posicionamiento tecnologico y clinico de la braquiterapia frente a
Transcripción
posicionamiento tecnologico y clinico de la braquiterapia frente a
POSICIONAMIENTO TECNOLOGICO Y CLINICO DE LA BRAQUITERAPIA FRENTE A LOS AVANCES DE LA ALTA TECNOLOGIA MODERNA Alfredo Polo MD, PhD Brachytherapy & Intraoperative Radiotherapy Unit Ramon y Cajal University Hospital Madrid. Spain BRACHYTHERAPY IN THE FRAMEWORK OF MODERN TECHNOLOGY IN RADIATION ONCOLOGY Alfredo Polo MD, PhD Brachytherapy & Intraoperative Radiotherapy Unit Ramon y Cajal University Hospital Madrid. Spain Cyberknife SBRT Adaptive IMRT ART IGRT Radiosurgery Tomotherapy SAR SRS Ablative IGRT is a component of the radiation therapy process that incorporates imaging coordinates from the treatment plan to be delivered in order to ensure that the patient is properly aligned in the treatment room The goal of IGRT is to improve the accuracy of the radiation field placement IGRT systems allow imaging/correction of the target position before each RT session IGRT increases the precision by frequently imaging the target and/or healthy tissues just before treatment and acting on this images to adapt the treatment CURRENT PARADIGMS TO ACHIEVE LOCAL CONTROL IN RADIATION ONCOLOGY DOSE ESCALATION Prostate cancer Soft tissue sarcoma Breast cancer • GI cancer GYN (Cervix) CNS cancer NHL Prostate cancer (low risk) Breast cancer (low risk) DOSE/TREATMENT DE-ESCALATION • • • H&N cancer Lung cancer CONCOMITANT TREATMENTS • • • • • • • • • • • CRISIS SCENARIO IN RADIATION ONCOLOGY LOBBY CRISIS IDENTITY ECONOMY CRISIS SCENARIO IN RADIATION ONCOLOGY LOBBY CRISIS ECONOMY Healthcare (hospital) ecosystem Trends in technology Research paradigm Hype-cycle Onconomics GDP expenditure in healthccare IDENTITY Clinically vs. technologically driven Research paradigm Organizational model REAL ACADEMIA ESPAÑOLA CRISIS. (Del lat. crisis, y este del gr. κρίσις). 1. f. Cambio brusco en el curso de una enfermedad, ya sea para mejorarse, ya para agravarse el paciente. 2. f. Mutación importante en el desarrollo de otros procesos, ya de orden físico, ya históricos o espirituales. 3. f. Situación de un asunto o proceso cuando está en duda la continuación, modificación o cese. 4. f. Momento decisivo de un negocio grave y de consecuencias importantes. 5. f. Juicio que se hace de algo después de haberlo examinado cuidadosamente. 6. f. Escasez, carestía. 7. f. Situación dificultosa o complicada. IDENTITY RADIATION ONCOLOGY IN THE HOSPITAL ECOSYSTEM SURGICAL SERVICES MEDICAL SERVICES PATIENT CENTRAL SERVICES RT RADIATION ONCOLOGY AND HOSPITAL PROCESSES MANAGEMENT PROCESSES CORE PROCESSES PATIENT PATIENT SUPPORT PROCESSES RT RADIATION ONCOLOGY AND HOSPITAL PROCESSES MANAGEMENT PROCESSES CORE PROCESSES PATIENT RT SUPPORT PROCESSES PATIENT CLINICAL RESEARCH INPATIENT RADIATION ONCOLOGY DEPARTMENT BT & IORT UNIT EBRT CLINICAL RESEARCH INPATIENT RADIATION ONCOLOGY DEPARTMENT BT & IORT UNIT Hospital OR Committee Surgical quality indicators Preventive Medicine Department Surgical Day-Hospital EBRT LOBBY RESEARCH PARADIGM IN ONCOLOGY New-drug discovery Lobbying Mobbing Lobby exclusion IDENTITY CRISIS New-drug discovery Lobbying Mobbing Lobby exclusion IDENTITY CRISIS Target an up-regulated molecule Ad-hoc clinical trials: EBM Big Pharma Mass-media and social media Intra-hospital Extra-hospital ONCONOMICS “The Journey of Oncology as a field, from a field to study tumors of unknown etiology and characteristics, has been very eventful for the human race, but seems to be hijacked by the compulsions of onconomics, a term I suggest to partly describe the economics of oncology drug discovery and development and the payer dynamics.” Kovvali G. Systems oncology: A new paradigm in cancer research. J Carcinog. 2014;13:6. ALTERNATIVE RESEARCH PARADIGM IN RADIATION ONCOLOGY A NEW RADIOBIOLOGY? Finkelstein SE, Timmerman R, McBride WH et al. The confluence of stereotactic ablative radiotherapy and tumor immunology. Clin Dev Immunol. 2011;2011:439752. ENDOTELIAL MEDIATED CELL DAMAGE Fuks Z, Kolesnick R. Engaging the vascular component of the tumor response. Cancer Cell. 2005;8:89-91. ECONOMY Meropol NJ, Schulman KA. Cost of cancer care: issues and implications. J Clin Oncol. 2007;25:180-186. RISK: a state of uncertainty where some possible outcomes have an undesired effect or significant loss. CONCLUSION FUNCTIONAL INTEGRATION Anaesthesia, surgery, radiation oncology, physics, RTTs OPERATION MANAGEMENT Overseeing, designing and controlling the process of production of goods or services OPTIMIZED RESOURCE USAGE Efficient: using as few resources as needed INTEGRATED Effective: meeting customer requirements PATIENT SAFETY AND QUALITY MANAGEMENT Process-oriented SKILLS Homogeneous decision-making, implant procedure and follow-up TEACHING Homogeneous teaching concepts RESEARCH Integrated technological platform Access to biological samples