Brachytherapy for Bladder carcinoma
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1 Brachytherapy for Bladder carcinoma Geert Smits MD PhD FEBU Onco-urology, Robotsurgery 010
2 Intuitive: International proctor Electa: Scientific collaboration Stichting vrienden Rijnstate Intellectual property NO patents NO shares
3 Robot Assisted Laparoscopy and Brachytherapy for Bladder carcinoma Geert Smits MD PhD FEBU Onco-urology, Robotsurgery 010
4 020
5 Elzbieta vd Steen-Banasik Geert Smits
6 Muscle Invasive Bladder Cancer Cystectomy Lnn dissection Part.cystectomy Chemotherapy Neo / Adjuvant Brachytherapy EBRT Multimodality- treatments
7 Bladder preserving brachytherapy muscle invasive bladder cancer 1/ External Beam RT 2/ Surgery ± lnn dissection / ± tumorexcision (partial cystectomy) placement of brachytherapy catheters/source carier tubes Open surgery laproscopy robot assisted laparoscopy 3/ Interstitial RT = Brachytherapy
8 Bladder preserving brachytherapy muscle invasive bladder cancer Open surgery
9
10
11
12 Bladder preserving brachytherapy muscle invasive bladder cancer What do we know? UCC is radiosensitive!! Can be curative in well defined cases Survival: comparable with cystectomy data Considerable toxicity Extensive and intensive collaboration Only few centres perform this technique N>1000 patients worldwide
13 Bladder preserving brachytherapy muscle invasive bladder cancer Literature: Ann Oncol, nov 2012 Int J Radiat Oncol Biol Phys, march 2014
14 Bladder preserving brachytherapy muscle invasive bladder cancer Literature: J of contemp brachytherapy, juni 2014 Radiother Oncol, nov 2009
15 Cystectomy vs Brachytherapy Overall survival Brachytherapy Cystectomy Disease specific survival Brachytherapy Cystectomy At risk: Time [y] At risk: Time [y] Radiotherapy & Oncology: 93 (2009)
16 Bladder preserving brachytherapy muscle invasive bladder cancer Conclusions literature: Multimodality bladder-sparing regimen using IRT offers excellent long-term oncological outcome in selected patients with MIBC Still considerable toxicity
17 OUR GOAL Organ preservation Improve toxicity Enhance effectivity ROBOT-assisted laparoscopy 3D monitors real-time virtual&augmented reality
18 RIJNSTATE
19 Surgery OPEN LAPAROSCOPIC Patiënt: Lithotomy & Trendelenburg position Simultaneous Laparoscopy and Cystoscopy Exposure and defining the target-volume Placing the canulas with the Arnhem-needle davinci robot platform N=57
20 Arnhem-needle
21 Arnhem-needle Luneray
22
23 Brachytherapy-bladdercarcinoma TUR-Bladder tumor, radical Solitary, rec. T1 or T2-3 tumor, no CIS 2-4 weeks post TUR-B: MRI and Cystoscopy it3a in0. 5 cm Not in the trigone or bladderneck Sufficient bladderfunction Informed consent 20 x 2Gy Implantation canulas +/- partial cystectomy +/- lymphenodedissection Afterloading: HDR (few cases PDR)
24
25
26 ing Position
27 ing Dock
28 Docking
29 Assistent
30 Simultaneous cystoscopy
31 Simultaneous laparoscopic and cystoscopic view
32 2D vs 3D vision
33
34 View in console
35 Needle handling
36 Positioning clips
37 Robot assisted partial cystectomy
38
39
40 Postop Hospital stay: 4-6 days afterloading Bloodloss: nihil (90%) max 200ml
41 Follow-up 1 year: 3m cystoscopy and cytology 2 year: 4m 3 year: 5m 4 year: 6m PET-CT or MRI when indicated (6/58)
42 na 3 mnd na 7 mnd
43 na 3 mnd na 7 mnd
44 na 5 mnd na 3 mnd na 7 mnd
45 na 5 mnd na 3 mnd na 7 mnd
46 Bladder preserving brachytherapy muscle invasive bladder cancer ct2-3a, cn0, solitary tumor, no CIS Should be mentioned in EAU guidelines Should be discussed in MDT Increasing awareness for bladder preservation Increasing number of patients can benefit Standardisation of treatment protocols Studies: sentinal node, HDR, comb. chemo, imaging
47 In the long history of human kind (and animal kind too), those who learned to collaborate and improvise most effectively have prevailed Ch. Darwin 2013 MVVDSTEEN
Curie - davinci connection
Organ sparing treatment in MIBC: Robot assisted laparoscopy & Interstitial Radiotherapy brachytherapy Curie - davinci connection Geert Smits MD PhD FEBU Rijnstate Hospital, Arnhem, NL 010 Geert Smits Intuitive:
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