Message from the President, 2015
We all live with radiation visible or invisible, within near or from far. We know radiation is hazardous when a measure/quantity exceeds said limit; is very much useful in the management of cancer. We know usefulness of ionizing radiation in diagnosis and treatment since the discovery of x-rays in 1895, by Wilhelm Conrad Rontgen and later radioactivity and Radium by Henry Becquerel, Marie Curie et al. Since then the use of brachytherapy rolled in the clinics. We have seen sea changes in its advancement and today we are reaping the benefit for the betterment of patients suffering from a cancer.
I have worked at the Tata Memorial Hospital for almost 34 years (1973-2007) before I superannuated in the year 2007. I had through my experience those days known the usefulness of radiation in their potential of preservation of anatomy and to a great extent physiology dreamt to replace radiation with surgery for treatment of early cancers of oral cavity. With the transfer of knowledge and technology we at TMH brought brachytherapy in HN region in the year 1975 & about. Although I was not part of HN group then because of interest&continued my efforts in understanding, expert sing brachytherapy; did a lot for buccal mucosa and oral tongue brachytherapy. With lots of initial fallacy and unexpected failure made us to intro-spect the work done and came to the conclusion of improvement in the technique to correct the pitfalls.
Arrived a technique economically viable with plastic bead technique and first case was done in early 1978 and then continued unabatedly and did many numbers to formalize the technique and adopt the same in routine clinical practice. The technique now practiced largely under the name Plastic Bead/Ball technique designed and utilized and progressed all over.
It is my proud privilege to open IBS web portal which will keep members in close contact and highlight the various activity conducted by them and by society and allow them to interact online for asking query to support brachytherapy in their center and also upload what one has done for the benefit of other members, for the ultimate benefit of cancer patients of our country and even other country members who are interested in brachytherapy. I congratulate the team with whose effort IBS web portal is there, where we wanted it to be.
Word about its use now and in future….
Brachytherapy plays an important therapeutic role in the cancer management. Brachytherapy is an important tool in the armamentarium of radiotherapy which uses tele-therapy and brachytherapy as independent mode and/or as combination and is under the care of Radiation Oncologist and his allies.
Brachytherapy has a long history and served an important role in the treatment of cancer by radiotherapy since the discovery of Radioactivity and Radium and continues to these days. Brachytherapy promotion and up gradation and teaching of the interested students and colleagues required a separate forum to give its importance it deserves, a society named Indian Brachytherapy Society was formed in the year 2005 as per regulatory act of this country.
Brachytherapy is the utmost conformal form of radiation with his best physical distribution allows the core of disease and the subclinical potential disease radiated in the exponential manner the way a clinician would desire sparing normal surrounding]g tissue without compromising on the disease areas. It may not be an overstatement if one said brachytherapy has led the way for EBRT in the development of conformal and image guided treatment. It has posed a challenge in the use of brachytherapy but one who knows its uses know what is best for patients with the disease and uses as alone or in combination to its best advantage.
Brachytherapy is useful in the management of wide range of malignancy including gynecological malignancy viz Prostate, HN cancer various sites, Sarcomas, Breast, Penis etc. It also plays an important role in the management of recurrent and palliative cases.
Results are highly technique dependent and arguably more akin to surgery then EBRT. Brachytherapy thus when applied as radical and curative setting akin to surgery for where and when indicated is the best organ and physiological preservation treatment compared to surgery and without compromising on the outcome. The limitation that we face in this country is that presentation & detection of cancer is delayed for many reasons beyond discussion here; however still brachytherapy does not lose its importance in its uses for early case.
India is a country where the role of brachytherapy is well defined and forms a part of standard of care in its management. Today its use in gynecological brachytherapy is well established and forms part of standard of care in all stages and for relapse too. Brachytherapy has shown considerable evolution with improvisation in its dosimetry from 2D to 3D using MRI/CT and now even expertising under USG guidance (for cervix) and other site where applicable and change of LDR to HDR (continuous to fractionated delivery ) has expanded its horizon and allowed its utility with reduced fear of isolation (reduced personnel and public/community radiation) when not on treatment.
Nonetheless I must say Brachytherapy is the best modality from the point of its characteristics, longevity in uses (Time tested) through research and development w.r.t its utility and outcome ie. controls, survival and toxicity and stands at clear advantages when used judiciously where indicated either alone or in combination with external RT + CT.
Brachytherapy is useful in variety of cancers at various sites but has more potential for lesions with histopathological type, SCC & adenocarcinomas and can be used for others viz. sarcomas etc. It has its use in Cervix, Head and neck cancers (almost all sub-sites), Endometrium, Prostate, breast, Oesophagues.
Brachytherapy is used widely in Prostate and Breast in developed countries USA and Europe ofcourse one can understand why, and the reasons are, these cancers form leading type of cancers there and they found out brachytherapy utility in this cancer and used independently or with combination of EBRT or as adjuvant for tumour bed boost with success.
We at our place, where Cervix and HN cancers form highest incidence have to take a step in this direction. We have made use of brachytherapy in cervix and put it into a standard of care in the management of carcinoma cervix, but have not been able to do so for HN cancers. It is only we have to think and show the others its utility which we in our mind know that brachytherapy has high potential in HN cancer management and put it across in our own country, although not been able to put into randomize trail so far to support its use and then put it across in other country too.
I have experience of brachytherapy in HN cancer and have performed in > 800 cases with various sub sites in HN cancers viz. Lip, BM, Oral Tongue, Hard Palate, BOT, SP, Tonsil, Vallecula, Epiglottis, Post- Pharyngeal wall, Neck nodes, nose, ear, eyelid etc.
That is the reason I started what is needed to improve cancer patient care in our country but in vain. I could not impress my own colleague and other treating faculties dealing with cancer treatment only because it was self-experience and not supported by statistical evidence ie under randomized trial to establish same. That is why I say……
One needs to decide upon a balance between conflicting forces for improving outcome keeping patient safety, economy convenience and expertise in mind.
I.e. …… one should understand for the progress in cancer care …..What it means ……..
Improving cancer patient care means selecting the right treatment, as independent modality or in combination and make it available when requires and this asks for timely investment in working relationships, skills and technologies. One needs to decide upon a balance between conflicting forces for improving outcome, patient safety, economy convenience and expertise. We must enforce and convince our surgical colleagues and encourage a prospective study to get the correct answer of its utility discussing both its pros and cons.
Through the IBS I intend to undertake collaborative statistical trial for various cancers that are common in our country namely Cervix, Endometrium, HN cancers (various suitable sub-sites), oesophagusetc so as to come out with better protocol with brachytherapy as alone or in combination with EBRT/EBRT+CT/Surgery so as develop a standard of care treatment for the cancers prevalent in this country.
I know there has been continuous development in technology and new tools are on its way like use of proton, carbon ions and will make its way into clinical practice with the time but remember this will be at huge cost !!!. Let us not forget brachytherapy and use its potential in the benefit of cancer and mankind.
I convey my members and IBS a great success in its endeavor and call for support from all necessary front.
Looking forward to meet you at IBS meet at Kolkatta. 28- 30th Aug 2015
