A World of Research, Care, and Science: Becoming A Radiation Oncologist

James B. Yu, MD, MHS, FASTRO, didn’t always envision himself as a radiation oncologist, but now works tirelessly to treat patients and advance research for genitourinary cancers.

Early in his life, James B. Yu, MD, MHS, FASTRO, did not plan to become a radiation oncologist. At first, he studied physics at Yale between 1995 and 1999, with plans to become a physicist. In fact, it wasn’t until he spent a summer at the Hole in the Wall Gang Camp, a camp for kids with cancer and other serious diseases, in Ashford, Connecticut, that he realized he wanted to help people with cancer.

As he put it, “In the Venn diagram of life, physics and cancer come together in radiation oncology. There’s a lot of patient care and there’s a lot of handholding, but it’s also very computational and technology-driven.”

From that point on, his path was set; first as a student at the University of Michigan Medical School aiming for a medical degree, then as an intern at California Pacific Medical Center, and, finally, as a residency student at Yale New Haven Hospital.

Today, he is a practicing radiation oncologist, the deputy editor-in-chief of the journal Practical Radiation Oncology, on the editorial boards of ONCOLOGY®, the Journal of Clinical Oncology – Clinical Cancer Informatics, Journal of the National Cancer Institute, European Urology – Oncology, and the Journal of Surgical Oncology, and, most recently, a professor in the Department of Radiation Oncology and the Genitourinary Cancers lead at the Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire.

Now, an expert in radiation oncology, Yu spoke with CancerNetwork®, about how he helps patients, collaborates with other physicians, and delves into research to further advance the field.

Cooperation, Collaboration, and Interaction as a Radiation Oncologist

As someone who wants to care for those with cancer, Yu is in a role that is often dependent on communication and interaction. Aside from the likely hundreds of patients he sees annually, it’s crucial to maintain strong relationships and discourse with other multidisciplinary professionals who are also involved with each patient.

“Radiation oncologists are at the end of the referral stream, so if you can’t collaborate with people or respond to referring physicians, then you’re not going to do very well,” said Yu.

Similar to most doctors working in oncology, he also places a large emphasis on striving to create more patient-friendly environments, whether it’s through constant research to improve treatments or in pushing for more accessible accommodations. “We are doing everything we can to make radiation [treatment] more convenient,” he said.

The Radiation Oncology Landscape

“Radiation treatment is getting better, faster, [becoming more] tolerated, and more effective,” Yu stated.

He also added that the fact that oncologists have the luxury to discuss whether 2-, 3-, or 5-mm margins are better for prostate radiation points to a progressive and impressive growth in technology and technique. Beyond this, time has also given experts the ability to see the longer-term effects of specific methods like stereotactic body radiation therapy (SBRT).

Yu mentioned the phase 3 PACE-B trial (NCT01584258) and the phase 3 NRG-GU005 trial (NCT03367702) as 2 that are noteworthy and investigating and propelling SBRT in prostate cancer.^1,2 Results from the PACE-B trial found that SBRT was non-inferior to control radiotherapy with regards to biochemical or clinical failure; the 5-year incidence of freedom from biochemical or clinical failure was 95.8% (95% CI, 93.3%-97.4%) in patients who received SBRT and 94.6% (95% CI, 91.9%-96.4%) in patients who received control radiotherapy (unadjusted HR, 0.73; 90% CI, 0.48-1.12; P = .004). NRG-GU005 has not yet published results, though Yu anticipates they will be reporting soon.

Yu added, “Some [clinicians] in radiation and surgery are a little threatened by super effective systemic therapy [because they think] it’s going to obviate the need for local therapy, but I disagree. I think the better systemic therapy, immunotherapy, or targeted therapy get; the more important a non-invasive, local treatment will be.”

This is precisely why he believes it’s so important to continue to make steps towards more improved radiation techniques.

Recently, results from a large retrospective study demonstrated that SBRT yielded “excellent” local control and renal function preservation in patients with renal cell carcinoma; at 1 year and 5 years, the probability of local control was 98% (95% CI, 94%-99%) and 96% (95% CI, 92%-99%), respectively.³

“We’re learning that renal tumors and the kidney move quite a bit during breathing, and so intra-fraction motion management is critical,” he said, and also added that when he’s able to use innovations such as MRI-linac or judicial markers, he has “been more enthusiastic about doing more focused renal radiosurgery.”

On top of that, at the 2025 ASCO Genitourinary Cancer Symposium, a presentation on radical prostatectomy vs radiotherapy in high-risk prostate cancer analyzed data from 2 phase 3 randomized trials—the CALGB 90203 trial (NCT00430183) and the NRG-RTOG 0521 trial (NCT00288080).⁴

The analysis found that neoadjuvant chemotherapy plus androgen deprivation therapy (ADT), radical prostatectomy, and personalized postoperative radiotherapy or ADT alone might mitigate the risk of recurrence or further treatment. The 8-year inverse probability of treatment weighting (IPTW) cumulative instance of distant metastasis with surgery was 23% (95% CI, 19%-28%) and 16% (95% CI, 10%-21%) with radiotherapy (sHR, 0.56; 95% CI, 0.38-0.81; P = .002).

“I prefer the long-term hormone therapy and the radiation over the potential of surgery and radiation, and that’s the main reason why I push radiation to my high-risk patients,” Yu said.

Yu’s Research

In many ways, it makes a great deal of sense that Yu is so involved with research—having published over 350 original manuscripts—when considering his interest in physics and technology growing up. Dating back to his time at Yale, when he had limited clinical research opportunities, Yu began working with larger database studies, or “comparative effectiveness research” as he called it. These studies give him, and others, the opportunity to answer questions without needing to enroll in major trials. Often, these questions come directly from patients.

Some of his more recent research ventures include a study on the comparative effectiveness of SBRT and on the comparative toxicity of proton and photon radiation for prostate cancer.^5,6

For one example, a patient asked, “Doc, should I go get proton [therapy]? Are they better than photon [therapy]?” In Yu’s own words, “We just had no answer for them.” In June 2024, he published the study, “Updated Analysis of Comparative Toxicity of Proton and Photon Radiation for Prostate Cancer”, in an attempt to find that answer.

Ultimately, this research found that there were no statistically significant differences between photon beam therapy and intensity-modulated radiation therapy concerning gastrointestinal or genitourinary toxicity. At 24 months, the rates of gastrointestinal toxicity were 20.5% with radiation therapy vs 23.4% with photon beam therapy (P = .11) and the rates of genitourinary toxicity were 28.2% vs 25.8%, respectively (P = .21).⁶

“The key [to an impactful study] is to find a data set that is novel or unique, or [to] come up with a very creative, novel way of looking at the question,” he said.

The Future

As a radiation oncologist, Yu sees many patients with many different disease types, though he spoke about reirradiation for prostate cancer as a particularly fascinating area of care. Currently, patients are told that if they receive surgery and fail, they have the opportunity to salvage it with radiation therapy, however, if a patient receives radiation first, they are unable to undergo surgery. It’s a process that ultimately leads many to opt for surgery first, simply because it offers an extra chance at alleviating the disease.

Yu believes that once enough time has passed, with the right conditions like a discrete tumor, patients may be able to receive radiation before surgery. He also spoke to a desire to see a conversation shift with regards to radiation as a cost-effective treatment, simply because, with rising biologics and immunotherapy costs, radiation simply isn’t as relatively expensive as it used to be.

At the basis of the conversation, there was a very clear sentiment from Yu that much of what he does as a radiation oncologist is to try to make the patient’s treatment as seamless and convenient as possible, but in such a way that he finds enjoyment in the day-to-day aspects of his work, going back to his time as a physics studying undergrad at Yale.

“We are doing everything we can to make radiation more convenient with the super high interest in radiosurgery,” Yu said. “Five treatments are way more convenient than 40 treatments. As a field, we’re trying to push hard to make it centered, and because of that, the future of the field is bright.”

References

1. van As N, Griffin C, Tree A, et al. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. N Engl J Med. 2024;391(15):1413-1425. doi:10.1056/NEJMoa2403365
2. Stereotactic body radiation therapy or intensity-modulated radiation therapy in treating patients with stage IIA-B prostate cancer. ClinicalTrials.gov. Updated December 19, 2024. Accessed February 28, 2025. https://tinyurl.com/msys9d4b
3. Pasquier D, Abancourt L, Ali M, et al. Results of stereotactic body radiation therapy for primary renal cell carcinoma in a large multicenter series. Eur Urol Oncol. Available online February 7, 2025. doi:10.1016/j.euo.2025.01.001
4. Roy S, Sun Y, Eastham JA, et al. Radical prostatectomy vs radiotherapy in high-risk prostate cancer: Individual patient data from two phase III randomized trials. J Clin Oncol. 2025;43(suppl_5):309. doi:10.1200/JCO.2025.43.5_suppl.309
5. Shen J, Sritharan DV, Yu JB, Aneja S. Comparative Effectiveness of SBRT. Springer, Cham. 455-467. doi:10.1007/978-3-031-67743-4_33
6. Yu JB, DeStephano DM, Jeffers B, et al. Updated Analysis of Comparative Toxicity of Proton and Photon Radiation for Prostate Cancer. J Clin Oncol. 2024;42(16):1943-1952. doi:10.1200/JCO.23.01604