American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy

Davis, Brian J.; Horwitz, Eric M.; Lee, W. Robert; Crook, Juanita M.; Stock, Richard G.; Merrick, Gregory S.; Butler, Wayne M.; Grimm, Peter D.; Stone, Nelson N.; Potters, Louis; Zietman, Anthony L.; Zelefsky, Michael J.

doi:10.1016/j.brachy.2011.07.005

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Volume 11, Issue 1 , Pages 6-19, January 2012

American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy

Brian J. Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
- Corresponding author. Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Tel.: +1-507-284-3191; fax: +1-507-284-0079.
Eric M. Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
W. Robert Lee
- Department of Radiation Oncology, Duke University, Durham, NC
Juanita M. Crook
- British Columbia Cancer Agency, Kelowna, British Columbia, Canada
Richard G. Stock
- Department or Radiation Oncology, Mt. Sinai Medical Center, New York, NY
Gregory S. Merrick
- Schiffler Cancer Center and Wheeling Jesuit University, Wheeling Hospital, Wheeling, WV
Wayne M. Butler
- Schiffler Cancer Center and Wheeling Jesuit University, Wheeling Hospital, Wheeling, WV
Peter D. Grimm
- Prostate Cancer Treatment Center, Seattle, WA
Nelson N. Stone
- Department of Urology, Mt. Sinai Medical Center, New York, NY
Louis Potters
- Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, Oceanside, NY
Anthony L. Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
Michael J. Zelefsky
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY

Received 11 March 2011; received in revised form 23 July 2011; accepted 26 July 2011.

Abstract

Purpose

To provide updated American Brachytherapy Society (ABS) guidelines for transrectal ultrasound-guided transperineal interstitial permanent prostate brachytherapy (PPB).

Methods and Materials

The ABS formed a committee of brachytherapists and researchers experienced in the clinical practice of PPB to formulate updated guidelines for this technique. Sources of input for these guidelines included prior published guidelines, clinical trials, published literature, and experience of the committee. The recommendations of the committee were reviewed and approved by the Board of Directors of the ABS.

Results

Patients with high probability of organ-confined disease or limited extraprostatic extension are considered appropriate candidates for PPB monotherapy. Low-risk patients may be treated with PPB alone without the need for supplemental external beam radiotherapy. High-risk patients should receive supplemental external beam radiotherapy if PPB is used. Intermediate-risk patients should be considered on an individual case basis. Intermediate-risk patients with favorable features may appropriately be treated with PPB monotherapy but results from confirmatory clinical trials are pending. Computed tomography–based postimplant dosimetry performed within 60 days of the implant is considered essential for maintenance of a satisfactory quality assurance program. Postimplant computed tomography–magnetic resonance image fusion is viewed as useful, but not mandatory.

Conclusions

Updated guidelines for patient selection, workup, treatment, postimplant dosimetry, and followup are provided. These recommendations are intended to be advisory in nature with the ultimate responsibility for the care of the patients resting with the treating physicians.

Keywords: Prostate cancer, Brachytherapy, Quality assurance, Safety, Dosimetry, Guideline, Standard, Interstitial, Radiation therapy, Radiotherapy