Interview with Bradley Pieters,

recipient of the GEC-ESTRO Iridium 192 Award at ESTRO 2024

 

Bradley Pieters Amsterdam University Medical Center Amsterdam, The Netherlands

 

The "GEC-ESTRO Iridium Award" is presented to the brachytherapist or physicist who, in the opinion of the GEC-ESTRO Committee members, has made a major contribution to the development of the Brachytherapy speciality.

The recipient of this award delivers a lecture at the annual ESTRO Congress.

 

Congratulations on being honoured with the GEC-ESTRO Iridium 192 Award! How does it feel to be recognised for your significant contributions to the development of the brachytherapy specialty by the GEC-ESTRO committee?

I’m very honoured and grateful to receive the GEC-ESTRO Iridium 192 Award. Very early in my training as a radiation oncologist, I visited a radiotherapy department in my home country of Curaçao. There, Dr Ronald Veen made me enthusiastic about brachytherapy, and I knew from then on that this was the subspeciality that I would choose. I have been lucky enough to dedicate a large part of my professional career to brachytherapy and to contribute to its development within ESTRO. It is like a dream come true, so you can imagine my gratitude.

 

Brachytherapy is a specialised field within radiation oncology. Can you share some insights into the specific areas or advancements in brachytherapy that you believe contributed to this prestigious recognition?

At the Amsterdam University Medical Center , we have always been involved in the development of various areas and topics of brachytherapy. For example, together with the Emma Childrens’ Hospital, we developed the ablative surgery, moulage brachytherapy and reconstruction (AMORE) technique for the treatment of paediatric rhabdomyosarcoma in the orbit and head and neck region. We have published several papers on bladder brachytherapy with The Netherlands Cancer Institute. In The Netherlands, with the Erasmus Medical Center, we conducted a randomised trial in prostate brachytherapy. We have also been involved in more general aspects of brachytherapy, such as the transition from low- to pulsed-dose-radiation, for which staff from many centres have visited us; research into external beam and brachytherapy dose summation; and automated artificial intelligence (AI)-based treatment planning with Centrum Wiskunde & Informatica and Leiden UMC. These are some of the many projects that we have carried out with several partners over the last two decades, but I must also mention the collaboration I have within ESTRO to develop and promote brachytherapy.

 

Brachytherapy involves collaboration between clinicians and medical physicists. How do you see the synergy between these two roles contributing to the advancements and evolution of brachytherapy, and how has this collaboration shaped your work?

As in external beam radiotherapy, brachytherapy involves close working of clinicians with physicists. Interdisciplinary collaboration is very important in the field of radiotherapy and particularly brachytherapy. There is also intensive collaboration with cell biologists and, more recently, computer scientists. Physicists and computer scientists are involved mainly in technological development. To develop brachytherapy, we rely heavily on technological advances, such as image processing, navigation technologies, adaptive dose strategies, and quality assurance, in which physicists play a crucial role. Example of recent developments that we are embracing with computer scientists are new AI-based techniques to optimise treatment planning, and with cell biologists, the use of brachytherapy for immunomodulation.

 

As a recipient of this award, you will be delivering a lecture at the ESTRO Congress. Can you provide a glimpse of the key themes or insights you plan to share during your lecture, and how it aligns with the goals of advancing brachytherapy?

We see that in Europe, and in other parts of the world, there is a discrepancy between the skills that young professionals have in brachytherapy after their training compared with those that they hold in other fields of radiotherapy. In my opinion, the advancement of brachytherapy should not only lead to a better cure and less toxicity for our patients, but also help young and experienced professionals in their daily work. The title of my lecture is “Confidence through Certainty”.
 

What innovations or techniques do you find most promising in brachytherapy?

Many new techniques are being developed. All these techniques have their value for certain parts of our field. One innovative technique I’m working on now at the Amsterdam UMC, together with Centrum Wiskunde & Informatica and Leiden UMC, is the development of an AI-based optimisation algorithm for better and more insightful brachytherapy treatment planning. Today, we can produce prostate treatment plans within minutes that take advantage of all possible optimisation possibilities for dwell positions and dwell times. We are able to plan and adapt directly to the desired dose objectives. I’m very impressed with what we have achieved so far and I’m excited to see how this algorithm will work in other areas.

 

The GEC-ESTRO committee plays a crucial role in selecting the award recipient. How do you perceive the role of such committees in acknowledging and promoting excellence within specialised fields of radiation oncology, particularly in brachytherapy?

I’m very grateful to the GEC-ESTRO committee and the ESTRO board for awarding me this prize. I understand that this award is in recognition of my work in the field of brachytherapy, something that I have done and continue to do with great pleasure. When I received the news, after telling my wife and children, I immediately informed my colleagues and thanked them. This award from GEC-ESTRO is an important recognition of groups that have made great efforts to advance the field of brachytherapy. If it were not for my colleagues and other partners, I would not have received the award. Last but not least, the support of my family has been crucial.

 

Brachytherapy often involves tailoring treatments to individual patients. Can you share a case or experience where personalised or innovative approaches in brachytherapy had a particularly positive impact on patient outcomes?

Special cases that I can talk about are patients with orbital tumours or skin tumours that have invaded the orbit. In many centres, these patients are treated with external beam radiotherapy, or they may even face exenteration. With high dose external beam radiotherapy, there is a risk of severe damage and even loss of vision. After a mutilating exenteration, the loss of vision is immediate. At the Amsterdam UMC we treat with brachytherapy if possible. In many cases, patients have been cured and their vision has been preserved. For me, these are special cases, because serious side effects of the treatment were prevented.

 

Reflecting on your career in brachytherapy, what advice would you offer to aspiring brachytherapists aiming to make significant contributions to the field and possibly receive recognition like the GEC-ESTRO Iridium 192 Award?

The key is to collaborate with other professionals in the field. With this collaboration, it is possible to create projects that will have a significant impact in the field of brachytherapy and will be of value not only to patients but also to the brachytherapy community. In ESTRO and GEC-ESTRO, there are many opportunities to participate in all kinds of working groups, task forces, etc. Collaborations within one’s own institute and with others will make a significant contribution to the field.