Video: Is HDR Brachytherapy An Outdated Treatment? | Ask a Prostate Expert, Jeffrey Demanes, MD

Ask a Prostate Expert, Jeffrey Demanes, MD | Transcription

Alex: So, I think when it comes to the concept of brachytherapy, I know a lot of patients are not offered this as a treatment right away. In fact, I've talked to a lot of people on our Helpline and we kind of have to get them to a different doctor sometimes just for them to hear all of their options. So, can you speak to why brachytherapy is almost like—I think some radiation doctors almost consider it like outdated or old-fashioned. 

Dr. Demanes: Well, I think it's anything but old-fashioned. It's very modern and high-tech. From the time that Madame Curie discovered radium in 1898 and in the years after, they started putting radiation sources on or in malignant tumors and it was amazingly effective. It's got some physics basis, that is, the radiation stays where it's supposed to be and gives a high dose to the target so you end up with little collateral damage and high tumor control rates. And with the advent of modern surgery, improved radiation delivery devices (robotic delivery devices), better radiation sources we've been able to bring this into the 21st century and there's more to come. Robotic catheter insertions, all kinds of improved computerized treatment delivery methods. But it's not commonly known, I think, because, in part, it is asking doctors who went into a specialty that was not hands-on so much, radiation oncology, to do a hands-on surgical procedure. So, only a small percentage of the people who go into radiation oncology have that orientation and that skill set.

So, that's kind of one problem. The other problem, I guess, is that you know, publications and the studies in radiation oncology could have been a little bit better organized. So, back in the 1980s some doctors in Seattle, the Seattle group, started publishing the outcomes on seed implants and lo and behold the values were and the results were so good that actually brachytherapy for prostate had become fairly well known, but there still weren't a lot of training centers in the United States. And then moving on to HDR. HDR is a more complicated high dose-rate, involves a computerized robotic delivery device, more staff, a shielded room, and so forth, and it's a bigger program than seeds for prostate, but it also has the advantage of being able to reuse the source multiple times, so it's good for the environment in that you don't just create seeds and then have them in the environment, but rather you're using the same seed over and over again. It does require a sophisticated team of helpers and physicians and physicists and so forth to make the program work.

Alex: Well, that's definitely high tech. That's super cool.

Dr. Demanes: Yeah, it's high tech. High tech computers, high tech CT scanners, high tech physicists, dosimetrists, high tech nurses, anesthesia, and there's a whole team, but you can use high dose—what I wanted to say earlier and I didn't—is that you can use high dose-rate brachytherapy for all kinds of places in the body: head and neck, breast, GYN, skin, you name it, there are places in the body. Prostate just happens to be an ideal gland or cancer site suitable for brachytherapy because the bladder and the rectum are just above and below and the prostate is situated in between, so you need to be able to get that radiation dose, high dose, right into the target, and there's not much room for error, and brachytherapy is ideal for that.

Alex: That's incredible.

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