Inter-institutional variation of implant activity for permanent prostate brachytherapy

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

doi:10.1016/j.brachy.2008.07.002

Cited by 12 publications

(5 citation statements)

References 6 publications

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“…To our knowledge, most American centers generally use seeds with activities <0.45 mCi; some use seeds with an activity <0.40 mCi (9)(10)(11). In contrast, some European centers use much higher activities of $0.6 mCi (12, 13).…”

Section: Discussionmentioning

confidence: 89%

Comparison Between High and Low Source Activity Seeds for I-125 Permanent Seed Prostate Brachytherapy

Masucci

Donath

Tétreault-Laflamme

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 89%

Comparison Between High and Low Source Activity Seeds for I-125 Permanent Seed Prostate Brachytherapy

Masucci

Donath

Tétreault-Laflamme

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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“…Furthermore, identifying plans that are outside of institutional norms can prevent medical events/mistreatments and reduce seed waste (leading to reduced risk and cost), ultimately improving the value of BT (14). Of note, the implementation of nomograms from external institutions should be done with caution owing to unaccountable interinstitutional variabilities, despite standardized dosing and relatively identical techniques (15). One possible solution for industry to meet this need would be to incorporate independent nomogram checks into the treatment planning system as part of treatment workflow.…”

Section: Discussionmentioning

confidence: 99%

MRI-assisted radiosurgery: A quality assurance nomogram for palladium-103 and iodine-125 prostate brachytherapy

et al. 2020

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We sought to develop an activity nomogram for magnetic resonance (MR)eplanned permanent seed prostate brachytherapy to improve quality assurance through a secondary dosimetric check. METHODS AND MATERIALS: Patients undergoing MRI-assisted radiosurgery (MARS), whereby MRI is used for preoperative planning and postimplant dosimetry, were reviewed from May 2016 to September 2018. Planned activity (U) was fitted by MR-prostate volume (cc) via simple linear regression. Resulting monotherapy nomograms were compared with institutional nomograms from an ultrasound-planned cohort. Dosimetric coverage and external urinary sphincter (EUS) dose were also assessed for MR-planned patients. RESULTS: We identified 183 patients treated with MARS: 146 patients received palladium-103 (103 Pd; 102 monotherapy and 44 boost), and 37 received iodine-125 (125 I) monotherapy. Median prostate volume was 28 cc (interquartile range: 22e35). Lines of best fit for implant activity were U 5 4.344 Â (vol) þ 54.13 (R 2 : 95%) for 103 Pd monotherapy, U 5 3.202 (vol) þ 39.72 (R 2 : 96%) for 103 Pd boost and U 5 0.684 (vol) þ 13.38 (R 2 : 96%) for 125 I monotherapy. Compared with ultrasound, MR-planned nomograms had lower activity per volume (p ! 0.05) for both 103 Pd monotherapy (~6%) and 125 I monotherapy (~11%), given a median size (30 cc) prostate. Across all MARS implants, postimplant dosimetry revealed a median V100% of 94% (interquartile range: 92e96%). Median EUS V125 was !1 cc for all patients, regardless of isotope. CONCLUSIONS: We developed a quality assurance nomogram for MR-planned prostate brachytherapy. When compared with ultrasound-planned, MR-planned monotherapy resulted in a lower activity-to-volume ratio while maintaining dosimetric coverage, likely secondary to EUS-sparing and reduced planning target margins.

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“…It may be unsatisfactory to adopt a ‘generic’ nomogram obtained from medical literature or provided by a seed distributor, as it has been demonstrated that experienced brachytherapists espousing the same implant philosophy and prescribing to the same dose will implant the same volume with a different number of seeds and total activity [ 17 ]. Indeed, the variation in total implant activity can exceed 40% [ 15 ]. It has therefore been recommended that a nomogram be generated to reflect an institution's own practices [ 3 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the variation in total implant activity can exceed 40% [ 15 ]. It has therefore been recommended that a nomogram be generated to reflect an institution's own practices [ 3 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…As implant preferences (prescription dose, seed distribution pattern, extra-capsular seed placement, organ constraints) differ among institutions, it has been recommended that each institution derive nomograms reflective of their program's implant philosophy [ 3 , 15 ]. We relate a simple method, utilizing ubiquitous spreadsheet software, to generate institution-specific nomograms for the calculation of seed number and strength for permanent prostate brachytherapy.…”

Section: Purposementioning

confidence: 99%

See 1 more Smart Citation

A simple technique for the generation of institution-specific nomograms for permanent prostate cancer brachytherapy

Lafata¹,

Bushe²,

Aronowitz³

2014

jcb

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PurposeNomograms once had a vital role in prostate brachytherapy practice. Although some of their functions have been assumed by computerized dosimetry, many programs still find them useful to determine the number and strength of seeds to be ordered in advance of the implant. As it has been demonstrated that brachytherapists differ in their implant practices and preferences (in regard to seed distribution and total implanted activity), we propose a simple technique for generating institution-specific nomograms.Material and methodsUsing the data generated by previous implants, we demonstrate a simple technique, utilizing ubiquitous software, for generating nomograms to predict seed number, strength, and total implant activity.ResultsDespite wide variations in the degree of post-implant swelling (+12% to +56%), nine of the first ten implants using the generated nomogram have met all target dose parameters.ConclusionsIt is appropriate for each institution to develop nomograms specific to their prostate brachytherapy technique and constraints. Nomograms can estimate the number and strength of seeds to be ordered, and may partially compensate for the effects of implant-induced swelling.

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Inter-institutional variation of implant activity for permanent prostate brachytherapy

Cited by 12 publications

References 6 publications

Comparison Between High and Low Source Activity Seeds for I-125 Permanent Seed Prostate Brachytherapy

Comparison Between High and Low Source Activity Seeds for I-125 Permanent Seed Prostate Brachytherapy

MRI-assisted radiosurgery: A quality assurance nomogram for palladium-103 and iodine-125 prostate brachytherapy

A simple technique for the generation of institution-specific nomograms for permanent prostate cancer brachytherapy

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