Urologist and radiation oncologist collaborate in laparoscopic implantation of new brachytherapy catheters for bladder cancer
Physicians at Arnhem Radiotherapy Institute (ARTI) and Rijnstate Hospital have dramatically transformed brachytherapy to treat bladder cancer. By employing new sophisticated Luneray™ brachytherapy catheters by Nucletron, an Elekta company, and robot-assisted laparoscopy, clinicians can treat bladder cancer patients far less invasively than previously possible, enabling bladder preservation in an increased number of patients.
On January 20, ARTI radiation oncologist Dr. Elzbieta van der Steen-Banasik and Rijnstate urologist Dr. Geert Smits used the technique they developed to treat an 80-year-old male patient with bladder cancer. He was the first in which the physicians debuted the recently introduced Luneray brachytherapy catheters. The ARTI-Rijnstate clinicians have been working in close collaboration with Nucletron perfecting the needle-catheter solution.
"The patient had a small T3 tumor that we treated initially with a four-week course of external beam radiation therapy (EBRT)," Dr. Smits says. "We then removed a bladder diverticule – where the tumor was located – with a partial cystectomy. During the same procedure we implanted two Luneray catheters using our robot-assisted laparoscopic approach and delivered the first of 10 brachytherapy fractions of 2.5 Gy each. The remaining nine fractions were delivered over the next three days. After the tenth fraction, the catheters were removed and the patient went home. There were no complications and he is doing well."
ARTI-Rijnstate's laparoscopic method with Luneray is a vast improvement over the traditional open surgical procedure for implanting brachytherapy catheters. After an initial EBRT course, the traditional method involved a large incision to expose the bladder, then opening the bladder for implantation of catheters. This complex procedure often incurs lengthy hospitalization and the possibility of wound and bladder infections.
"The laparoscopic technique involves just four 8-10 mm incisions in the abdominal wall for the insertion of instruments and, in most cases, minimal manipulation of the bladder wall, resulting in significant reduction in tissue trauma," Dr. van der Steen-Banasik explains. "Also hospitalization is dramatically shorter – an average of just six days, versus 17 days on average for the open procedure."
Innovative Luneray needle-catheter
The Luneray catheters are a critical component in the success of ARTI-Rijnstate's minimally invasive bladder brachytherapy program. Both Dr. Smits and Dr. van der Steen-Banasik worked together with Nucletron to create an entirely new class of pre-assembled brachytherapy needle/catheter applicators for laparoscopic use. The needles have a slight curve to enable optimal access to the targeted part of the bladder. The catheters are made of the same innovative material as the also recently introduced LumenCare™ Azure applicator for lung brachytherapy. This unique material makes the applicators strong, yet flexible and highly kink-resistant.
"The availability of Luneray catheters really creates new possibilities to treat selected bladder cancers in a minimally invasive way using brachytherapy," Dr. van der Steen-Banasik observes. "We hope that more patients will benefit from this bladder-sparing treatment in the future."
*Luneray is pending US FDA 510(k) clearance and not available for sale or distribution in all markets.
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