POSICIONAMIENTO TECNOLOGICO Y CLINICO DE LA BRAQUITERAPIA FRENTE A LOS AVANCES DE LA ALTA TECNOLOGIA MODERNA

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1 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

2 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

3 Cyberknife SBRT Adaptive ART IMRT Tomotherapy IGRT Radiosurgery SAR Ablative SRS

4 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

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6 CURRENT PARADIGMS TO ACHIEVE LOCAL CONTROL IN RADIATION ONCOLOGY DOSE ESCALATION CONCOMITANT TREATMENTS DOSE/TREATMENT DE-ESCALATION Prostate cancer Soft tissue sarcoma Breast cancer H&N cancer Lung cancer GI cancer GYN (Cervix) CNS cancer NHL Prostate cancer (low risk) Breast cancer (low risk)

7 CRISIS SCENARIO IN RADIATION ONCOLOGY LOBBY CRISIS ECONOMY IDENTITY

8 CRISIS SCENARIO IN RADIATION ONCOLOGY LOBBY CRISIS ECONOMY Healthcare (hospital) ecosystem Research paradigm Onconomics Trends in technology Hype-cycle GDP expenditure in healthccare IDENTITY Clinically vs. technologically driven Research paradigm Organizational model

9 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.

10 IDENTITY

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12 RADIATION ONCOLOGY IN THE HOSPITAL ECOSYSTEM SURGICAL SERVICES MEDICAL SERVICES PATIENT CENTRAL SERVICES RT

13 RADIATION ONCOLOGY AND HOSPITAL PROCESSES MANAGEMENT PROCESSES PATIENT CORE PROCESSES PATIENT SUPPORT PROCESSES RT

14 RADIATION ONCOLOGY AND HOSPITAL PROCESSES MANAGEMENT PROCESSES PATIENT CORE PROCESSES RT PATIENT SUPPORT PROCESSES

15 CLINICAL RESEARCH IN- PATIENT RADIATION ONCOLOGY DEPARTMENT EBRT BT & IORT UNIT

16 CLINICAL RESEARCH IN- PATIENT RADIATION ONCOLOGY DEPARTMENT EBRT BT & IORT UNIT Hospital OR Committee Surgical quality indicators Preventive Medicine Department Surgical Day-Hospital

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18 LOBBY

19 RESEARCH PARADIGM IN ONCOLOGY

20 New-drug discovery Lobbying Mobbing Lobby exclusion IDENTITY CRISIS

21 New-drug discovery Target an up-regulated molecule Ad-hoc clinical trials: EBM Lobbying Big Pharma Mass-media and social media Mobbing Intra-hospital Extra-hospital Lobby exclusion IDENTITY CRISIS

22 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.

23 ALTERNATIVE RESEARCH PARADIGM IN RADIATION ONCOLOGY

24 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:

25 ENDOTELIAL MEDIATED CELL DAMAGE Fuks Z, Kolesnick R. Engaging the vascular component of the tumor response. Cancer Cell. 2005;8:89-91.

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27 ECONOMY

28 Meropol NJ, Schulman KA. Cost of cancer care: issues and implications. J Clin Oncol. 2007;25:

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34 RISK: a state of uncertainty where some possible outcomes have an undesired effect or significant loss.

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37 CONCLUSION

38 FUNCTIONAL INTEGRATION Anaesthesia, surgery, radiation oncology, physics, RTTs INTEGRATED OPERATION MANAGEMENT OPTIMIZED RESOURCE USAGE PATIENT SAFETY AND QUALITY MANAGEMENT Overseeing, designing and controlling the process of production of goods or services Efficient: using as few resources as needed Effective: meeting customer requirements Process-oriented SKILLS Homogeneous decision-making, implant procedure and follow-up TEACHING Homogeneous teaching concepts RESEARCH Integrated technological platform Access to biological samples