Radiation oncology in the third millennium

Major changes have occurred in the last 25 years which have impacted significantly on the practice of radiation oncology. Twenty-five years ago, less than 40% of all patients had radiation therapy as a part of their management either for cure, palliation or in combination with surgery and/or chemotherapy. In 1998, about 60% of all patients had radiation therapy as a part of their treatment program either initially or at some time during the course of their disease process. Clearly, randomized clinical trials have made their contribution in cancer management but probably the most significant impact has been improving the standards of care relative to cancer treatment through better education and more cooperative efforts. It is extraordinarily difficult to predict the future for radiation oncology in the third millennium primarily because of the major changes in technology as well as the financial limitations with regards to treatment.