Does
25 years the IVO was one of the
first centers in Spain to start treating patients with high-rate brachytherapy, a type of radiation therapy that allows high doses of radiation to be applied directly to the tumor or surgical site. The precision of this technique reduces the irradiation of healthy tissues, close to the tumor, implies less toxicity for the patient and healthcare personnel, contributes to preserving the function of the affected organ and allows, in most cases, to be performed on an outpatient basis.
In December 1996, the
Valencian Institute of Oncology (IVO), was one of the first centers in Spain to transition from traditional low-rate brachytherapy to modern high-rate brachytherapy for the treatment of small tumors. «A risky bet», as they remember from the
IVO Radiation Oncology Service, which years later made the Valencian cancer hospital a benchmark due to its high degree of specialization, contributing through work and research groups to the consolidation of this radiotherapy technique in Spain and Europe.
What in those years was “swimming against the current”, as they remember from the
IVO Doctors Vicente Crispín, Leoncio Arribas and Jose Luís Guinot, today is a very consolidated radiation technique throughout the world in cancer treatment. In Spain there are more than 70 high-rate brachytherapy units.
In the Valencian Community, the IVO is one of the centers that treats the largest number of patients each year with this type of radiotherapy, with an average of 230 patients per year. This represents “10% of all patients who are treated in the IVO with radiation”, as pointed out by the head of the Radiation Oncology service, Dr. Arribas. In its balance after 25 years, the figure reaches about 5,458 patients of which: 2,471 correspond to breast cancer; 2,201 to gynecological pathologies; 437 to head and neck tumors and 192 to skin cancer, in addition to other tumors.
The benefits of high-rate brachytherapy in cancer treatment
Although there were not many references at the time, “the benefits of high-rate brachytherapy were many.” Among the main ones – «it was achieved in a few minutes what used to take several days» -, recalls Vicente Crispín, head of the Service of
Radiophysics and Radiation Protection of the IVO. «With the transition from brachytherapy from low to high rate, patients went from being hospitalized for several days, unable to move and isolated, to being treated in sessions of a few minutes, with a technique that – in addition to being ambulatory – could offer better results, faster, with identical or less toxicity and greater precision ».
High-rate brachytherapy, can be understood as internal radiotherapy, is a type of radiotherapy that allows high doses of radiation to be applied directly to the tumor or the surgical site. The precision of this technique reduces the irradiation of healthy tissues, close to the tumor –compared with external radiotherapy–; it implies less toxicity for the patient and healthcare personnel, and contributes to preserving the function of the affected organ. In addition, it considerably reduces the total time of hospitalization, from several days to a few hours. Another of the great advantages of this technique is that it can be performed on an outpatient basis in most cases and eliminates the long isolation that patients were subjected to years ago. In addition, it entails a reduction in the side effects of radiation, “which are in no way severe”, clarifies Dr. Arribas.
This technique, which by location is applied preferably in tumors of the breast, gynecology, head and neck, prostate and skin, can be applied exclusively in small tumors or as a complement to external radiotherapy, to increase the dose with high precision without increasing toxicity.
A milestone in the treatment of cancer patients
In those early years, the IVO was an active part of what would later become the
Spanish Brachytherapy Group (GEB): this “seed” – as Dr. Arribas recalls – held the first “Consensus Meeting in Brachytherapy” in Spain at the IVO in 2001. Years later, in 2008, the then Clinical Head of Radiation Oncology, Dr. José Luís Guinot, was appointed the first coordinator of this national body, the IVO being one of the promoters of the first book on brachytherapy in Spanish.
Since then the
IVO has led –Together with centers in Spain and Europe–
the advances of this technique, promoting forums and contributing to its development in the field of research: “High rate brachytherapy was a milestone in the way patients are treated and IVO has been part of that revolution”, underlines Vicente Crispín.
Leader in research in Spain
The IVO is one of the centers in Spain that has conducted more studies on brachytherapy high rate: “In these 25 years, 47 articles have been published in specialized journals, 27 with their own results, and others in collaboration with other hospitals”, emphasizes Dr. Guinot.
As a reference center, the IVO receives patients referred from other Communities every year: “Many times, the experience of the center in the management of this technique is what determines its treatment,” says the doctor. José Luis Guinot. Being, in addition, the center of the
Valencian Community with a greater number of high-rate brachytherapy treatments in early relapses of previously treated breast cancer. «Normally in these cases the breast is removed, but the application of radiation through brachytherapy allows it to be preserved. The efficacy of high-rate brachytherapy is also very high in gynecological cancer, where it is essential to achieve a high cure rate. And in skin cancer, which does not require intervention in the operating room and provides great precision and greater comfort to the patient.
Throughout these 25 years, much of the research carried out since the IVO has served as a “stimulus” to other centers. This is the case of the study of 16 European hospitals of partial radiation to the breast –of which Drs Arribas and Guinot are co-authors– which has shown that it is the treatment of choice in low-risk cases. IVO has been reflected in the treatment of patients around the world ”.
Since then,
the technology used in high-rate brachytherapy has evolved as has the most advanced external radiation therapy today, they point from the IVO. CT, ultrasound, MRI images are now available in treatment planning, which contributes to the high precision of treatment. That is, image-guided radiotherapy techniques are also used in brachytherapy.
Multidisciplinary team
From the IVO they point out the participation of multidisciplinary teams and collaboration between services as another of the key factors in the success of this technique: In the case of, for example, the treatment of breast cancer with brachytherapy, in the operating room there is a total collaboration between the breast surgeon, the physical radiographer and the oncologist. A multidisciplinary team whose work guarantees maximum precision when irradiating the tumor and in which the role of nursing professionals is key.
The same occurs with a tumor in the tongue treated with brachytherapy: the coordinated work of the ENT, surgeon and radiophysicist, in the operating room, allows the removal and implantation of the affected area in the operating room, to give the radiation in the exact place, in less time and preserving a better function of that organ.
In brachytherapy, the team of professionals is made up of the radiation oncologist; the physical radius – in charge of calculating the treatment times, the design of the techniques or the determination of the distribution of the energy imparted inside the patient -; nursing staff, radiotherapy-brachytherapy technicians, and is combined, depending on the location of the tumor, with the rest of oncological specialists: gynecologists, ENT specialists, urologists, dermatologists, thoracic …
– .