posicionamiento tecnologico y clinico de la braquiterapia frente a

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