Renowned Goan-origin Doctor (Surgeon) and Professor of Surgery and Oncology at UCL, London, Prof. Dr. Jayant S. Vaidya shares details of his medical career in oncology and his groundbreaking breast cancer research, TARGIT-IORT – radiotherapy given during surgery for breast cancer.
Early Life and Education
I grew up in Panaji, going to MushtiFund Saunstha, People’s High School and then Dhempe College and Goa Medical College. I would like to mention here that, during my GMC days, Dr Ramesh Dhume helped me get my first grant and complete my first research project in physiology. Throughout my life, my parents Dr Sharad Vaidya and Dr Nirmala Vaidya and the large joint families that I came from, inspired me and encouraged my curious mind to explore new avenues all the time.
I went to Mumbai to pursue my post-graduation in surgery, and then specialisated in surgical oncology at Tata Memorial Hospital. I learnt cancer surgery from several eminent surgeons. Dr Praful Desai was my supervisor for my MS degree and Dr Indraneel Mittra and Dr Rajan Badwe nurtured my thirst for research. About 25 years ago, we moved to London for my PhD and FRCS. I have continued my clinical work side by side with research.
What made you choose the medical sciences as your career?
My quest is to help people and improve the well-being of humanity. The most satisfying way to do this is by directly looking after those who are unwell as a surgeon; and by making progress in medical science by doing research.
Taking preventive community action such as eradicating tobacco-use from society can have a huge impact. In all approaches, working with open-minded people has been the greatest pleasure of all.
What made you specialize in Oncology?
In my opinion, cancer is an enigma wherein a lot of work has been already done in the field and so it is mature for advanced research.
Further, cancer is very common – almost every family has someone afflicted by it. So, successfully treating patients with cancer and hopefully improving cancer treatments with research can be both challenging as well as fulfilling. I am currently Professor of Surgery and Oncology at University College London, London, UK. My clinical practice is at Harley Street, at King Edward VII Hospital, the London Clinic and HCA, more details of which can be gathered from www.londonbreastcancer.com.
Noteworthy experiences over the years
Long ago, contributing to the tireless work of my father, mother and colleagues at the Goa Cancer Society and National Organisation of Tobacco Eradication, on education about tobacco and research into how to eradicate was a fulfilling experience. This has led to a substantial fall in the number of deaths from heart attacks in Goa. Our research showed how sports sponsorship by tobacco industry initiated children’s use of tobacco.
The Goan Anti-Tobacco Bill in 1999 was the first of its kind in India. I am glad this work continues under the leadership of Dr Shekhar Salkar.
I had the honour of presenting the excellent results of our new treatment (TARGIT-IORT) for breast cancer – which allows women to have their radiotherapy during their surgery, at the largest breast cancer conference (San Antonio Breast Cancer Conference), to lead the team of researchers in one of the largest clinical trials in breast cancer radiotherapy, and publish our results in major journals such as the Lancet, Journal of American Medical Association- Oncology and the British Medical Journal. There is great satisfaction in speaking with, diagnosing and treating every patient to the highest level of care, on a day-to-day basis.
More about TARGIT- IORT
We developed the technique of ‘TARGeted Intraoperative Radio Therapy’ (TARGIT-IORT) along with Professor Michael Baum and Professor Jeffrey Tobias at UCL in 1998. With TARGIT-IORT, women can have their surgery as well as radiation treatment for breast cancer at the same time.
We tested this approach in randomised clinical trials along with clinicians from over 50 centres around the world. This has led to a conceptual change in breast cancer treatment and it has now been adopted around the world, with at least 45,000 patients already treated in 260 centres in 38 countries.
Traditionally speaking, breast cancer is treated by removing the cancerous lump with a margin of surrounding normal tissue. Radiotherapy to the remaining breast after such a lumpectomy reduces the risk of cancer coming back in the breast. Traditional external beam radiotherapy (EBRT) is given to the whole breast a few weeks after surgical removal of the cancer. As it is not focused, it needs to be given in daily small doses over three to six weeks. So, when working in Tata hospital in Mumbai, I had to tell patients with breast cancer that if they cannot stay in Mumbai for 1-2 months after their operation they could not preserve their breast – they had to have a mastectomy.
We have now shown that risk-adapted single-dose TARGIT-IORT when administered under the same anaesthetic can replace the traditional form of radiotherapy in suitable patients. It greatly cuts down on the amount of time spent in hospitals and women can recover faster and go back to their normal lives at the earliest. For four out of five women given TARGIT–IORT, this single-shot of radiotherapy is the only radiotherapy they will need. It therefore substitutes the conventional and prolonged treatment that lasts several weeks. The long-term results show that it is as effective, so it should be made available more freely in every hospital that treats breast cancer and must be accessible to all health-care providers. Patients should be informed about this treatment before they have their surgery for breast cancer because it is administered during their operation.
After a cancer has been removed from the breast, and while the patient is still under the general anaesthetic, radiotherapy is delivered using the TARGIT-IORT technique. It is focussed to the area where tumour had been and is given from within the breast. A small ball-shaped radiation applicator of the Intrabeam device is precisely placed in the tumour bed – the cavity left behind when the tumour is removed. TARGIT-IORT is administered over about 25 minutes, the applicator then is removed and the breast skin is surgically closed. Intrabeam TARGIT intraoperative radiotherapy effectively treats the tissues where cancer might have come back while avoiding radiation to the skin and other healthy tissues such as the heart and lungs. This method has been used worldwide (over 260 centres in 38countries) to treat over 45,000 patients.
One important finding of the latest research is that with TARGIT-IORT, considerably fewer women have died from causes other than breast cancer. In addition, previous studies have shown that TARGIT-IORT has fewer radiation-related side effects compared with conventional whole breast radiotherapy, with less pain, a cosmetically superior result and a better quality of life.
I am very keen for this treatment to be available all over India. It is a better treatment and costs less than traditional treatment because it takes less time and the equipment is much less expensive. (More information is available at http://www.targit.org.uk and http://youtube.com/jayantvaidya and http://www.jayantvaidya.org
The latest research paper is available at https://www.bmj.com/content/370/bmj.m2836.full.pdf and the story behind it is accessible at https://blogs.bmj.com/bmj/2020/08/19/targeted-intraoperative-radiotherapy-for-early-breast-cancer-new-evidence.
A video explanation at https://youtu.be/5Xby04NBanY and https://www.bmj.com/company/newsroom/single-dose-radiotherapy-as-good-as-conventional-radiotherapy-for-most-women-with-early-breast-cancer/ and https://www.ucl.ac.uk/news/2020/aug/single-dose-radiotherapy-effective-treating-breast-cancer
Advice to people and cancer patients
Eat healthy food, with plenty of fruits, vegetables, grains and nuts and reduce the amount of fat in the diet. Exercise regularly. Don’t use tobacco either for chewing or smoking. Consider all evidence-based options for treatment, balancing their benefits and side effects. The outcomes have greatly improved, so there is every reason to be optimistic.
As an accomplished surgeon and professor of oncology, what would be your success mantra for the youngsters out there who want to pursue the same career?
Develop critical thinking and do not be afraid to question dogmas. Have great compassion for everyone around you. Have the courage of your conviction and do not give up – keep at it, despite all obstacles.
Suggestions for dealing with oncology-related health issues during COVID times
Cancer treatment needs to continue during COVID-times. TARGIT-IORT is the ideal option for suitable breast cancer patients, especially during these times, because, the radiotherapy is administered during lumpectomy for breast cancer, so they can avoid daily trips to the hospital for the long course of radiotherapy.
So, TARGIT-IORT can help greatly to reduce viral exposure to such a vulnerable population. It should be made more widely available to breast cancer patients.
Future Plans
My plan is to continue treating patients and doing research with the goal of improving the length and quality of life. There are very exciting developments, so we can look forward to new breakthroughs!
