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"Brach" to the Future

Hark back to a story we published in 2017 - The first time that procedure called 'interstitial brachytherapy' was performed in SingHealth and NCCS with a team led by Dr Kiattisa Sommat. Back to the present, and finally reaching an end goal - a full, independent cancer treatment service that's now available at the National Cancer Centre Singapore.

NCCS recently opened its first dedicated interstitial brachytherapy facility in May this year.  Speaking at the private launch, Dr Kiattisa reflected on the team's feelings on the opening of the facility: "Definitely happy and accomplished," she said. "I fondly remember the challenges that forced us to think out of the box and be creative." 

Radiation Therapist Jeannie Lin chimes in, "We learnt to never give up!" inducing a laugh from the team. 

Offering interstitial brachytherapy (IB) as an option for cervical cancer treatment may seem simple on the surface. However, not many oncology centres in Asia offer IB - only the large oncology centres in Thailand and India, for example - putting NCCS is a select group of medical institutions.

Recently retired Dr Chua Eu Jin (front row, 3rd from left) cuts the ribbon with Dr Kiattisa. They are joined by Seinor Consultants and senior management members of the Division of Radiation Oncology.

Equipment used during the procedure on display

Speaking of India, in early 2018, a core team was sent for training at one of the most prominent oncology centres of the region. The team of Consultant Radiation Oncologist Dr Kiattisa, Medical Physicist Melvin Chew and Senior Radiation Therapist Jeannie Lin spent nearly a month undergoing brachytherapy training with Tata Memorial Hospital, located in Mumbai. The team presented a scientific poster at the International Gynaecologic Cancer Society Meeting later that year in Kyoto, Japan. 

(From left to right): Medical Physicist Melvin Chew, Radiation Therapist Jeannie Lin and Consultant Radiation Oncologist Kiattisa Sommat

This new IB facility is a major improvement over the previous model of care which required the team to book an operating theatre Level 3 of NCCS, and thereafter, shuttle the patient to radiation oncology at Basement 2 to complete the procedure. Thus, with improvements to the procedure, workflow, as well as the opening of this new facility, a patient can be transported seamlessly after brachytherapy applicator insertion to the CT room and brachytherapy treatment room, all within the same area. Another advancement is the use of a combination of local anaesthesia with sedation rather than general anaesthesia. This combination brings the patient the benefit of quicker recovery and several side benefits too. A shorter time required for a procedure brings benefits to both patient and institution.

"Not only does the patient recover quickly, but there's other downstream benefits," explains Dr Kiattisa. "Without the use of an operating theatre, general anaesthesia or requiring long recovery periods, this also translates into cost savings for patients."

Together with the new facility comes a new Venezia brachytherapy applicator - an advanced applicator system which allows Oncologists the flexibility to treat advanced genealogical cancers with IB. Apart from better ergonomics and design, this new applicator allows the team the option to treat more advanced cancers. Because of the stage of growth of advanced cancers, some areas of the tumour may be difficult to be covered with optimal dose of radiation with conventional intracavitary brachytherapy. 

The Venezia brachytherapy applicator

So what's next for the team?  'The future', came a swift reply. The team is looking to put in stone several aspects like workflow and layout for the future. "We're doing this with one eye on the future - the new NCCS Building," explains Dr Kiattisa. "By refining our workflows and layout, we can replicate this model in the new NCCS building when it opens." The team also hopes to expand their services to include transperineal brachytherapy to treat lower vagina diseases.

From 2017 to 2019, so much has happened in two years. But we look forward another 2 years toward the NCCS New Building in 2021. We'll keep our eyes open for the next new development in the Division of Radiation Oncology!