Endovascular Brachytherapy

[Ursus Martimus]

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Hello, could anyone chat up the subject of endovascular brachytherapy, ie:
- Is this in the kingdom of RadOnc at most places or interventional cards?
- Where are the best places to train in such an area and is it something residents can get experience in?
- Other than restenosis s/p PTCA and Renal artery stenosis what are some other uses?
- And while on the topic of "newer" toys of the trade, where would one consider a top institution in the area of radio-conjugated mAbs and again how much of this is shaping up to be a heme/onc v RadOnc territorial grudge-match?

Thought I'd milk the minds of the enlightened ones on this site. Thanks in advance.

 

[stephew]

- Is this in the kingdom of RadOnc at most places or interventional cards?
both. And frankly its the most godaweful boring thing on the face of the earth.


- Where are the best places to train in such an area and is it something residents can get experience in?
You can. Can you shift a switch? Youre trained. Want credentialling? Do it three times and your credentialed. You literally stand there, and flick a switch on, off. Its not hot, its not exciting, and frankly if the darned taxol imrpegnanted things actually worked I'd be happy to chuck the little device or give it to a kid to play submarine with.

- Other than restenosis s/p PTCA and Renal artery stenosis what are some other uses?
not a whole heck of a lot


- And while on the topic of "newer" toys of the trade, where would one consider a top institution in the area of radio-conjugated mAbs and again how much of this is shaping up to be a heme/onc v RadOnc territorial grudge-match?

Hemeonc will have little to do with it. Radonc and nuc medicine sort of vye for it. A lot of places do it. 2nd in godaweful boring. A good tool for patients in some circumstances, but boring from a doctoring stand point ("Inject; draw back, inject, flush"). Its not going to be the mainstay of radonc, just another little thing we do.

 

[Thaiger75]

steph, you sound so fond of IVB 😛
Isn't the monetary compensation pretty good considering the little amount of physical work that is required for it?

 

[stephew]

steph, you sound so fond of IVB 😛
Isn't the monetary compensation pretty good considering the little amount of physical work that is required for it?

Yes it is. And its not just little physical exertion. Mental and spiritual too! In all seriousness, as a resident do yourself a favor and dont go to a place because they do a lot of these. Im hardly joking about what's involved in doing it.

 

[AlexanderJ]

Yes, I agree that endovascular brachytherapy is a fairly mindless and simple procedure. I also think Rad Oncs feel a little out of their element in the cath lab. However, I do know that these procedures reimburse very well (I was told you could do 3 of these procedures per week and justify your salary based solely on that, not sure if that is completely true). In any event, I do not think it is a good idea to give up any procedure we do. Its a slippery slope and could result in loss of other turf. I do wonder what the future of this procedure will be in the era of drug eluting stents...

 

[stephew]

Yes, I agree that endovascular brachytherapy is a fairly mindless and simple procedure. I also think Rad Oncs feel a little out of their element in the cath lab. However, I do know that these procedures reimburse very well (I was told you could do 3 of these procedures per week and justify your salary based solely on that, not sure if that is completely true). In any event, I do not think it is a good idea to give up any procedure we do. Its a slippery slope and could result in loss of other turf. I do wonder what the future of this procedure will be in the era of drug eluting stents...

well that's a very different question but a very important one. The cardiologists often greatly resent radoncs presence because they do deal to some extend with radiation themselves But the necessity of physics is what made radonc win out.

The issue of the slippery slope is a real one. While I think its a must to have gynonc, urology and ortho etc in the OR with us, and neurosurgeons chiming in on stereotactic procesures for CNS, its very clear they know their thing but often think they know more about radonc than they do. Radiation oncologists must work as a team with other services. We must master our areas of expertise and not contribute to problems with the turf war; either way. Its the best th ing for us and the best thing for the patients.

 

[Htowngsp]

http://abcnews.go.com/sections/living/SecondOpinion/secondopinion010423.html

 

[stephew]

a discussion on this topic with folks from work have resulted in the general consensus, catagory 1A data that everyone hates endovascular brachy, even the private practice guys because they can't schedule consults while "on call" to the OR.

 

[stephew]

http://abcnews.go.com/sections/living/SecondOpinion/secondopinion010423.html

yeah well that shows you the importance of physics and not letting someone without extensive radiation training do something. ANd they know who they are. Oh and by the way? Mammosite? some real horrors with that device if your not very very careful

 

[Thaiger75]

I do wonder what the future of this procedure will be in the era of drug eluting stents...

The preliminary data on these drug eluting stents are quite impressive. They will most likely decrease the use of IVB, but I'm sure there will always be a role for IVB, be it for in-stent restenosis or lesions resistant to drug eluting stents.

From talking to some attendings, the most annoying part is having to wait around (early in the morning) for the green light page to go to the OR.