Ensuring Safety For Oncologists And Patients

The Indian Brachytherapy Society is coming up with guidelines for brachytherapy, reports Nayantara Som

"The science and practice of brachytherapy is growing very fast" - Dr Ramesh Billimaga Radiation Oncologist Bangalore Institute of Oncology

To ensure risk-free brachytherapy treatment and efface out fears of exposure to radiation, national guidelines on brachytherapy is on the cards. The draft guidelines, to be prepared by the Indian Brachytherapy Society (IBS), is expected to be finalised by August 2006. The draft will be scrutinised by an expert committee specially constituted for the purpose before it is circulated to the hospitals and the public.

Dr Ramesh Billimaga, Director and Radiation Oncologist at Bangalore Institute of Oncology, points out to the need to initiate such guidelines. "The science and practice of brachytherapy is growing very fast. And as even mid-size and smaller cancer centres are acquiring the latest brachytherapy equipment, everybody is seeking guidelines," he says.

The decision to formulate guidelines was taken at the National Brachytherapy Update 2006 Conference, held in May this year in Bangalore. These guidelines are based on the already existing guidelines of the American Brachytherapy Society with some modifications to suit the Indian context.

"This draft contains the summary of extensive discussions from various experts on various cancers: cancer of breast, cancer of head and neck, cancer of prostrate, cancer of oesophagus and gynaec cancer," adds Dr Billimaga, who was the course Director of the conference.

Lack of common guidelines regarding this modified form is a cause for severe discomfort both for patients and radiation oncologists in India. This causes an imbalance in the level of radio-active isotopes being used. Almost all developed countries including the UK, the US and Australia have constituted these guidelines, thereby minimising the radioactivity of this therapy. While some experts dismiss the guidelines as publicity gimmick by the IBS, the unanimous opinion is that this draft will ensure quality patient care.

Brachytherapy, also known as sealed source radiotherapy or endocurietherapy, is a form of therapy where a radioactive source is placed inside or next to the area requiring treatment, thereby preventing radiation from spreading to the healthy cells around the cancerous area. It is commonly used for treatment of localised prostrate cancer, cancers of the head and neck and ocular cancer.

Brachytherapy is not a recent practice in the West; this therapy is in practice for nearly a century. However, it has become popular only in the past five years. Unfortunately in India, the treatment is not so popular. Dr Vivek J Anand, Consultant, Radiation Oncology, P D Hinduja National Hospital & Medical Research Centre, Mumbai opines, "Brachytherapy is not developed due to lack of expertise. Moreover, patients are not aware of this therapy, thereby doctors are not willing to import technologies pertaining to brachytherapy."

Dr Ravi Kiran, Radiation Oncologist, Kidwai Memorial Institute of Oncology, Bangalore, who had also attended the conference mentions, "The radiation that should be given in the various stages to cancer treatment were discussed, mainly brachytherapy guidelines for cervical cancer."

The conference was attended by as many as 50 experts from different parts of the country. Apart from Dr Billimaga and Dr Kiran, Professor M Jagadeeshan, President, IBS, Dr K A Dinshaw, Director of Mumbai’s Tata Memorial Hospital and the pioneer of brachytherapy treatment in India, were some of the leading experts who were also present.

According to Dr Billimaga, outcomes of the discussions were reviewed during the concluding days of the conference in Bangalore, which will serve as a backgrounder to the final draft.

The step to initiate the draft is laudable because it has given a new direction to brachytherapy treatment in the country. On the macro level, it also signifies a step forward for cancer treatment in India.