Pionero con la primera intervención en España en 1998, con la mayor serie de Braquiterapia Prostática de España con más de 6.000 intervenciones.
Experiencia Propia
Realicé la primera intervención de Braquiterapia Prostática en España (1998), hace más de 25 años de ese primer tratamiento, aunque previamente participó en el tratamiento de un grupo de 28 pacientes a los que se les realizó Braquiterapia con 198Au a nivel prostático a través de cirugía abierta, como sobre impresión a radioterapia externa entre 1980 y 1986 y cuyos resultados están publicados en Archivos Españoles de Urología.
Durante este período de tiempo y hasta la actualidad, he superado las 6.000 braquiterapias prostáticas, lo que representa la mayor serie Braquiterapia prostática en nuestro país y una de las mayores europeas.
Desde hace más de 20 años, soy el único especialista que realiza una técnica de planificación intraoperatoria por cálculo dinámico de dosis (tiempo real), al creer que dicha técnica es la más segura en el control de la distribución de las dosis a aplicar, lo que permite administrar grandes dosis de radiación de forma muy selectiva y controlada evitando la irradiación de las zonas sanas y por lo tanto las complicaciones.
Las ventajas que representa dicha técnica respecto a las otras técnicas existentes son:
- ▪︎ Todo el proceso se realizará en un único acto quirúrgico incluyendo la post planificación.
- ▪︎ Es la única técnica que permite correcciones de zonas infra o sobre-dosificadas durante la propia intervención.
Durante todo este tiempo he contribuido a la mejora del tratamiento braquiterápico del cáncer de próstata con el desarrollo de avances técnicos y terapéuticos propios:
- ▪︎ La utilización de dos actividades de semillas en el mismo paciente y durante la misma intervención, me permite utilizar un menor número de catéteres, lo que supone menor traumatismo para el paciente y por lo tanto menor número de complicaciones, así como una mejora en la distribución de las dosis a administrar.
- ▪︎ La técnica de protección rectal desarrollada me permite llegar a anular la toxicidad a nivel del recto (ver multimedia).
- ▪︎ La técnica de protección uretral, (ensayo clínico) me permite disminuir la toxicidad a dicho nivel.
Los resultados propios a largo plazo, han sido publicados y comunicados en los foros científicos nacionales e internacionales, siendo equiparables a las mejores series universales.
De forma resumida quedan expuestos a continuación.
Resultados a largo plazo >10 años Braquiterapia de Baja Tasa de dosis.
| Grupos | Blasko | Stone-Stoke | Wallner | Beyer | Battermann |
|---|---|---|---|---|---|
| Bajo Riesgo | 94% | 94-88% | 85% | 85% | 92 -90% |
| Riesgo Interm. | 84% | 81% | 75% | 75% | 86% |
| Alto Riesgo | 54% | 66% | 65% | 65% | 52% |
| Análisis | Resultados propios a 25 años |
|---|---|
| Control Bioquímico | 95 % ± 2% |
| Control Local | 97% ± 1% |
| Superv. Libro Enf. | 98% ± 1% |
Casuística Propia
Evolución PSA - Relación PSA ng/m - Meses
Preservación función eréctil
Conclusiones
Podemos afirmar que los tumores localizados prostáticos considerados de bajo riesgo (PSA ≤ 10 ng/ml y Gleason < 7 y Estadio ≤ T2a) y en casos seleccionados de riesgo intermedio (PSA 10.1-20 ng/ml o Gleason = 7 o Estadio T2b-c), la braquiterapia de baja tasa de dosis (125I) es un tratamiento curativo con excelentes resultados a largo plazo (94% de control bioquímico) iguales a los conseguidos con prostatectomia radical, pero con menor índice de complicaciones, teniendo la ventaja de ser un tratamiento ambulatorio que permite la incorporación a la vida habitual inmediata (alta 6 h).
Por lo tanto, la braquiterapia es una opción terapéutica en este tipo de tumores que debe de ser valorada y ofertada a los pacientes, dentro de grupos multidisciplinarios de tratamiento.
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