Sarasota Memorial HealthCasts

High-Dose Rate Brachytherapy for Cancer Treatment | Healthcasts Season 4, Ep 12

Episode Summary

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.

Episode Notes

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.

Episode Transcription

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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

 

231

00:10:39,720 --> 00:10:42,690

of a local recurrence as

giving external radiation

 

232

00:10:42,690 --> 00:10:44,310

which you know, might consist

 

233

00:10:44,310 --> 00:10:46,470

of giving external radiation

 

234

00:10:46,470 --> 00:10:49,800

to the entire pelvis over

the course of five weeks.

 

235

00:10:49,800 --> 00:10:52,020

- So you kind of mentioned

there how many treatments

 

236

00:10:52,020 --> 00:10:53,400

but how long would someone

 

237

00:10:53,400 --> 00:10:56,760

with a GYN cancer typically undergo?

 

238

00:10:56,760 --> 00:10:58,830

- So in that scenario

where you're treating for

 

239

00:10:58,830 --> 00:11:01,560

you're treating postoperatively

for endometrial cancer

 

240

00:11:01,560 --> 00:11:03,592

those patients typically are treated

 

241

00:11:03,592 --> 00:11:05,742

in three to four treatments

 

242

00:11:05,742 --> 00:11:08,970

usually over the course

of about two weeks.

 

243

00:11:08,970 --> 00:11:12,450

The other cancer that

it's that brachytherapy

 

244

00:11:12,450 --> 00:11:16,792

is commonly used that's a GYN

malignancy is cervical cancer.

 

245

00:11:16,792 --> 00:11:19,320

So in cervical cancer

it's a little different.

 

246

00:11:19,320 --> 00:11:23,683

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.