The impact of trainee involvement on outcomes in low-dose-rate brachytherapy for prostate cancer

Abstract

Purpose To determine the impact of fellow, resident, or medical student (MS) involvement on outcomes in patients undergoing permanent Iodine-125 prostate seed implant. Methods and Materials The study population consisted of men with clinically localized low-/intermediate-risk prostate cancer treated with low dose rate permanent interstitial brachytherapy. Cases were stratified according to resident, fellow, MS, or attending involvement. Outcomes were compared using ANOVA, logistic regression, and log rank tests. Results A total of 291 patients were evaluated. Fellows, residents, and MS were involved in 47(16.2%), 231(79.4%), and 34(11.7%) cases, respectively. Thirteen (4.4%) cases were completed by an attending physician alone. There was no difference in FFBF when comparing the resident, fellow, or attending alone groups (p=0.10). There was no difference in V100 (volume of the prostate receiving 100% of the prescription dose) outcomes when comparing resident cases to fellow cases (p=0.72) or attending alone cases (p=0.78). There was no difference in D90 (minimum dose covering 90% of the post-implant volume) outcomes when comparing resident cases to fellow cases (p=0.74) or attending alone cases (p=0.58). When examining treatment toxicity, fellow cases had higher rates of acute grade 2+ GU toxicity (p=0.028). With the exception of higher urethra D90 among PGY 2-3 cases (p=0.02), dosimetric outcomes were similar to cases with PGY4-5 resident participation. There was no difference in outcomes for cases with and without MS participation. Conclusions Interstitial prostate seed implants can be safely performed by trainees with appropriate supervision. Hands-on brachytherapy training is effective and feasible for trainees.

Resident training in brachytherapy in France: A 10-year update after the first survey of SFJRO members

“…Forty-six percent of the residents in our survey mentioned the lack of supervised practice as a barrier to their learning, especially when the senior physician never hands over the implantations to the resident. And yet, it has been shown by Shaikh et al that interstitial prostate seed implants can be safely performed by trainees with appropriate supervision: in 291 patients treated with low-dose-rate permanent interstitial brachytherapy for a localized low-/intermediate-risk prostate cancer, there was no impact on V 100 , D 90 at the prostate or on freedom from biochemical failure, when comparing the resident, fellow, or attending groups [23]. In the INTERACTS survey from Italy, the main barriers to BT education were comparable, since 63% of school directors mentioned the lack of clinical practice (63%) [11].…”