The bell tolls on: brach to the past, present and future

Sanchia GoonewardeneTwenty years ago, brachytherapy was the final frontier for uro-oncology. Training today, especially for urologists, focuses on development of operative ability, rarely minimally invasive procedures. Very often, trainees are hesistant to learn about lesser invasive techniques. With that in mind, one of my mentors encouraged me to attend the UK and Ireland prostate brachytherapy conference on 27 March 2015.     

The venue was the Tower Hotel, London, where the programme was held over the course of one day, with a truly international faculty from the USA, Japan and France. The meeting was chaired by the uro-oncology team at Guy’s and St Thomas’ Hospitals – Mr Rick Popert and Dr Stephen Morris. At the very start of the meeting, a bell was rung, symbolising a bell which would toll on and on. This meeting was not only for physicians, but physicists and surgeons alike – a truly ‘super’ multidisciplinary meeting.

The overall theme was very exciting – reflecting on the past, applying evolution to the present and looking to future developments of brachytherapy. Whilst the past was reflected upon, changes in management with practical applications in the present day were also highlighted.

One of the best ways of emphasising this was by case presentation, with input from five different demographic areas – Leeds, Guilford, Mount Vernon, Galway, and Guy’s and St Thomas’ Hospitals. Also outlined were possible new evolutions of brachytherapy including HDR – a ground-breaking service. 

Professor Louis Potters gave a US perspective on brachytherapy and also highlighted how brachytherapy had developed within the UK. The pertinent questions for any trainees would be – brachytherapy versus robotic surgery – which one would you choose for your patient and why? Which one would your patient prefer? A minimally invasive procedure with reduced risk of sexual complications, or robotic surgery? With so many patients pursuing technology today, brachytherapy is often a ‘cinderella’ treatment – one that is neglected, not often considered and needs more funding in research. The question we often have to ask ourselves, is what would the men of today want?

What was brilliantly outlined was evidence of all levels for brachytherapy. However, what became apparent, as in so many areas of medical research, was the requirement for further research and for the younger generation to take this over. The rate of growth and brachytherapy was highlighted by Brendan Carrey together with the evolution of brachytherapy – from poor imaging to high-quality imaging and now thinking about MRI fusion guided and focal brachytherapy.

In between oncology and urology, complications of brachytherapy were also outlined by a physicist, Dr Sarah Aldridge (Guy’s and St Thomas’ Hospitals). Additionally change in guidance and practice was given together with evolution of brachytherapy to LDR, focal techniques and becoming a day-case procedure. The role of ADT with brachytherapy was also reflected upon.

Professor Kenta Miki (Japan) went onto speak about the role of focal salvage brachytherapy – a not often considered problem. This again highlighted the need for research in a much deprived area. The focal experience was taken one step further by Professor Jean-Marc Cosset (France) discussing hemi-gland ablation, with UK-based application from Professor Stephen Langley.

To close the meeting, the evolving future of brachytherapy was reflected upon by Professor Gary Cook (Guy’s and St Thomas’ Hospitals). The UK and Ireland brachytherapy meeting will be ‘brach’ in 2016.

Sanchia S. Goonewardene, Great Western Hospitals, Swindon

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