medical Expert Supplement(S)
MIBG
Meta Iodobenzylguanidine
Mini-CEX
Mini-Clinical Evaluation Exercise
MRA
Magnetic Resonance Angiography
MRC
Medical Research Council
MRI
Magnetic Resonance Imaging
MRS
Magnetic Resonance Spectroscopy
MSCC
Malignant Spinal Cord Compression
MSF
Multi-Source Feedback
MV
Megavoltage
NHL
Non-Hodgkin’s Lymphoma
NHMRC
National Health And Medical Research Council
NSCLC
Non-Small Cell Lung Cancer
NSGCT
Non-Seminomatous Germ Cell Tumours
NZ
New Zealand
PBCL
Primary B-Cell Lymphoma
PCR
Polymerase Chain Reaction
PDR
Pulsed Dose Rate
PET
Positron Emission Tomography
PNET
Primitive Neuroectodermal Tumour
PSA
Prostate-Specific Antigen
PTCL
Primary T-Cell Lymphoma
PTV
Planning Target Volume
QoL
Quality of Life
RANZCR
Royal Australian and New Zealand College of Radiologists
RB
Retinoblastoma
RFA
Radiofrequency Ablation
RMS
Rhabdomyosarcoma
RNA
Ribonucleic Acid
ROCKSS
Radiation Oncology Central Knowledge and Skills Summary
RT-PCR
Reverse Transcriptase – Polymerase Chain Reaction
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
S
Ability to perform the specified activity under Supervision
SCC
Squamous Cell Carcinoma
SCLC
Small Cell Lung Cancer
SF 36/12
Short Form Health Survey Questionnaire (36/12 Items)
SMART
Statistical Methods, evidence Appraisal and Research for Trainees
SIOP
International Society of Paediatric Oncology
SSD
Source-Surface Distance
SVCO
Superior Vena Caval Obstruction
TAHBSO
Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy
TATTs
Trainee Assessments of Training Terms
TBI
Total Body Irradiation
TCC
Transitional Cell Carcinoma
TNM
Tnm (Tumour, Nodes and Metastases) Classification of Malignant Tumours
TROG
Trans-Tasman Radiation Oncology Group
TURB
Trans-Urethral Resection of The Bladder
TURBT
Trans-Urethral Resection of Bladder Tumour
US
Ultrasound
UV
Ultraviolet
vs.
Versus
WHO
World Health Organisation
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
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© 2012 RANZCR. Radiation Oncology Training Program Curriculum
ALPHABETICAL INDEX OF
MEDICAL EXPERT SUPPLEMENTS
Acoustic Neuroma
94
Adrenal Tumours
114
Adult Gliomas
88
Aggressive Fibromatosis
106
Anal Cancer
81
Biliary Tract and Gall Bladder Cancers
82
Bladder Cancer
74
Bone Metastases
105
Breast Cancer
44
Carcinoid Tumour
84
Cerebral Arteriovenous Malformations
95
Cerebral Metastases
91
Cervical Cancer
68
Colon Cancer
85
Gastric Carcinoma
78
Gastrointestinal Stromal Tumours
84
Gestational Trophoblastic Disease
72
Head and Neck Cancers
53
Hepatocellular Carcinoma
83
Hodgkin Lymphoma
98
Kaposi’s Sarcoma
59
Kidney and Ureter Cancer
75
Leukaemia100
Liver Metastases
86
Malignant Spinal Cord Compression
92
Medulloblastoma and
Primitive Neuroectodermal Tumours
90
Melanoma59
Meningioma89
Mesothelioma50
Metastases at Sites Not Otherwise Specified
118
Metastatic Carcinoma of Unknown Primary Site 118
Multiple Myeloma
100
Non Melanomatous Skin Cancer
58
Non-Hodgkin Lymphoma 99
Non-Malignant Diseases treated
with Radiation Therapy
122
Non-Seminomatous Germ Cell Tumours
64
Non-Small Cell Lung Cancer 48
Oesophageal Cancer
78
Other CNS tumours: ependymoma,
pineal and germ cell tumours
93
Ovarian Cancer
69
Paediatric Cancers
110
Pancreatic Cancer
79
Penile Cancer
65
© 2012 RANZCR. Radiation Oncology Training Program Curriculum
Pituitary Tumours
Primary Tumours of the Bone
Prostate Cancer
Quality of Life
Rectal Cancer
Seminoma of the Testis
Small Cell Lung Cancer Soft Tissue Sarcoma
Superior Vena Caval Obstruction Symptom Control
Thyroid Cancer
Tumours of the Mediastinum
Uterine Cancer
Vaginal Cancer
Vulval Cancer
89
106
62
125
80
63
49
104
50
124
114
51
69
71
70
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