Inter-institutional variation of implant activity for permanent prostate brachytherapy

Aronowitz, Jesse N.; Crook, Juanita M.; Michalski, Jeff M.; Sylvester, John E.; Merrick, Gregory S.; Mawson, Christie; Pratt, David; Naidoo, Devi; Butler, Wayne M.; Karolczuk, Kathryn

doi:10.1016/j.brachy.2008.07.002

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Volume 7, Issue 4 , Pages 297-300, October 2008

Inter-institutional variation of implant activity for permanent prostate brachytherapy

Jesse N. Aronowitz
- Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, MA
- Corresponding author. Department of Radiation Oncology, University of Massachusetts Medical School, Levine Cancer Center, 33 Kendall Street, Worcester, MA 01605. Tel.: +1-508-334-6550; fax: +1-508-334-5624.
Juanita M. Crook
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Radiation Medicine, Princess Margaret Hospital, Toronto, ON, Canada
Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
John E. Sylvester
- Seattle Prostate Institute, Seattle, WA
Gregory S. Merrick
- Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV
Christie Mawson
- Department of Radiation Medicine, Princess Margaret Hospital, Toronto, ON, Canada
David Pratt
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
Devi Naidoo
- Seattle Prostate Institute, Seattle, WA
Wayne M. Butler
- Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV
Kathryn Karolczuk
- Quality Assurance Review Center, Providence, RI

Received 12 February 2008; received in revised form 29 June 2008; accepted 18 July 2008. published online 11 September 2008.

Abstract

Purpose

Despite the existence of guidelines for permanent prostate brachytherapy, it is unclear whether there is interinstitutional consensus concerning the parameters of an ideal implant.

Methods and material

Three institutions with extensive prostate brachytherapy expertise submitted information regarding their implant philosophy and dosimetric constraints, as well as data on up to 50 radioiodine implants. Regression analyses were performed to reflect each institution's utilization of seeds and implanted activity.

Results

Despite almost identical implant philosophy, target volume, and dosimetric constraints, there were statistically significant interinstitutional differences in the number of seeds and total implant activity across the range of prostate volumes. For larger volumes, the variation in implanted activity was 25%; for smaller glands, it exceeded 40%.

Conclusions

There remain wide variations in implanted activity between institutions espousing seemingly identical implant strategies, prescription, and dosimetry constraints. Brachytherapists should therefore be wary of using nomograms generated at other institutions.

Keywords: Prostate neoplasms, Brachytherapy, Nomograms, Dosimetry