High-dose rate (HDR) brachytherapy is a newer, accelerated cancer treatment that allows physicians to deliver equivalent doses of radiation in as little as one to four outpatient treatments that last just a few minutes each. Matthew Biagioli, MD, a radiation oncologist at the Brian D. Jellison Cancer Institute at Sarasota Memorial, discusses this treatment and why it's another great option for cancer care.
High-dose rate (HDR) brachytherapy is a newer, accelerated cancer treatment that allows physicians to deliver equivalent doses of radiation in as little as one to four outpatient treatments that last just a few minutes each. Matthew Biagioli, MD, a radiation oncologist at the Brian D. Jellison Cancer Institute at Sarasota Memorial, discusses this treatment and why it's another great option for cancer care.
You can also watch the video recording on our YouTube channel here.
For more health tips & news you can use from experts you trust, sign up for Sarasota Memorial’s monthly digital newsletter, Healthe-Matters.
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- From Sarasota Memorial
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and the Deb Kabinoff Multimedia
Studio, this is Health Cast
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a healthy dose of information
from experts you can trust.
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- Hi everybody.
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Welcome to Health Cast.
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I'm Allison Gothermier.
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Thank you so much for
joining us today as we talk
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about a cancer treatment newly available
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at the Brian D. Jellison Cancer Institute
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at Sarasota Memorial called
High Dose Rate brachytherapy.
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Our guest today is Dr. Matthew Biagioli
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a radiation oncologist here in Sarasota.
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Fellowship trained in brachytherapy.
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Dr. Biagioli, thank you
so much for joining us.
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- Oh, thanks for having me.
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- Let's start from the beginning here.
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- Yeah.
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- What exactly is brachytherapy
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and how does it differ
from external radiation?
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- Yeah, I mean, I think when you think
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about radiation treatments
specifically for cancer
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there's kind of like
three main modalities.
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So you've got external radiation therapy
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which is what most
people are familiar with
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where you have kind of these
high energy beams coming
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from a big machine that are kind of going
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through tissue to get
to where the cancer is.
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And then you've got some
radioactive isotopes
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that are occasionally labeled
to say like an antibody
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or something like that,
that are given, they're very
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specific treatments that
are given intravenously.
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And then you've got brachytherapy
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which is really basically
internal radiation
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I think the way that I
would think of it, where
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you're basically introducing
kind of a radioactive element
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inside the tumor and you're
radiating from the inside out
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you know, and in the, the best scenario
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you're given a really high
dose of radiation to the cancer
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without really giving any
radiation to surrounding tissues.
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- So how does high dose rate differ
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from previous brachytherapy
techniques you used?
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- Yeah, so the original form
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of brachytherapy was something
called low dose rate,
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and what they're talking
about is it's still
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a radioactive element that's
delivering that radiation dose.
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With low dose rate the radiation is given
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over the course of usually days to months.
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And so like a classic example
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of that would be, you
know, prostate seed implant
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where they place these radioactive pellets
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into the prostate and then the
radiation might be delivered
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over the course of really, you know
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depending on the isotope
up to nine months, you know
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with high dose rate you're
usually introducing a catheter
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or you think of it almost
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like a needle that's being
inserted into the tumor
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and then the radioactive
source goes inside the catheter
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it delivers a high dose
of radiation, usually
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over the course of a few
minutes, and then it comes out
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you take the catheter out
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and nothing's actually
permanently left inside
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of the person or the cancer itself.
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- So you mentioned prostate cancer there
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but what types of cancer patients
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are candidates for brachytherapy?
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- That's an excellent question.
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So primarily like the
majority of patients treat
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with brachytherapy are typically prostate
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cancer GYN cancers, both
cervical and endometrial cancer
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breast cancer and skin cancers.
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And then there's some not
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there's some more specific
treatments that are not
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that are not done as commonly,
which include, you know
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for certain brain
cancers, for liver cancer
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for in Europe they do it for
in, in some places they do it
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for bladder cancer, but it can
be used just about anywhere.
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But primarily, at least in
the US it's the focus has been
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on prostate, gyn cancer, skin and breast.
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- And are there different criteria used
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for this high dose rate brachytherapy?
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- Yeah, I mean I think
it's really not so much
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like patient characteristics
that would determine
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someone that would get low
dose rate versus high dose rate
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but think of it more
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of like an evolution of the
technology where, you know
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low dose rate was kind
of the original form
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of brachytherapy that was introduced.
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And it still has a role to play
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in today's healthcare
market, albeit smaller.
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High dose rate is kind
of like generation two
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of brachytherapy where
it allows for some much
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more sophisticated imaging
that allows us to kind of
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cater those treatments more
specifically to those patients.
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- So you mentioned that
it's most commonly used
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with prostate cancer
and those GYN cancers.
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Let's start with prostate
brachytherapy first.
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Why might this be a preferred treatment
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for a patient with prostate cancer?
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- So there's really kind
of two different patient
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populations that might
benefit from brachytherapy
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in terms of prostate cancer patients.
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So the first are those patients
that might have, you know
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a less aggressive type of
cancer where you're looking
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at really primarily like a
more localized treatment.
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And so those patients
might be a good candidate
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for either external radiation,
brachytherapy, or surgery.
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And it's really more of
a function of, you know
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what are the side effect
profiles that you know
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that would, that a patient
might feel comfortable with?
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Because you know, the side effects
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and possible complications
with surgery are very different
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than what they would be for brachytherapy
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and what they would be
for external radiation.
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But the outcomes are all the same.
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So you could undergo a major
surgery versus, you know, go
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through what might be 28 to 40
external radiation treatments
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versus go through one or two
internal radiation treatments.
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The other patient population
that that we know benefits
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from it are those patients that
have more aggressive tumors
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where their typically classified
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as high risk cancer patients.
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And so in those patients,
there was a landmark
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trial that came outta
British Columbia called
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the Ascent RT trial that
wherein they kind of
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randomize patients with
high risk prostate cancer
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to those getting hormone therapy
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with external radiation
therapy over the course
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of eight weeks versus those
that got hormone therapy
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with external radiation
just for five weeks followed
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by a one single internal HD
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or brachytherapy treatment.
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And what they found is
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that those patients
that got the combination
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of external and internal
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it reduced their likelihood
of of a recurrence by 50%.
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- So you mentioned there
are different side effects
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to brachytherapy
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or different things
that someone might take
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into account if they're
gonna choose brachytherapy
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over surgery or another treatment option.
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What are those, are there
additional side effects
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or what are the side effects
you discuss with patients?
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- Yeah, so for patients
that are looking at just
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getting HDR brachytherapy
alone for their prostate cancer
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the way that that procedure's
done is basically, you know
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we put the patients asleep.
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We, you know, we through the
skin introduce these catheters
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into the prostate, usually
under ultrasound guidance
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although it can be done
under CT guidance as well.
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And then they use some fancy
software that essentially
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figures out where the
radiation needs to go
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inside each one of those
catheters to treat the cancer
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and avoid giving radiation
treatment to, you know,
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the organs that might
be in close proximity.
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In this case it's the
bladder and the rectum.
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And then that treatment
is delivered usually
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over the course of about five minutes.
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Those catheters are removed, you know,
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the patient's woken up, we make
sure they're urinating okay
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and they go home.
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Because of the trauma introduced
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from the placement of
the catheters as well
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as because some
inflammation that's created
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by the radiation, the
most common side effect
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we see are lower urinary tract symptoms.
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And so what I mean
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by that are patients will
typically have some increase
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in frequency of urination,
maybe some urgency maybe getting
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up in the middle of the night to urinate
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most of which will resolve
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over the course of about a week or two.
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- How long will someone
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with prostate cancer undergo
this brachytherapy treatment?
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- Yeah, so it really kind
of is determined based
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on how it's being used.
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So for patients that
might have an early stage
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cancer where we're just
doing brachytherapy alone
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our typical regimen would be
it's two treatments separated
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by three weeks apart.
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So we do the procedure,
which usually consists
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as an outpatient procedure
that might take a morning
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we do the, deliver that treatment
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that patient goes home,
we have 'em come back
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three weeks later we
do a second treatment.
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And that's actually
their entire treatment.
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- And you kind of mentioned
this before, but this is a
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a benefit of brachytherapy
over external radiation.
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It's less treatments.
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So for someone who might
have a challenging schedule
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especially, that's an added bonus.
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- Yeah, and so when we guide patients
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in helping them to make a determination
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of what treatment option might
be best for them, you know
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a lot of it that we take
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into account is obviously, you know
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the type of cancer that they have,
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what stage is their cancer
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but the other things, the
other X factors, you know
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that affect every individual
that they're kind of bringing
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to the table in terms of you
know, what their situation is
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and you know what their
job situation might be
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what their home situation
might be, so that we can try
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and best find the right
treatment that not only
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is gonna give them them
an optimal chance at cure
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but also that kind of fits
into their life pattern.
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- So we spoke a little
bit about prostate cancer
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patients who may use brachytherapy.
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Let's also talk about
some of those GYN cancers.
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How can brachytherapy help those patients?
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- Yeah, so there are really
two primary populations
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within the GYN cancers that
benefit from brachytherapy.
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The first is endometrial cancers.
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And so the primary treatment
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for endometrial cancer is still surgery.
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However, we then kind of
do an assessment, you know
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usually based on the pathology
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from that surgical specimen
to determine what's
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the risk this patient has of
developing a distant recurrence
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or developing a local recurrence.
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You know, for those patients
that have a high enough risk
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for a local recurrence,
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they're typically
offered radiation therapy
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to the pelvis in order
to reduce that risk.
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Historically
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that had always been external
beam radiation therapy
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but then there was a series
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of studies that were done
that essentially showed that
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if you do brachytherapy in
three to four treatments
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that, that where you're just
treating basically the top
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of the vaginal cuff that is
equivalent to reducing that risk
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of a local recurrence as
giving external radiation
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which you know, might consist
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of giving external radiation
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to the entire pelvis over
the course of five weeks.
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- So you kind of mentioned
there how many treatments
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but how long would someone
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with a GYN cancer typically undergo?
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- So in that scenario
where you're treating for
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you're treating postoperatively
for endometrial cancer
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those patients typically are treated
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in three to four treatments
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usually over the course
of about two weeks.
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The other cancer that
it's that brachytherapy
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is commonly used that's a GYN
malignancy is cervical cancer.
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So in cervical cancer
it's a little different.
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So in patients that have
locally advanced cancers
247
00:11:23,683 --> 00:11:26,430
typically they're not treated with surgery
248
00:11:26,430 --> 00:11:29,550
they're treated with chemo and
radiation therapy together.
249
00:11:29,550 --> 00:11:33,660
And so those patients would
usually receive five weeks
250
00:11:33,660 --> 00:11:37,020
of external radiation where
they're treating their tumor
251
00:11:37,020 --> 00:11:39,780
and they're treating the
lymph nodes that are at risk.
252
00:11:39,780 --> 00:11:42,450
And that's done usually with weekly chemo
253
00:11:42,450 --> 00:11:47,450
and that's followed by
typically three to five sessions
254
00:11:47,490 --> 00:11:50,949
of brachytherapy where the
radiation is just delivered
255
00:11:50,949 --> 00:11:54,641
to the tumor within the cervix itself.
256
00:11:54,641 --> 00:11:56,520
There are a lot of benefits
257
00:11:56,520 --> 00:11:59,264
to doing that kind of a treatment regimen.
258
00:11:59,264 --> 00:12:01,560
There have been a few
studies that have come
259
00:12:01,560 --> 00:12:05,400
out that have looked at when
you exclude doing brachytherapy
260
00:12:05,400 --> 00:12:09,030
and you try to just give
chemo and radiation therapy
261
00:12:09,030 --> 00:12:11,640
meaning external beam
radiation therapy together.
262
00:12:11,640 --> 00:12:13,440
And what they've found is
263
00:12:13,440 --> 00:12:17,340
that those patients survival is decreased
264
00:12:17,340 --> 00:12:19,080
by approximately 10%
265
00:12:19,080 --> 00:12:22,320
versus those patients that
get a package treatment
266
00:12:22,320 --> 00:12:26,283
that includes external radiation
plus brachytherapy itself.
267
00:12:27,660 --> 00:12:32,250
- What side effects might
those, can those patients have
268
00:12:32,250 --> 00:12:33,540
from brachytherapy?
269
00:12:33,540 --> 00:12:36,090
Both for endometrial
cancers as well as cervical?
270
00:12:36,090 --> 00:12:37,050
- Yeah, so that's a good point.
271
00:12:37,050 --> 00:12:39,090
They're two totally different populations.
272
00:12:39,090 --> 00:12:40,950
So those patients that
are getting brachytherapy
273
00:12:40,950 --> 00:12:42,930
for endometrial cancer, you know
274
00:12:42,930 --> 00:12:45,442
we're typically just
treating a very small area
275
00:12:45,442 --> 00:12:48,420
at the very top of the
vaginal cuff, kind of
276
00:12:48,420 --> 00:12:50,920
where the uterus used to
be attached to the vagina
277
00:12:51,840 --> 00:12:55,590
and so those patients have
very minimal side effects.
278
00:12:55,590 --> 00:12:57,260
Usually less than 10%
279
00:12:57,260 --> 00:13:00,565
of patients might notice some loosening
280
00:13:00,565 --> 00:13:03,185
of their stool for a few days to a week
281
00:13:03,185 --> 00:13:06,870
or maybe they notice some
minor urinary irritations.
282
00:13:06,870 --> 00:13:09,270
But again, that probably
represents about less
283
00:13:09,270 --> 00:13:11,970
than 10% of the patient population.
284
00:13:11,970 --> 00:13:14,250
Probably 80 to 90% of
the patient population
285
00:13:14,250 --> 00:13:16,890
that undergoes that
treatment really has minimal
286
00:13:16,890 --> 00:13:18,420
to no side effects.
287
00:13:18,420 --> 00:13:20,400
It's very different than
when you compare that
288
00:13:20,400 --> 00:13:23,400
to the patients that we're
treating for cervical cancer.
289
00:13:23,400 --> 00:13:25,740
Those patients have just
gone through five weeks
290
00:13:25,740 --> 00:13:29,040
of chemotherapy and external
beam radiation therapy.
291
00:13:29,040 --> 00:13:30,870
And so they're already kind of coming
292
00:13:30,870 --> 00:13:35,070
to the table with some
urinary symptoms for sure
293
00:13:35,070 --> 00:13:37,950
probably some rectal symptoms usually
294
00:13:37,950 --> 00:13:41,490
in the form of diarrhea
when we do the brachytherapy
295
00:13:41,490 --> 00:13:44,029
because it's such a localized treatment
296
00:13:44,029 --> 00:13:48,476
it's not contributing very
much to those existing symptoms
297
00:13:48,476 --> 00:13:52,143
but it may protract those
symptoms by another week.
298
00:13:53,250 --> 00:13:56,700
- There are a lot of
misconceptions when you hear even
299
00:13:56,700 --> 00:13:59,250
just the word radiation.
300
00:13:59,250 --> 00:14:01,020
So what do you want people to know
301
00:14:01,020 --> 00:14:04,770
about this particular radiation
therapy in brachytherapy?
302
00:14:04,770 --> 00:14:07,230
- Yeah, I mean I think
anyone that's kind of grown
303
00:14:07,230 --> 00:14:10,650
up post World War II when
they hear the term radiation
304
00:14:10,650 --> 00:14:14,280
you know, it gives them pause
for concern, understandably.
305
00:14:14,280 --> 00:14:15,810
But you have to keep in mind
306
00:14:15,810 --> 00:14:18,240
that when we're delivering
radiation therapy
307
00:14:18,240 --> 00:14:21,450
in kind of this medical
context, we're really looking
308
00:14:21,450 --> 00:14:25,255
at kind of treating small
volumes that are very
309
00:14:25,255 --> 00:14:28,436
with very kind of focused
radiation treatments
310
00:14:28,436 --> 00:14:31,200
where we're really trying
to limit the amount
311
00:14:31,200 --> 00:14:33,810
of tissue that's getting radiotherapy.
312
00:14:33,810 --> 00:14:37,440
And so under modern
techniques, it can be delivered
313
00:14:37,440 --> 00:14:40,770
in a much more safe manner so
314
00:14:40,770 --> 00:14:43,093
that you're less likely
to see complications
315
00:14:43,093 --> 00:14:46,920
that people might think of from
some of, you know, from some
316
00:14:46,920 --> 00:14:48,990
of the older techniques of
radiation that, you know
317
00:14:48,990 --> 00:14:50,700
for patients that might
have received radiation
318
00:14:50,700 --> 00:14:52,470
in the 80s or in the 90s where
319
00:14:52,470 --> 00:14:55,230
they might have had like
some bad skin reactions
320
00:14:55,230 --> 00:14:58,920
or they might have had, you
know, bowel complications.
321
00:14:58,920 --> 00:15:01,863
So the technology, just like
all the technology around us
322
00:15:01,863 --> 00:15:04,583
has really progressed significantly
323
00:15:04,583 --> 00:15:07,560
in the last, you know, 10 years.
324
00:15:07,560 --> 00:15:10,830
And so a lot of the focus has been
325
00:15:10,830 --> 00:15:12,720
on minimizing the side effects.
326
00:15:12,720 --> 00:15:14,610
And how we do that is
327
00:15:14,610 --> 00:15:17,520
by catering that
radiation treatment to try
328
00:15:17,520 --> 00:15:20,220
and treat really primarily
just the area where
329
00:15:20,220 --> 00:15:23,040
those tumors are and
eliminate the radiation
330
00:15:23,040 --> 00:15:25,410
to the normal structures around it.
331
00:15:25,410 --> 00:15:28,140
Brachytherapy just happens to
be kind of one of the tools
332
00:15:28,140 --> 00:15:31,110
in our tool belt that we can
pull out that's, you know
333
00:15:31,110 --> 00:15:34,710
is kind of an elegant
treatment when done correctly
334
00:15:34,710 --> 00:15:37,012
because you're delivering
the radiation from the inside
335
00:15:37,012 --> 00:15:39,480
out that allows you to give a high dose
336
00:15:39,480 --> 00:15:43,680
of radiation to the cancer
with really not giving much
337
00:15:43,680 --> 00:15:46,710
of any radiation to
the surrounding organs.
338
00:15:46,710 --> 00:15:51,360
- So there are some types of
radiation therapy that results
339
00:15:51,360 --> 00:15:54,480
in the patient not being
able to be around loved ones
340
00:15:54,480 --> 00:15:58,200
or friends or family for
some time after treatment.
341
00:15:58,200 --> 00:16:01,018
That's not the case with this
high dose rate brachytherapy.
342
00:16:01,018 --> 00:16:03,210
- Yeah, so you bring
up an excellent point.
343
00:16:03,210 --> 00:16:06,270
So you can think back to the
example that we used before
344
00:16:06,270 --> 00:16:08,760
which is the treatment of prostate cancer.
345
00:16:08,760 --> 00:16:12,210
So kind of the, the historical
way that was done is
346
00:16:12,210 --> 00:16:15,304
they would take these permanent
seeds that were radioactive
347
00:16:15,304 --> 00:16:17,610
and implant them into the prostate
348
00:16:17,610 --> 00:16:21,180
and those patients would
be radioactive, you know
349
00:16:21,180 --> 00:16:23,220
for three to nine months depending
350
00:16:23,220 --> 00:16:24,660
on the isotope that they use.
351
00:16:24,660 --> 00:16:26,040
So there's precautions that they have to
352
00:16:26,040 --> 00:16:27,750
take around their loved one
353
00:16:27,750 --> 00:16:30,961
especially around grandkids
or children or small animals.
354
00:16:30,961 --> 00:16:35,010
In this case, when we're doing
high dose rate brachytherapy
355
00:16:35,010 --> 00:16:36,090
you know, the source
356
00:16:36,090 --> 00:16:38,700
or the radioactive element is
usually only in the patient
357
00:16:38,700 --> 00:16:42,420
for a few minutes and so, and
then everything is removed.
358
00:16:42,420 --> 00:16:44,430
So those patients, you
know, when they leave
359
00:16:44,430 --> 00:16:47,820
after treatment at no
time are they radioactive.
360
00:16:47,820 --> 00:16:49,620
- How long is recovery time
361
00:16:49,620 --> 00:16:52,620
though after someone
receives this brachytherapy?
362
00:16:52,620 --> 00:16:53,640
- Yeah, I mean, again,
363
00:16:53,640 --> 00:16:57,840
it depends on the area that
we're treating and the type
364
00:16:57,840 --> 00:16:59,700
of cancer that they have
and the type of treatments
365
00:16:59,700 --> 00:17:03,270
that they may have had
preceding the brachytherapy.
366
00:17:03,270 --> 00:17:04,302
So for example
367
00:17:04,302 --> 00:17:07,110
in the case of those
patients that might just
368
00:17:07,110 --> 00:17:10,380
be getting HDR brachytherapy
for prostate cancer, you know
369
00:17:10,380 --> 00:17:13,920
the primary symptom we
see is urinary symptoms.
370
00:17:13,920 --> 00:17:16,980
Most of that will go away
within the first two weeks.
371
00:17:16,980 --> 00:17:18,600
Usually within four to six weeks
372
00:17:18,600 --> 00:17:20,820
those patients are completely recovered.
373
00:17:20,820 --> 00:17:24,300
You know, in the case of
cervical cancer, you know
374
00:17:24,300 --> 00:17:25,620
those patients have gotten a bunch
375
00:17:25,620 --> 00:17:27,570
of external radiation, you know
376
00:17:27,570 --> 00:17:31,558
their recovery time might look
more like five to six weeks.
377
00:17:31,558 --> 00:17:34,710
And it's not necessarily
because of the brachytherapy
378
00:17:34,710 --> 00:17:36,090
but because of the compilation
379
00:17:36,090 --> 00:17:38,640
of treatments that they've
had with the chemo,
380
00:17:38,640 --> 00:17:42,240
the external radiation and
the internal radiation.
381
00:17:42,240 --> 00:17:44,670
- So if someone has
recently been diagnosed
382
00:17:44,670 --> 00:17:46,650
with one of the cancers we've discussed
383
00:17:46,650 --> 00:17:50,059
and they think that
they might be interested
384
00:17:50,059 --> 00:17:53,910
in this high dose rate
brachytherapy, who should they speak
385
00:17:53,910 --> 00:17:57,990
to if they're interested in
this as a potential treatment?
386
00:17:57,990 --> 00:18:00,960
- Yeah, I mean I think a good
place to start is talking
387
00:18:00,960 --> 00:18:02,798
to a radiation oncologist.
388
00:18:02,798 --> 00:18:06,240
Not all community based
radiation oncologists
389
00:18:06,240 --> 00:18:08,820
offer brachytherapy,
or if they do offer it
390
00:18:08,820 --> 00:18:10,230
it may not be some
391
00:18:10,230 --> 00:18:12,360
of the treatments that
they're able to offer may not
392
00:18:12,360 --> 00:18:14,610
be as sophisticated as many
393
00:18:14,610 --> 00:18:19,170
of the others because it is a
resource dependent treatment.
394
00:18:19,170 --> 00:18:20,399
We tend to see that it's focused
395
00:18:20,399 --> 00:18:25,399
at larger hospitals or at
academic centers, but starting
396
00:18:25,890 --> 00:18:28,110
with your local radiation
oncologists and asking them
397
00:18:28,110 --> 00:18:30,780
about it and if they don't
offer that treatment, you know
398
00:18:30,780 --> 00:18:33,390
requesting referral is
a good place to start.
399
00:18:33,390 --> 00:18:34,890
- And that brings us to a good point.
400
00:18:34,890 --> 00:18:38,640
I mean, why is it so
important to have a resource
401
00:18:38,640 --> 00:18:40,860
like the Brian D. Jellison
and Cancer Institute
402
00:18:40,860 --> 00:18:43,115
which has these therapies available
403
00:18:43,115 --> 00:18:45,660
at a community hospital right
404
00:18:45,660 --> 00:18:47,340
in the community close to home?
405
00:18:47,340 --> 00:18:50,477
- Yeah, so, you know, cancer therapy
406
00:18:50,477 --> 00:18:54,810
over the last 40 years
has, you know, really
407
00:18:54,810 --> 00:18:58,440
evolved and it's gone
from going to see maybe
408
00:18:58,440 --> 00:19:00,180
one doctor who might have been a surgeon
409
00:19:00,180 --> 00:19:02,288
or might have been an oncologist to now
410
00:19:02,288 --> 00:19:06,000
it's become really what
we would call a team sport
411
00:19:06,000 --> 00:19:09,277
you know, where the
best outcomes come from
412
00:19:09,277 --> 00:19:12,660
those patients that
benefit from discussion
413
00:19:12,660 --> 00:19:15,870
of their treatments ahead
of time with the surgeon
414
00:19:15,870 --> 00:19:18,768
with the medical oncologist,
with radiation oncologists
415
00:19:18,768 --> 00:19:22,110
with the pathologists, and
with the radiologists so
416
00:19:22,110 --> 00:19:24,810
that all the doctors can
kind of come together
417
00:19:24,810 --> 00:19:26,490
and create a game plan.
418
00:19:26,490 --> 00:19:30,060
And then, you know, that
game plan may require
419
00:19:30,060 --> 00:19:32,250
some more sophisticated treatments.
420
00:19:32,250 --> 00:19:35,400
So, you know, we're kind
of fortunate here where
421
00:19:35,400 --> 00:19:37,590
we've got a lot of treatments, you know
422
00:19:37,590 --> 00:19:39,630
under the sun that we
can offer those patients
423
00:19:39,630 --> 00:19:41,610
that may not necessarily be available
424
00:19:41,610 --> 00:19:43,680
at all community centers just
425
00:19:43,680 --> 00:19:46,530
because either the
sophistication that's required
426
00:19:46,530 --> 00:19:47,880
in delivering the treatment either
427
00:19:47,880 --> 00:19:50,820
from physician training or equipment
428
00:19:50,820 --> 00:19:54,180
or just the resource
dependence that it may require
429
00:19:54,180 --> 00:19:56,670
in terms of having a whole team, you know
430
00:19:56,670 --> 00:19:59,763
that can involve nurses and
involve technicians as well.
431
00:20:00,990 --> 00:20:03,060
- Is there anything else
you want the community to
432
00:20:03,060 --> 00:20:05,310
know about this high
dose rate brachytherapy
433
00:20:05,310 --> 00:20:07,650
that we're now offering
at Sarasota Memorial?
434
00:20:07,650 --> 00:20:09,930
- Yeah, I mean, it's
the important thing is
435
00:20:09,930 --> 00:20:12,660
that it can be a very effective treatment
436
00:20:12,660 --> 00:20:15,030
but in the appropriate patient population.
437
00:20:15,030 --> 00:20:18,540
And so patient selection
is of utmost importance.
438
00:20:18,540 --> 00:20:20,910
And so finding, you
know, if this is the type
439
00:20:20,910 --> 00:20:22,650
of treatment that you're interested in
440
00:20:22,650 --> 00:20:25,521
it's really important not
only that you find a physician
441
00:20:25,521 --> 00:20:29,220
you know, that that is
comfortable with the procedure
442
00:20:29,220 --> 00:20:30,870
but someone that has a fair
443
00:20:30,870 --> 00:20:32,910
that has the appropriate training
444
00:20:32,910 --> 00:20:35,430
and does a fair amount
of volume because it's
445
00:20:35,430 --> 00:20:37,740
think of it just like a
surgeon, you know, you would
446
00:20:37,740 --> 00:20:39,330
you don't wanna be, you don't want to go
447
00:20:39,330 --> 00:20:41,970
and get an operation from a
surgeon that's only done two
448
00:20:41,970 --> 00:20:43,883
or three of these operations a year.
449
00:20:43,883 --> 00:20:46,230
You want to go to someone
that's doing a hundred
450
00:20:46,230 --> 00:20:47,640
of these operations a year.
451
00:20:47,640 --> 00:20:49,200
And so the same thing could be said
452
00:20:49,200 --> 00:20:51,883
for brachytherapy that you know,
453
00:20:51,883 --> 00:20:55,020
in order to get excellent outcomes
454
00:20:55,020 --> 00:20:57,420
you want to go to someone that does a lot
455
00:20:57,420 --> 00:21:01,800
of these procedures, you know,
and has a lot of familiarity
456
00:21:01,800 --> 00:21:03,630
not only with how the procedure's done
457
00:21:03,630 --> 00:21:05,298
but how it's done really well
458
00:21:05,298 --> 00:21:08,010
and how to manage those side effects
459
00:21:08,010 --> 00:21:11,400
if they do arise so that
patients don't really
460
00:21:11,400 --> 00:21:13,830
have any complications
associated with the treatment.
461
00:21:13,830 --> 00:21:14,850
- But it's important to note
462
00:21:14,850 --> 00:21:17,550
that other radiation therapy
treatments still have a place
463
00:21:17,550 --> 00:21:18,390
in cancer care
464
00:21:18,390 --> 00:21:20,790
and not everyone is
eligible for brachytherapy.
465
00:21:20,790 --> 00:21:21,623
- Exactly.
466
00:21:21,623 --> 00:21:24,750
You know, so again, it's
kind of like going back
467
00:21:24,750 --> 00:21:28,020
to the analogy of using
it as a tool, right?
468
00:21:28,020 --> 00:21:31,260
So the way that we look in
radiation oncology is, you know
469
00:21:31,260 --> 00:21:33,150
we've got a bunch of
different sophisticated
470
00:21:33,150 --> 00:21:35,130
treatments that we're able to offer
471
00:21:35,130 --> 00:21:37,290
whether it's traditional
external radiation
472
00:21:37,290 --> 00:21:40,680
whether it's stereotactic
radiosurgery or some
473
00:21:40,680 --> 00:21:42,540
of the other stereotactic treatments
474
00:21:42,540 --> 00:21:45,090
or whether it's brachytherapy,
you know, and part
475
00:21:45,090 --> 00:21:47,700
of finding a good radiation
oncologist is finding
476
00:21:47,700 --> 00:21:50,300
someone that's able to kind
of pick the right treatment
477
00:21:50,300 --> 00:21:54,480
for the right patient, you
know, at the right time.
478
00:21:54,480 --> 00:21:56,370
- Dr. Biagioli, thank you so much
479
00:21:56,370 --> 00:21:59,670
for joining us today and for
sharing all this information.
480
00:21:59,670 --> 00:22:02,137
As always, we encourage
everyone in the community to
481
00:22:02,137 --> 00:22:04,920
visit smh.com to get
the latest information
482
00:22:04,920 --> 00:22:06,270
from Sarasota Memorial.
483
00:22:06,270 --> 00:22:07,120
Have a great day.