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American brachytherapy society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy

American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy Brian J. DaEric M. HorwitzW. Robert , Juanita M. Richard G. Stock, Gregory S. MerrickWayne M. Butler, Peter D. Nelson N. Louis Potters 1Department of Radiation Oncology, Mayo Clinic, Rochester, MN 2Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 3Department of Radiation Oncology, Duke University, Durham, NC 4British Columbia Cancer Agency, Kelowna, British Columbia, Canada 5Department or Radiation Oncology, Mt. Sinai Medical Center, New York, NY 6Schiffler Cancer Center and Wheeling Jesuit University, Wheeling Hospital, Wheeling, WV 7Prostate Cancer Treatment Center, Seattle, WA 8Department of Urology, Mt. Sinai Medical Center, New York, NY 9Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, Oceanside, NY 10Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 11Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY PURPOSE: To provide updated American Brachytherapy Society (ABS) guidelines for transrectalultrasound-guided transperineal interstitial permanent prostate brachytherapy (PPB).
METHODS AND MATERIALS: The ABS formed a committee of brachytherapists and researchersexperienced in the clinical practice of PPB to formulate updated guidelines for this technique. Sourcesof 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 approvedby the Board of Directors of the ABS.
RESULTS: Patients with high probability of organ-confined disease or limited extraprostatic exten-sion are considered appropriate candidates for PPB monotherapy. Low-risk patients may be treatedwith PPB alone without the need for supplemental external beam radiotherapy. High-risk patientsshould receive supplemental external beam radiotherapy if PPB is used. Intermediate-risk patientsshould be considered on an individual case basis. Intermediate-risk patients with favorable featuresmay appropriately be treated with PPB monotherapy but results from confirmatory clinical trials arepending. Computed tomographyebased postimplant dosimetry performed within 60 days of theimplant is considered essential for maintenance of a satisfactory quality assurance program. Postim-plant computed tomographyemagnetic resonance image fusion is viewed as useful, but not mandatory.
CONCLUSIONS: Updated guidelines for patient selection, workup, treatment, postimplant dosim-etry, and followup are provided. These recommendations are intended to be advisory in naturewith the ultimate responsibility for the care of the patients resting with the treating physicians.
Ó 2012 Published by Elsevier Inc. on behalf of American Brachytherapy Society. All rights reserved.
Prostate cancer; Brachytherapy; Quality assurance; Safety; Dosimetry; Guideline; Standard; Interstitial; Radia-tion therapy; Radiotherapy Received 11 March 2011; received in revised form 23 July 2011; accepted Conflict of interest notification: The authors state that potential Prostate cancer (CaP) is the most common malignancy in men in the United States and the developed world. It is esti- * Corresponding author. Department of Radiation Oncology, Mayo mated that in 2010, nearly 218,000 men will be diagnosed Clinic, 200 First Street SW, Rochester, MN 55905. Tel.: þ1-507-284- and 32,050 will die of CaP Current common treatment options for early stage CaP include radical prostatectomy, 1538-4721/$ - see front matter Ó 2012 Published by Elsevier Inc. on behalf of American Brachytherapy Society. All rights reserved.
doi: B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 external beam radiation therapy (EBRT), temporary and experience in PPB to provide guidelines for current prac- permanent brachytherapy, androgen deprivation therapy tice. Sources of recommendations include current and prior (ADT), and watchful waiting Transrectal ultrasound guidelines published by medical societies (TRUS)-guided permanent prostate brachytherapy (PPB) is an outpatient procedure that is associated with a rapid literature, and the clinical experience and consensus of recovery and return to normal activity. Modern PPB using the committee. The guideline is designed for TRUS- sealed sources of iodine-125 (125I) with template and guided PPB performed as primary management of CaP.
TRUS guidance was pioneered over 25 years ago. Subse- Specific recommendations for further investigations and quently, PPB has produced excellent 10e15-year serum for therapy were made when there was a consensus. Where prostate-specific antigen (PSA) and clinical outcome associ- major controversy or lack of evidence persists, the ABS has ated with relatively low morbidity . The procedure declined to make specific recommendations. This report is readily acknowledged as a standard option in low-risk was reviewed and approved by the Board of Directors of CaP by organizations including the National Cancer Institute the ABS with the acknowledgment that the management American Cancer Society National Comprehen- of CaP patients undergoing PPB is constantly evolving sive Cancer Network American Urologic Association and the guidelines will be subject to modifications as new and radiation oncology associations PPB is no longer considered an experimental or investigationaltreatment and is reimbursed by Medicare and most healthinsurance organizations .
PPB TRUS guidance and the transperineal approach have evolved since its introduction into clinical practice. The previous American Brachytherapy Society (ABS) guideline Important elements of the initial workup include an by Nag et al. was published over a decade ago. In the appropriate history and investigations as required to estab- interim, it is estimated that over 250,000 patients in the lish the stage and risk group and to determine the appropri- United States and a half million worldwide have been treated with this modality. Clinical trials have been conducted by theRadiation Therapy Oncology Group (RTOG) American College of Surgeons Oncology Group , NorthCentral Cancer Treatment Group, and Cancer and Leukemia The medical assessment will determine the eligibility for Group B . Over 500 articles have been published in the PPB as a viable option for the patient with CaP. Aspects of last decade and with this as background the indications, tech- the history that influence eligibility for PPB include, but are niques, treatment regimens, and methods of dosimetry are not limited to, items listed in These include deter- reviewed to provide timely updated guidelines for PPB.
mining the relevant medical, urologic, and surgical histories Variation in the approach toward PPB is common. The and the International Prostate Symptom Score (IPSS) .
guidelines presented here are intended to aid practitioners The self-administered IPSS questionnaire, type American in managing patients, but not to rigidly define process or Urologic Association-7, includes seven items with scores practice requirements, or to establish a legal standard of care.
from 0 to 5, with higher values being associated with We have categorized this ABS guideline into five areas: increased urinary irritative and obstructive symptoms that (1) patient evaluation, (2) patient selection, (3) contraindica- could potentially be aggravated by PPB. Other elements tions, (4) planning postimplant dosimetry and (5) manage- of the urologic history include documentation of any prior ment. Where accepted practice is evolving and specificrecommendations cannot be established discussion may be provided. It is emphasized that the definition of a ‘‘relative Elements of patient history for permanent prostate brachytherapy contraindication’’ is that a patient may be at a higher risk of complications but that this risk may be outweighed or miti- a. Prior transurethral or open resection of the prostate or other surgery gated by other considerations. Such relative contraindications do not preclude patients from undergoing PPB. Indeed, there b. Prior procedure for benign prostatic hyperplasia such as transurethral are often substantial published studies from experienced c. Medications for treatment of urinary obstructive symptoms groups, which demonstrate that such supposed relative contraindications demonstrate little or no appreciable differ- 2. Prior diagnosis of cancer, especially bladder or rectal 3. Prior pelvic radiotherapy, surgery, or fracture4. Inflammatory bowel disease 5. Connective tissue disorders6. Documentation of International Prostate Symptom Score In 2009, the ABS Board of Directors appointed a group 7. Documentation of erectile function, International Index of Erectile of practitioners with extensive clinical and research B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 transurethral or open resection, or other invasive prostate surgeries or procedures. Medication history, especially Absolute contraindications to TRUS-guided PPB including the use of alpha-blockers or anticoagulants, is Unacceptable operative risksDistant metastases The appropriate workup for patients being considered for Absence of rectum such that TRUS guidance is precluded PPB requires, among other items, determination of biopsy Large TURP defects, which preclude seed placement and acceptable Gleason score, pretherapy serum PSA, and clinical tumor classification In addition to establishing a patient’s risk group and stage, factors relevant for planning and perform- TRUS 5 transrectal ultrasound; PPB 5 permanent prostate brachyther- ing the procedure as provided in include prostate apy; TURP 5 transurethral resection of the prostate.
volume determination, establishing a patient’s ability to beplaced in the dorsal lithotomy position and suitability for suited to PPB than the alternative options. Clearly, lack general or spinal anesthesia. If centers are experienced in of a rectum, because of prior abdomino-perineal resection, performing brachytherapy under local anesthesia then rules out feasibility of a TRUS-guided procedure appropriate clearance for such an approach is also indicated.
It is recommended that the IPSS value be determined Patients with documented localized CaP as established by and recorded for each patient before the procedure so as prostate biopsy and metastatic workup for nonelow-risk to facilitate assessment and treatment of postimplant presentations where the history and minimum elements of urinary symptoms. Patients with a high IPSS for urinary the workup have been completed, may then be considered irritative and obstructive symptoms are at increased risk as potential candidates for PPB, provided the absolute of developing postimplant urinary retention and relative contraindications, as given in Tables 3a and 3b Numerous studies have demonstrated a correlation between high IPSSs and increased toxicity after PPB The recommended cutoff values for recent RTOG clinical trial eligibility range from 15 to 18 Detailed analysesby Terk et al. and Gutman et al. of patients with Patients who are considered poor candidates for an IPSS less than 20 demonstrates acceptable rates of urinary outpatient procedure requiring general or spinal anesthesia toxicity. In men with an elevated IPSS, it is important to because of comorbid medical conditions may not be candi- review the questions with the patient to determine validity dates for PPB. Although the committee declines to recom- of the score. Other medical conditions associated with mend any absolute lower or upper age limit, patients should increased urinary frequency, such as diabetes, or the use have an acceptable performance status and life expectancy, of diuretics, may result in increased IPSSs, which are unre- lated to prostate morphology and urinary obstruction. These Assessment for the presence of regional or distant patients may undergo PPB without increased risk of post- metastases is essential in patients with two or three PPB toxicity. Other factors that should be considered in intermediate-risk factors or high-risk presentations. Both evaluating an elevated IPSS include (1) prostate volume, a bone scan and cross-sectional imaging of the abdomen (2) urodynamic study to evaluate the postvoid residual and pelvis are appropriate. Patients with metastases are volume, volume voided, and peak flow, (3) cystoscopic not candidates for curative PPB. Obesity is not a contraindi-cation provided that performance status and life expectancyare acceptable . Obese patients may be better Table 3bRelative contraindications for TRUS-guided PPB The items listed below are considered as essential elements of the history in determining eligibility, but the criteria by themselves do not Minimum required elements of workup for permanent prostate necessarily preclude therapy. They should, however, be considered closely in electing to proceed with PPB. Published experience 1. Prostate biopsy indicating adenocarcinoma within the preceding 12 demonstrates that patients with such conditions may undergo PPB if months of planned permanent prostate brachytherapy. Additional appropriately evaluated by an experienced team.
synoptic information is required and includes the Gleason grading and percent cancer in the biopsy specimen.
2. Pretherapy serum prostate-specific antigen 3. Digital rectal exam with clinical tumor classification, ‘‘T stage’’ 4. Prostate volume determination, transrectal ultrasound preferred Gland size O60 cm3 at time of implantation 5. Determination of a patient’s ability to tolerate an extended dorsal TRUS 5 transrectal ultrasound; PPB 5 permanent prostate brachyther- 6. Determination of suitability for general or spinal anesthesia apy; IPSS 5 International Prostate Symptom Score.
B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 evaluation to determine anatomic obstruction such as determination of biopsy Gleason score, pretherapy serum a stricture, bladder neck contracture or prominent obstruct- PSA, and clinical tumor classification . These three prognostic factors are combined to determine low-, inter- characterize the degree of a patient’s preimplant urinary mediate-, or high-risk classification. The ABS recommends obstruction and subsequent risk of acute urinary retention the use of the National Comprehensive Cancer Network . Caution and appropriate patient consent are indicated if the peak flow rate is !10 cc/s and postvoid Low risk: Gleason score #6, and PSA !10 ng/mL, and residual volume O100 cc, but these factors by themselves clinical tumor classification, T1, T2a.
do not preclude PPB as a treatment option.
Intermediate risk: Gleason score 7, or, PSA O10 ng/mL Previous pelvic irradiation such as that given for rectal !20 ng/mL, or clinical tumor classification of T2b, T2c.
cancer may increase the risk of postimplant toxicity.
High risk: Gleason score 8e10, or, PSA O20 ng/mL, or However, options other than PPB may be associated with clinical tumor classification of T3a.
an even greater risk of complications. In patients with prior Patients with seminal vesicle invasion (SVI), clinical pelvic radiotherapy, the dose delivered to the prostate, tumor classification T3b, are considered to be high risk in rectum, and bladder should be considered and any symp- terms of treatment and evaluation. Consideration may be toms of late gastrointestinal or genitourinary radiation given to performing seminal vesicle biopsies when evaluating toxicity. Cystoscopy and sigmoidoscopy may be useful in Although it is not an absolute contraindication, a prior Monotherapy, combined treatment, and treatment TURP is an important aspect of the urologic history, which impacts on recommending PPB . Because priorTURP may be associated with increased technical difficul- ties, such patients should be evaluated carefully. A large Low-risk CaP may be appropriately treated with PPB TURP defect may not permit implantation of seeds alone, also known as monotherapy. Published experience throughout the entire gland, resulting in unacceptable demonstrates that excellent long-term outcome can be ex- dosimetry. Opacification of the TURP defect with aerated pected when optimal dosimetric parameters are achieved gel at the time of prostate mapping allows clear visualiza- . Furthermore, the ABS recommends that PPB tion of the extent of the defect and assessment as to the combined with EBRT is unnecessary, as is ADT, except advisability of PPB. After a TURP, it is appropriate to defer for the purpose of prostate down sizing , or in the uncommon circumstance when other factors Pubic arch interference depends on many factors such as suggest more advanced disease than is immediately evident pelvic anatomy, prostate size, patient position, and technique such as high-volume disease in the biopsy specimen, or a rapidly rising PSA. For patients who undergo primary When a patient has a prostate O60 cc, and pubic arch interference is a concern, a short course of ADT will PPB for low-risk CaP and suboptimal prostate dosimetry reduce prostate volume by an average of approximately is achieved, supplemental treatment with EBRT may be appropriate as long as tolerance of adjacent normal struc- limit for prostate volume with regard to PPB eligibility . Larger prostates, up to 100 cc or more, are technicallychallenging, but toxicity and cancer control outcomes are acceptable Orientation of the TRUS probe and The presence of one or more intermediate-risk factors is template, use of an exaggerated dorsal lithotomy position, associated with adverse pathologic features including and implantation of a portion of the anterior prostate ‘‘free- substantial extraprostatic extension (EPE), SVI, or occult hand’’ are all known to circumvent pubic arch interfer- lymph node involvement. However, certain intermediate- ence. Nevertheless, practitioners with limited experience risk patients with otherwise low-risk features such as should avoid PPB on large prostates, or in patients with low-volume disease, predominant pattern 3, and only one restrictive pelvic anatomy. In cases with prior pelvic fracture,irregular pelvic anatomy, or a penile prosthesis, ultrasound, Table 4Suggested treatment schema for low-, intermediate-, and high-risk disease computed tomography (CT) or magnetic resonance (MR) imaging may help in assessment of the pubic arch, but are not completely reliable in predicting pubic arch interference.
Disease-specific characteristics, stage, and risk The appropriate workup for patients with localized CaP NCCN 5 National Comprehensive Cancer Network; EBRT 5 external being considered for PPB requires, among other items, beam radiation therapy; PPB 5 permanent prostate brachytherapy.
B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 adverse feature, can be effectively treated with PPB randomized controlled clinical trials is available, this recom- monotherapy, without supplemental EBRT or ADT. The mendation is viewed as prudent in view of acceptable re- ongoing RTOG clinical trial 0232 randomizes men with ported outcomes, pathologic analysis of prostatectomy intermediate-risk disease and only one adverse factor, to PPB monotherapy or PPB combined with EBRT.
The appropriateness of PPB monotherapy depends on many factors including the required treatment margin. In path- Patients with high-risk features being considered for ologic series of whole-mount prostatectomy specimens primary EBRT are known to benefit from treatment , the radial extension of extraprostatic CaP infre- combined with ADT from multiple randomized prospective quently extends beyond 5 mm in patients with clinically trials . Patients with high-risk features are also organ-confined CaP. The posterolateral prostate is at highest known to have substantial risk of EPE such that clinically risk for EPE; a site where the treatment margin may readily occult CaP exists beyond the tumoricidal range of a PPB be expanded laterally without increased dose to neighboring implant. Indeed, early series of PPB monotherapy for organs. Sengupta et al. analyzed the risk of adverse path- high-risk CaP revealed poor outcome compared with ologic features in the clinical scenario of low-risk disease contemporary series Therefore, it is considered stan- (T2a, Gleason 6, and PSA of 10 ng/mL) and found that many dard to combine EBRT with PPB for high-risk disease.
intermediate-risk tumors had equivalent or even lower risk of There is increasing evidence from single- and multi- adverse pathologic features such as significant EPE, SVI, or institutional retrospective series that the increased radiation lymph node involvement. Consequently, the recommended dose achieved with a PPB boost in combination with EBRT margin of 5 mm around the prostate to form the planning is advantageous for local control of CaP and metastasis-free target volume in all directions except posteriorly should survival. When compared with EBRT trials combined with readily encompass the vast majority of occult EPE in ADT, however, the data are less robust in demonstrating intermediate-risk disease. Furthermore, the radiation dose that ADT provides improvement in clinical endpoints for profile provides coverage for microscopic disease beyond high-risk CaP. In a series by Merrick et al. no ADT- the prescription isodose for several millimeters related improvements in cause-specific and overall survival The largest published series of PPB monotherapy is were observed, but high-risk disease had improved 10-year a multi-institutional analysis of 2693 CaP patients, which biochemical progression-free survival. Furthermore, in included 960 intermediate-risk patients with a reported a multi-institutional series reported by Stone et al. 8-year biochemical control rate of 70% However, most patients with Gleason score 8e10 demonstrated improved of these patients were treated before 1999 and fewer than overall and metastasis-free survival if a greater biologically 25% had formal postimplant quality assurance. Among those effective dose was delivered. Given these data, it is appro- patients in all risk groups who had postimplant dosimetry priate to combine ADT with EBRT and PPB for high-risk 130 Gy for 125I, or O115 Gy for 103Pd, the patients although further study is warranted.
8-year PSA relapse free survival was 92e93%. In a morerecent series of 144 intermediate-risk patients treated by PPB monotherapy with detailed dosimetry available, the12-year cause-specific and biochemical progression-free Integration of PPB into the management of patients with survival were reported as 100% and 96%, respectively .
known SVI is practiced, but there is not yet a standardized In examining present day practice patterns, a pattern-of- technical approach because questions of reproducibility care study by Frank et al. surveyed 18 brachytherapy and required extent of the SV implant volume are unan- practitioners with cumulative experience of over 10,000 swered. Because PPB in high-risk patients is recommended cases. Factors influencing selection of intermediate-risk only in combination with EBRT, the seminal vesicles (SVs) patients treated with brachytherapy monotherapy included SVs should be part of the target volume for both components the standard three risk factors of clinical tumor classification, of treatment SVI is most frequent in the proximal SVs PSA level, and Gleason score, along with percent cores posi- adjacent to the base of the prostate and as such, tive and presence of perineural invasion on the biopsy spec- a substantial portion may be included in the high-dose imen. Various combinations of these factors were examined volume of a typical PPB implant . Implantation of revealing that more than half of the practitioners would treat the SV is feasible and results in higher doses to the SV, certain intermediate-risk cases with PPB monotherapy although dose distribution can be variable. Nevertheless, depending on the number and type of risk factors. This further investigation of treatment approaches with patients survey demonstrated that experienced practitioners examine harboring, or at increased risk of harboring, SVI is necessary.
intermediate-risk patients on a case-by-case basis and usemonotherapy judiciously. Consistent with these observa- tions, the ABS recommends that intermediate-risk patientsmay be considered for PPB monotherapy at the discretion The ABS continues to recommend that dosimetric plan- of the treating physicians. Until long-term followup of ning be carried out for all patients before seed placement.
B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 Preimplant treatment planning may be performed either in Nonetheless, a recent prospective study confirmed that a separate procedure as in a preplan approach, or on the although 15% of strands shift 5 mm or more in the 4 weeks day of the procedure in the operating room as intraoperative after placement, there was little apparent effect on dosim- preplanning or in an intraoperative dynamic manner etry The ABS does not favor any particular seed TRUS is considered the standard imaging modality for deposition technique among those commonly practiced.
treatment planning, yet circumstances may dictate that an The relevant metrics are the postimplant dosimetry. If initial plan be performed using other volumetric imaging a given technique is reproducible, consistently results in data such as CT or MR. The treatment plan should indicate optimal dosimetry and is associated with excellent long- the needle locations according to the template, and the term outcome then differences relating to methods of seed number, and strength of seeds in each needle using contig- deposition and type are of secondary importance.
uous, transverse images of the prostate. Within the scopeof these guidelines, the use of TRUS for guidance during Recommended prescription doses for approved isotopes: needle implantation and for preimplant planning is favored.
monotherapy and therapy combined with EBRT Preimplant planning with MR is acceptable in experiencedhands, whereas the use of preplanning with CT alone is less The ABS supports the American Association of Physics reproducible than TRUS . A peripheral distribution of and Medicine Task Groups No. 43 (TG-43) No. 137 sources, frequently referred to as a ‘‘modified peripheral or (TG-137) dose calculation protocols, and other pub- modified uniform loading’’ is recommended so that the lished recommendations regarding dose prescriptions portion of the urethra receiving 150% dose (V as summarized in and consistent with prior ABS can be limited The volume of the rectum (RV statements It is important to recognize that early receiving the prescription dose ideally should be !1 cc literature on the use of 125I used a prescription dose of 160 Gy, which after TG-43 became equivalent to a dose Whereas no prospective dose escalation clinical trials The standard procedure for seed implantation is to use have been conducted in PPB for CaP, ample retrospective a transperineal approach under TRUS and template guid- data exists to confirm the importance of dosimetry in ance. Patient positioning and the TRUS-probe angle should outcomes. Guidelines for dose selection are based on avail- coincide with the preimplant planning study as closely as possible when a preplan approach is used, The TRUS unit used should have the electronic grid and perineal template the minimum dose received by the ‘‘hottest’’ 90% of the calibrated and coincident, and use frequencies between 5 prostate volume, also described as the isodose enclosing and 12 MHz. A high-resolution biplanar ultrasound system 90% of the prostate. Numerous studies have confirmed that with dedicated prostate brachytherapy software is manda- tory. Fluoroscopy is frequently used to monitor seed depo- volume delineated on the postimplant CT receiving 100% sition as a complementary imaging modality to TRUS of the prescribed dose) are correlated with outcome and is used in some centers for intraoperative dose compu- tation using image fusion but it is not considered . Nonetheless, investigators are cautioned that these important dosimetric parameters are not surrogates There are several acceptable approaches to seed place- ment including the use of a Mick applicator , preloadedneedles which may be loaded commercially accord- ing to the preplan or loaded on site, or by afterloading Prescription doses to the planning target volume Seeds may be loose or stranded. Pros and cons of each type of technique have been described. Loose seeds are associ- ated with a higher rate of seed migration , but only one report suggests an untoward outcome associated with such migration One multi-institutional random- ized prospective trial confirmed that stranded seeds migrated less frequently to the lung than loose seeds Although some authors note modest , or signif- icant improvement in dosimetry with stranded seeds, others have found stranded seeds to be associated PPB 5 permanent prostate brachytherapy; EBRT 5 external beam with intraprostatic seed movement in the weeks after implantation with adverse effects on dosimetry B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 In practice, many brachytherapists plan a dose higher than that listed in to compensate for edema, seed placement sequencing of PPB and EBRT, or the time interval between uncertainty, and other factors. Merrick et al. examined the two. Current practice and ongoing clinical trials favor variability in PPB preimplant dosimetry among eight experi- delivering EBRT first followed by PPB but there are ratio- enced brachytherapy teams. A range of D90 values from 112% nales for either approach. Delivering PPB before EBRT to 151% of the prescription dose was planned. Based on the exposes tissues to radiation simultaneously from both treat- published literature, an acceptable dose range for postimplant ments and may theoretically increase normal tissue toxicity, D90 for 125I may be 130e180 Gy as long as normal structures but also allows assessment of the implant such that the are not overdosed. D90s!130 Gy are associated with an EBRT dose may be adjusted if necessary.
increased risk of failure , whereas D90s from 180 to200 Gy seem to be well tolerated with no increased incidence of toxicity . High-risk CaP may benefit froma D O The ABS does not recommend the use of one specific 180 Gy The ABS acknowledges that the nature of PPB precludes exact precision in final seed placement and radionuclide. Both 125I and 103Pd have demonstrated excel- consequently a wide range of postplan variability is not only lent long-term outcomes. 131Cs is an isotope introduced in acceptable but expected. Furthermore, while D 2004 for PPB, which is being investigated in a multi- may be associated with increased failure, supplemental radia- institutional clinical trial. It has a shorter half-life (9.7 days) tion in the form of EBRT or a second implant may be possible compared with 125I (59.4 days) or 103Pd (17 days), but and ultimately yield excellent outcome while respecting slightly higher average energy than 125I. Its recent introduc- normal organ tolerance. In this immediate discussion D tion and short followup at this juncture prevent any recom- refer to 125I, but similar considerations are valid for 103Pd.
198Au is an isotope previously used in PPB on a limited basis but is not recommended for routine practice at No consensus exists regarding optimal seed activity, seed number, or total activity. In the RTOG clinical trials, seed activity has been specified at 0.23e0.43 mCi/seed for 125I, and 1.0e2.0 mCi/seed for 103Pd. In an ongoing Cystoscopy before, during, or after PPB may be used, CALBG trial seed strength for PPB combined with but is not mandatory. Flexible cystoscopy is generally EBRT was similar to the RTOG trials, but 0.8e1.0 mCi preferred over rigid cystoscopy to minimize urethral trauma for 103Pd. Experienced practitioners typically recommend . A cystoscopy during the pre-PPB evaluation may a range of seed activities but there is variation. Aronowitz identify urethral or bladder abnormalities such as urethral et al. analyzed variation of implant activity for PPB strictures, or bladder cancer, that may affect the treatment among three institutions with extensive experience and decision. Cystoscopy after PPB may be useful for removal found that total activity as a function of volume varied by of blood clots or misplaced seeds, but if bladder irrigation 25% for large prostates and 40% for small prostates.
is clear and fluoroscopy images do not show seeds that are Optimal equations were developed to describe the relation- suspected to be in the bladder, it is probably unnecessary.
ship between prostate volume, number of sources, and totalactivity in PPB . A randomized trial comparing low activity 125I seeds (0.31 mCi), vs. high activity (0.60 mCi) Radiation precautions should be explained to the patient, found excellent dosimetry in both arms . Although and preferably provided in writing. Although no mandatory information regarding typical seed activity is useful, the precautions after discharge are required by the Nuclear ABS does not recommend a specific seed activity or total Regulatory Commission [10 CFR 35] (CFR, Code of activity but does make recommendations regarding dose Federal Regulations), it is common to advise the avoidance planning. Total activity implanted varies as a function of of prolonged close contact with children and pregnant prostate volume and shape, and treatment margin, extrapro-static seed placement, and implant technique. As empha-sized, postimplant dosimetry is paramount in evaluating the quality of an implant and satisfactory postimplant Radionuclides for permanent prostate brachytherapy dosimetry is achievable using different techniques.
before PPB, the ABS makes no recommendation regarding the timing of PPB with respect to EBRT because of lack of B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 women for one half-life of the radionuclide. These recom- will produce differing results in postimplant dosimetry mendations are considered conservative, and exceed regula- because of variable degrees of edema . Postim- tory requirements. Smathers et al. measured dose rate plant CT on Day 0 or Day 1 is more convenient for the at the skin surface after either 125I or 103Pd PPB, demon- patient, allows early identification of dosimetric problems strating that patients need not be concerned about radiation and closes the learning loop while memory of the procedure risk to the general public. Radiation exposure to family is still recent, but undertaking dosimetry at this time will members of PPB patients is well below the limits recom- underestimate dosimetric parameters because of the pres- mended by the U.S. Nuclear Regulatory Commission ence of edema. The optimum CT timing to minimize Similarly, intercourse may be resumed, although ejacu- edema-derived dosimetry error is radionuclide specific; lation may be uncomfortable initially Ejaculatory 16 Æ 4 days for 103Pd and 30 Æ 7 days for 125I. Methods volume usually declines in the months after PPB of improving reproducibility of postimplant dosimetry such Although ejaculation of a seed is uncommon , some as MReCT image fusion are encouraged .
practitioners advise patients to wear condoms for the first Consistency in approach with respect to timing and postim- Postoperative anti-inflammatory drugs, antibiotics, and The ABS recommends the following postoperative dosi- alpha-blockers can be used prophylactically, or prescribed as needed. The use of prophylactic tamsulosin is associatedwith the improvement in urinary morbidity 5 weeks postop- eratively as demonstrated in a placebo-controlled blinded and randomized study by Elshaik et al. There is insufficient evidence to provide a recommendation in thisregard, although urinary anesthetics, antispasmodics, anal- gesics, perineal ice packs, and stool softeners may all be beneficial. Acute urinary retention is uncommon but should be managed by intermittent or continuous bladder drainage.
If the problem persists more than a few days, clean inter- mittent self-catheterization is preferred to continuous drainage by a Foley catheter. If the patient cannot manage Many critical organ dose parameters have been reported clean intermittent self-catheterization, suprapubic cystos- The ABS encourages a uniform approach to critical tomy should be considered. In most of the cases, symptoms organ dosimetry. For urethral doses, the UV5 (urethral resolve by the above temporary measures. The use of tran- volume) approximates the urethral maximum dose, whereas surethral incision of prostate should be avoided in the first 6 the UV30 represents a clinically significant volume of urethra months but if retention persists, transurethral incision of exposed to that dose level. Although one aims to keep the prostate or minimal TURP may be considered, recognizing the risk of urinary incontinence after these procedures recognized that this is not always possible, especially in smaller prostates (!20 cc). Similarly for rectal dosimetry,the RV100 is ideally ! 1 cc on Day 1 dosimetry and !1.3 cc at Day 30, the difference being due to changes in rectalproximity with resolution of periprostatic edema. Critical structures for postimplant erectile dysfunction have not been The ABS recommends that CT-based postoperative agreed on, although the internal pudendal artery, penile bulb, dosimetry be performed within 60 days of the implant.
and neurovascular bundles have been studied .
Planning systems able to generate doseevolume histo-grams, doseevolume statistics, and 2D and 3D isodose curves superimposed on CT and other images have becomewidely available over the past decade. The use of such plan- Close postoperative followup with digital rectal exami- ning systems is considered mandatory for good clinical nations and PSA at regular intervals is recommended.
practice and quality assurance. Careful postimplant assess- The optimal frequency of surveillance after PPB has not ment provides the brachytherapy team with objective been established, although an interval of every 6 to 12 measures of implant quality allowing for continual tech- months is considered suitable. For purposes of reporting nical improvement. Ongoing feedback from critical review and comparing results among radiotherapeutic management of dosimetry is a necessary link in this learning process.
strategies, the ABS favors the use of the Phoenix definition It is well known that there is inter- and intraobserver that dates failure at the time when the PSA has increased to variability in postimplant CT contouring of the prostate, 2 ng/mL above the nadir after treatment . For patients which results in differences in computed doses to the pros- with higher risk features, more frequent surveillance is tate The interval between the implant and CT appropriate. Routine ultrasound-guided biopsies are not B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 required. If a rising PSA occurs and prostate biopsy is  Intermediate-risk patients may be candidates for PPB undertaken, it should be recognized that the biopsy result monotherapy as the spectrum of risk factors are may not be interpretable before 30 months after PPB, and considered, but often have PPB in combination with a false call of failure may occur when actually a benign  High-risk patients are recommended to receive PPB The use of cautery to treat rectal bleeding, or biopsies to combined with EBRT. ADT, as ‘‘tri-modality’’ evaluate anomalies in the rectum, may result in the devel- therapy is also favored. There exists a need for opment of iatrogenic rectourethral fistulas post-PPB. The prospective controlled clinical trials in addition to ABS recommends that such procedures be avoided if  Patients with prior TURP may be candidates for PPB, depending on the size of TURP defect. Prostate size is generally not a contraindication to PPB for experi-enced practitioners, but PPB may be more readily The American College of Radiology and American facilitated with the use of cytoreduction by ADT.
Society of Radiation Oncology recently published guide-lines related to PPB and reviewed qualifications and respon- Since the last guideline statement from the ABS in 1999, sibilities of individuals involved in the procedure . As the widespread availability of prostate brachytherapy plan- a licensed user of sealed radioactive sources, a Radiation ning software enables all practices to engage in routine Oncologist is essential in the workup, evaluation, and treat- CT-based postimplant dosimetry in a timely manner. The ment of patients undergoing PPB. Similarly, a qualified ABS does not recommend one implant technique over Medical Physicist is essential to the planning and another but insists that postimplant assessment be a require- quality assurance for PPB. In addition, the multidisciplinary ment for all patients. Although several studies regarding team may include an Urologist, a certified Dosimetrist, a ‘‘learning curve’’ have been published Radiation Therapist, and other patient support staff.
since the last guideline statement demonstrating a relatively The ABS further recommends that any facility that short learning curve is possible and reaches a plateau after performs PPB be in compliance with the American College 20e30 cases the ABS strongly supports proctor- ing by experienced practitioners and appropriate training guidelines and have a well-documented quality improve- such that the learning curve manifested in substandard ment program that assures all staff involved in PPB are outcome is eliminated and that training and certification trained and competent. All junior faculty should undergo of brachytherapists is documented accordingly. Detailed extensive training and competency review.
analyses of outcomes with respect to cancer control andtoxicity have yielded a number of parameters by which toplan and evaluate PPB, yet further study and refinementof these parameters is in order.
This updated ABS guideline is intended to promote the safe and efficient delivery of PPB. It is based on the currentpractice of PPB as reviewed from clinical trials, published literature, other, and prior guideline statements. These These clinical guidelines for permanent TRUS-guided guidelines were developed as a consensus-based statement PPB represent a practical guide for clinicians performing and have been reviewed and approved by the board of the this common procedure. Over the past decade, multi- ABS. Since the previous formal guideline statement, PPB institutional prospective clinical trials have demonstrated has been broadly practiced and its use has expanded. It that PPB is a safe and efficacious procedure, acknowledged deserves reiterating that these guidelines are to be viewed as a standard therapy for men with localized CaP. The as an aid to practitioners in managing patients, but are selection criteria for patients undergoing PPB have broad- not to be judged as rigid practice requirements by which ened such that patients within all risk groups may be to establish a legal standard of care.
considered for PPB either as primary treatment or in Progress in the clinical practice and understanding of PPB has resulted in differences reflected in the updatedguidelines compared with those published by our Societyover a decade ago. Recommendations regarding the useof PPB are risk group specific.
 Low-risk disease: PPB monotherapy is appropriate [1] Jemal A, Siegel R, Xu J, et al. Cancer statistics. CA Cancer J Clin without the routine need for combined EBRT or [2] NCCN Clinical Practice Guidelines in Oncology. Prostate Cancer ADT except for prostate down sizing or in other B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 [3] Charyulu KK. Transperineal interstitial implantation of prostate [21] Hurwitz MD, Halabi S, Ou S-S, et al. Combination external beam cancer: A new method. Int J Radiat Oncol Biol Phys 1980;6: radiation and brachytherapy boost with androgen suppression for treatment of intermediate-risk prostate cancer: An initial report of [4] Holm HH. The history of interstitial brachytherapy of prostatic CALGB 99809. Int J Radiat Oncol Biol Phys 2008;72:814e819.
cancer. Semin Surg Oncol 1997;13:431e437.
[22] Nag S, Bice W, DeWyngaert K, et al. The American Brachytherapy [5] Sylvester JE, Grimm PD, Blasko JC, et al. 15-Year biochemical Society recommendations for permanent prostate brachytherapy relapse free survival in clinical Stage T1-T3 prostate cancer postimplant dosimetric analysis. Int J Radiat Oncol Biol Phys following combined external beam radiotherapy and brachytherapy; Seattle experience. Int J Radiat Oncol Biol Phys 2007;67:57e64.
[23] Nag S, Ellis RJ, Merrick GS, et al. American Brachytherapy Society [6] Lehrer S, Cesaretti J, Stone NN, et al. Urinary symptom flare after recommendations for reporting morbidity after prostate brachyther- brachytherapy for prostate cancer is associated with erectile apy. Int J Radiat Oncol Biol Phys 2002;54:462e470.
dysfunction and more urinary symptoms before implantation.
[24] Nath R, Bice WS, Butler WM, et al. AAPM recommendations on dose prescription and reporting methods for permanent interstitial [7] Sharkey J, Cantor A, Solc Z, et al. 103Pd brachytherapy versus brachytherapy for prostate cancer: Report of Task Group 137.
radical prostatectomy in patients with clinically localized prostate cancer: A 12-year experience from a single group practice. Brachy- [25] Rosenthal SA, Bittner NHJ, Beyer DC, et al. American Society for Radiation Oncology (ASTRO) and American College of Radiology [8] Critz FA, Levinson K. 10-year disease-free survival rates after (ACR) Practice Guideline for the transperineal permanent brachy- simultaneous irradiation for prostate cancer with a focus on calcula- therapy of prostate cancer. Int J Radiat Oncol Biol Phys 2011;79: tion methodology. J Urol 2004;172:2232e2238.
[9] Dattoli M, Wallner K, True L, et al. Long-term prostate cancer [26] Lee WR, Bae K, Lawton C, et al. Late toxicity and biochemical control using palladium-103 brachytherapy and external beam radiotherapy in patients with a high likelihood of extracapsular permanent-source prostate brachytherapy: Analysis of Radiation cancer extension. Urology 2007;69:334e337.
Therapy Oncology Group study 0019. Cancer 2007;109:1506e1512.
[10] Taira AV, Merrick GS, Butler WM, et al. Long-term outcome for [27] Lee WR, Bae K, Lawton CA, et al. A descriptive analysis of post- clinically localized prostate cancer treated with permanent intersti- implant dosimetric parameters from Radiation Therapy Oncology tial brachytherapy. Int J Radiat Oncol Biol Phys 2011;79: Group P0019. Brachytherapy 2006;5:239e243.
[28] Ghaly M, Wallner K, Merrick G, et al. The effect of supplemental [11] NCI. Prostate Cancer Treatmentdtreatment option overview.
beam radiation on prostate brachytherapy-related morbidity: National Cancer Institute Web site. Available at: Morbidity outcomes from two prospective randomized multicenter trials. Int J Radiat Oncol Biol Phys 2003;55:1288e1293.
[29] Narayana V, Troyer S, Evans V, et al. Randomized trial of high- and [12] Initial treatment of prostate cancer by stage. American Cancer low-source strength (125)I prostate seed implants. Int J Radiat Oncol [30] Barry MJ, Fowler FJ Jr, Bin L, et al. A nationwide survey of prac- ticing urologists: Current management of benign prostatic hyper- [13] Thompson I, Thrasher JB, Aus G, et al. Guideline for the manage- plasia and clinically localized prostate cancer. J Urol 1997;158: ment of clinically localized prostate cancer: 2007 Update. J Urol [31] Edge SB, Byrd DR, Compton CC, et al. AJCC Cancer Staging [14] Rosenthal SA, Bittner NHJ, Beyer DC, et al. American Society for Manual. 7th ed. New York: Springer; 2010.
Radiation Oncology (ASTRO) and American College of Radiology [32] Wallner K, Simpson C, Roof J, et al. Local anesthesia for prostate (ACR) practice guideline for the transperineal permanent brachy- brachytherapy. Int J Radiat Oncol Biol Phys 1999;45:401e406.
therapy of prostate cancer. Int J Radiat Oncol Biol Phys 2011;79: [33] Rockhill J, Wallner K, Hoffman C, et al. Prostate brachytherapy in obese patients. Brachytherapy 2002;1:54e60.
[15] Ash D, Flynn A, Battermann J, et al. ESTRO/EAU/EORTC recom- [34] Merrick GS, Butler WM, Wallner KE, et al. Influence of body mass mendations on permanent seed implantation for localized prostate index on biochemical outcome after permanent prostate brachyther- cancer. Radiother Oncol 2000;57:315e321.
[16] Goharderakhshan RZ, Grossfeld GD, Kassis A, et al. Additional [35] Skolarus TA, Wolin KY, Grubb RL 3rd. The effect of body mass treatments and reimbursement rates associated with prostate cancer index on PSA levels and the development, screening and treatment treatment for patients undergoing radical prostatectomy, interstitial of prostate cancer. Nat Clin Pract Urol 2007;4:605e614.
brachytherapy, and external beam radiotherapy. Urology 2000;56: [36] Efstathiou JA, Skowronski RY, Coen JJ, et al. Body mass index and prostate-specific antigen failure following brachytherapy for local- [17] Nag S, Beyer D, Friedland J, et al. American Brachytherapy Society ized prostate cancer. Int J Radiat Oncol Biol Phys 2008;71: (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 1999;44:789e799.
[37] Koutrouvelis PG, Theodorescu D, Katz S, et al. Brachytherapy of [18] Lee WR, DeSilvio M, Lawton C, et al. A phase II study of external prostate cancer after colectomy for colorectal cancer: Pilot experi- beam radiotherapy combined with permanent source brachytherapy ence. J Urol 2005;173:82e85. discussion 85e86.
for intermediate-risk, clinically localized adenocarcinoma of the [38] Crook J, McLean M, Catton C, et al. Factors influencing risk of prostate: Preliminary results of RTOG P-0019. Int J Radiat Oncol acute urinary retention after TRUS-guided permanent prostate seed implantation. Int J Radiat Oncol Biol Phys 2002;52:453e460.
[19] Feigenberg SJ, Lee WR, Desilvio ML, et al. Health-related quality [39] Keyes M, Schellenberg D, Moravan V, et al. Decline in urinary of life in men receiving prostate brachytherapy on RTOG 98-05. Int retention incidence in 805 patients after prostate brachytherapy: J Radiat Oncol Biol Phys 2005;62:956e964.
The effect of learning curve? Int J Radiat Oncol Biol Phys 2006; [20] Crook JM, Gomez-Iturriaga A, Wallace K, et al. Comparison of health-related quality of life 5 years after SPIRIT: Surgical Prosta- [40] Terk M, Stock R, Stone N. Identification of patients at increased risk tectomy Versus Interstitial Radiation Intervention Trial. J Clin for prolonged urinary retention following radioactive seed implanta- tion of the prostate. J Urol 1998;160:1379e1382.
B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 [41] Lee N, Wuu CS, Brody R, et al. Factors predicting for postimplan- [61] Gibbons EP, Smith RP, Beriwal S, et al. Overcoming pubic arch tation urinary retention after permanent prostate brachytherapy. Int J interference with free-hand needle placement in men undergoing Radiat Oncol Biol Phys 2000;48:1457e1460.
prostate brachytherapy. Brachytherapy 2009;8:74e78.
[42] Locke J, Ellis W, Wallner K, et al. Risk factors for acute urinary [62] Petit JH, Gluck C, Kiger WS 3rd, et al. Androgen deprivation- retention requiring temporary intermittent catheterization after pros- mediated cytoreduction before interstitial brachytherapy for prostate tate brachytherapy: A prospective study. Int J Radiat Oncol Biol cancer does not abrogate the elevated risk of urinary morbidity asso- ciated with larger initial prostate volume. Brachytherapy 2007;6: [43] Schwartz DJ, Schild SE, Wong WW, et al. Factors associated with the frequency of self-intermittent catheterization after prostate bra- [63] Solhjem MC, Davis BJ, Pisansky TM, et al. Prostate volume before chytherapy. Int J Radiat Oncol Biol Phys 2005;61:60e63.
and after permanent prostate brachytherapy in patients receiving [44] Bucci J, Morris WJ, Keyes M, et al. Predictive factors of urinary neoadjuvant androgen suppression. Cancer J 2004;10:343e348.
retention following prostate brachytherapy. Int J Radiat Oncol Biol [64] Kucway R, Vicini F, Huang R, et al. Prostate volume reduction with androgen deprivation therapy before interstitial brachytherapy. J Urol [45] Merrick GS, Butler WM, Lief JH, et al. Temporal resolution of urinary morbidity following prostate brachytherapy. Int J Radiat [65] Beyer DC, McKeough T, Thomas T. Impact of short course hormonal therapy on overall and cancer specific survival after [46] Gutman S, Merrick GS, Butler WM, et al. Severity categories of permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys the International Prostate Symptom Score before, and urinary morbidity after, permanent prostate brachytherapy. BJU Int 2006; [66] Crook J, Ludgate C, Malone S, et al. Report of a multicenter Canadian phase III randomized trial of 3 months vs. 8 months neo- [47] Martens C, Pond G, Webster D, et al. Relationship of the Interna- adjuvant androgen deprivation before standard-dose radiotherapy tional Prostate Symptom score with urinary flow studies, and for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys catheterization rates following 125I prostate brachytherapy. Brachy- [67] Grado GL. Techniques to achieve optimal seed placement in salvage [48] Thomas C, Keyes M, Liu M, et al. Segmental urethral dosimetry and primary brachytherapy for prostate cancer. Tech Urol 2000;6: and urinary toxicity in patients with no urinary symptoms before permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys [68] Landis DM, Schultz D, Cormack R, et al. Acute urinary retention after magnetic resonance image-guided prostate brachytherapy with [49] Williams SG, Millar JL, Duchesne GM, et al. Factors predicting for and without neoadjuvant external beam radiotherapy. Urology 2005; urinary morbidity following 125iodine transperineal prostate bra- chytherapy. Radiother Oncol 2004;73:33e38.
[69] Gibbons EP, Jacobs BL, Smith RP, et al. Dosimetric outcomes in [50] Ikeda T, Shinohara K. Peak flow rate is the best predictor of acute prostate brachytherapy: Is downsizing the prostate with androgen urinary retention following prostate brachytherapy: Our experience deprivation necessary? Brachytherapy 2009;8:304e308.
and literature review. Int J Urol 2009;16:558e560.
[70] Linzer DG, Stock RG, Stone NN, et al. Seminal vesicle biopsy: [51] Davis BJ, Wilson TM, Mynderse LA, et al. Analysis of pretreatment Accuracy and implications for staging of prostate cancer. Urology factors predictive of urinary morbidity following permanent prostate brachytherapy (PPB) including cystoscopic findings and uroflowme- [71] Grimm PD, Blasko JC, Sylvester JE, et al. 10-Year biochemical (prostate-specific antigen) control of prostate cancer with (125)I [52] Wehle MJ, Lisson SW, Buskirk SJ, et al. Prediction of genitourinary brachytherapy. Int J Radiat Oncol Biol Phys 2001;51:31e40.
tract morbidity after brachytherapy for prostate adenocarcinoma.
[72] Potters L, Morgenstern C, Calugaru E, et al. 12-Year outcomes following permanent prostate brachytherapy in patients with clini- [53] Wallner K, Lee H, Wasserman S, et al. Low risk of urinary incon- cally localized prostate cancer. J Urol 2005;173:1562e1566.
tinence following prostate brachytherapy in patients with a prior [73] Stone NN, Potters L, Davis BJ, et al. Customized dose prescription transurethral prostate resection. Int J Radiat Oncol Biol Phys for permanent prostate brachytherapy: Insights from a multicenter analysis of dosimetry outcomes. Int J Radiat Oncol Biol Phys [54] Stone NN, Ratnow ER, Stock RG. Prior transurethral resection does not increase morbidity following real-time ultrasound-guided pros- [74] Zelefsky MJ, Kuban DA, Levy LB, et al. Multi-institutional analysis tate seed implantation. Tech Urol 2000;6:123e127.
of long-term outcome for stages T1-T2 prostate cancer treated with [55] Moran BJ, Stutz MA, Gurel MH. Prostate brachytherapy can be per- permanent seed implantation. Int J Radiat Oncol Biol Phys 2007;67: formed in selected patients after transurethral resection of the pros- tate. Int J Radiat Oncol Biol Phys 2004;59:392e396.
[75] Stone NN, Stock RG. The effect of brachytherapy, external beam [56] Merrick GS, Butler WM, Wallner KE, et al. Effect of transurethral irradiation and hormonal therapy on prostate volume. J Urol resection on urinary quality of life after permanent prostate brachy- therapy. Int J Radiat Oncol Biol Phys 2004;58:81e88.
[76] Davis BJ, Pisansky TM, Wilson TM, et al. The radial distance of [57] Bellon J, Wallner K, Ellis W, et al. Use of pelvic CT scanning to extraprostatic extension of prostate carcinoma: Implications for evaluate pubic arch interference of transperineal prostate brachy- prostate brachytherapy. Cancer 1999;85:2630e2637.
therapy. Int J Radiat Oncol Biol Phys 1999;43:579e581.
[77] Sohayda C, Kupelian PA, Levin HS, et al. Extent of extracapsu- [58] Wallner K, Ellis W, Russell K, et al. Use of TRUS to predict pubic lar extension in localized prostate cancer. Urology 2000;55: arch interference of prostate brachytherapy. Int J Radiat Oncol Biol [78] Teh BS, Bastasch MD, Mai W-Y, et al. Predictors of extracapsular [59] Tincher SA, Kim RY, Ezekiel MP, et al. Effects of pelvic rotation extension and its radial distance in prostate cancer: Implications and needle angle on pubic arch interference during transperineal for prostate IMRT, brachytherapy, and surgery. Cancer J 2003;9: prostate implants. Int J Radiat Oncol Biol Phys 2000;47: [79] Chao KK, Goldstein NS, Yan D, et al. Clinicopathologic analysis of [60] Henderson A, Laing RW, Langley SEM. Identification of pubic arch extracapsular extension in prostate cancer: Should the clinical target interference in prostate brachytherapy: Simplifying the transrectal volume be expanded posterolaterally to account for microscopic ultrasound technique. Brachytherapy 2003;2:240e245.
extension? Int J Radiat Oncol Biol Phys 2006;65:999e1007.
B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 [80] Sengupta S, Davis BJ, Mynderse LA, et al. Permanent prostate bra- [96] Crook JM, Potters L, Stock RG, et al. Critical organ dosimetry in chytherapy: Pathologic implications as assessed on radical prostatec- permanent seed prostate brachytherapy: Defining the organs at risk.
tomy specimens of broadening selection criteria for monotherapy.
[97] Snyder KM, Stock RG, Hong SM, et al. Defining the risk of devel- [81] Butzbach D, Waterman FM, Dicker AP. Can extraprostatic exten- oping grade 2 proctitis following 125I prostate brachytherapy using sion be treated by prostate brachytherapy? An analysis based on a rectal dose-volume histogram analysis. Int J Radiat Oncol Biol postimplant dosimetry. Int J Radiat Oncol Biol Phys 2001;51: [98] Prestidge BR, Prete JJ, Buchholz TA, et al. A survey of current clin- [82] Davis BJ, Haddock MG, Wilson TM, et al. Treatment of extrapro- ical practice of permanent prostate brachytherapy in the United static cancer in clinically organ-confined prostate cancer by perma- States. Int J Radiat Oncol Biol Phys 1998;40:461e465.
nent interstitial brachytherapy: Is extraprostatic seed placement [99] Orio PF 3rd, Tutar IB, Narayanan S, et al. Intraoperative ultrasound- fluoroscopy fusion can enhance prostate brachytherapy quality. Int J [83] Frank SJ, Grimm PD, Sylvester JE, et al. Interstitial implant alone Radiat Oncol Biol Phys 2007;69:302e307.
or in combination with external beam radiation therapy for [100] Blasko JC, Mate T, Sylvester JE, et al. Brachytherapy for carcinoma intermediate-risk prostate cancer: A survey of practice patterns in of the prostate: Techniques, patient selection, and clinical outcomes.
the United States. Brachytherapy 2007;6:2e8.
[84] Horwitz EM, Bae K, Hanks GE, et al. Ten-year follow-up of radia- [101] Battermann JJ, van Es CA. The learning curve in prostate seed tion therapy oncology group protocol 92-02: A phase III trial of the implantation. Cancer Radiother 2000;(4 Suppl. 1):119se122s.
duration of elective androgen deprivation in locally advanced pros- [102] Older RA, Synder B, Krupski TL, et al. Radioactive implant migra- tate cancer. J Clin Oncol 2008;26:2497e2504.
tion in patients treated for localized prostate cancer with interstitial [85] Bolla M, Van Tienhoven G, Warde P, et al. External irradiation with brachytherapy. J Urol 2001;165:1590e1592.
or without long-term androgen suppression for prostate cancer with [103] Tapen EM, Blasko JC, Grimm PD, et al. Reduction of radioactive high metastatic risk: 10-Year results of an EORTC randomised seed embolization to the lung following prostate brachytherapy.
study. The Lancet Oncology 2010;11:1066e1073.
Int J Radiat Oncol Biol Phys 1998;42:1063e1067.
[86] Merrick GS, Wallner KE, Butler WM. Permanent interstitial brachy- [104] Merrick GS, Butler WM, Dorsey AT, et al. Seed fixity in the pros- therapy for the management of carcinoma of the prostate gland.
tate/periprostatic region following brachytherapy. Int J Radiat [87] Merrick GS, Butler WM, Wallner KE, et al. Androgen deprivation [105] Eshleman JS, Davis BJ, Pisansky TM, et al. Radioactive seed migra- therapy does not impact cause-specific or overall survival in high- tion to the chest after transperineal interstitial prostate brachyther- risk prostate cancer managed with brachytherapy and supple- apy: Extraprostatic seed placement correlates with migration. Int J mental external beam. Int J Radiat Oncol Biol Phys 2007;68: Radiat Oncol Biol Phys 2004;59:419e425.
[106] Al-Qaisieh B, Carey B, Ash D, et al. The use of linked seeds elim- [88] Stone NN, Potters L, Davis BJ, et al. Multicenter analysis of effect inates lung embolization following permanent seed implantation for of high biologic effective dose on biochemical failure and survival prostate cancer. Int J Radiat Oncol Biol Phys 2004;59:397e399.
outcomes in patients with Gleason score 7-10 prostate cancer treated [107] Fuller DB, Koziol JA, Feng AC. Prostate brachytherapy seed migra- with permanent prostate brachytherapy. Int J Radiat Oncol Biol tion and dosimetry: Analysis of stranded sources and other potential predictive factors. Brachytherapy 2004;3:10e19.
[89] Stock RG, Lo YC, Gaildon M, et al. Does prostate brachytherapy [108] Davis BJ, Pfeifer EA, Wilson TM, et al. Prostate brachytherapy seed treat the seminal vesicles? A dose-volume histogram analysis of migration to the right ventricle found at autopsy following acute seminal vesicles in patients undergoing combined pd-103 prostate cardiac dysrhythmia. J Urol 2000;164:1661.
implantation and external beam irradiation. Int J Radiat Oncol Biol [109] Davis BJ, Bresnahan JF, Stafford SL, et al. Prostate brachytherapy seed migration to a coronary artery found during angiography. J Urol [90] Goldstein NS, Kestin LL, Vicini FA, et al. The influence of percentage of preradiation needle biopsies with adenocarcinoma [110] Nakano M, Uno H, Gotoh T, et al. Migration of prostate brachyther- and total radiation dose on the pathologic response of unfavorable apy seeds to the vertebral venous plexus. Brachytherapy 2006;5: prostate adenocarcinoma. Am J Clin Pathol 2002;117:927e934.
[91] Davis B, Cheville J, Wilson T, et al. Histopathologic characteriza- [111] Nguyen BD, Schild SE, Wong WW, et al. Prostate brachytherapy tion of seminal vesicle invasion in prostate cancer: Implications seed embolization to the right renal artery. Brachytherapy 2009;8: for radiotherapeutic management. Int J Radiat Oncol Biol Phys [112] Zhu AX, Wallner KE, Frivold GP, et al. Prostate brachytherapy seed [92] Ho AY, Burri RJ, Jennings GT, et al. Is seminal vesicle implantation migration to the right coronary artery associated with an acute with permanent sources possible? A dose-volume histogram anal- myocardial infarction. Brachytherapy 2006;5:262e265.
ysis in patients undergoing combined 103Pd implantation and [113] Reed DR, Wallner KE, Merrick GS, et al. A prospective randomized external beam radiation for T3c prostate cancer. Brachytherapy comparison of stranded vs. loose 125I seeds for prostate brachyther- [93] Nag S, Ciezki JP, Cormack R, et al. Intraoperative planning and [114] Heysek RV, Gwede CK, Torres-Roca J, et al. A dosimetric analysis evaluation of permanent prostate brachytherapy: Report of the of unstranded seeds versus customized stranded seeds in transperi- American Brachytherapy Society. Int J Radiat Oncol Biol Phys neal interstitial permanent prostate seed brachytherapy. Brachyther- [94] Stone NN, Stock RG. Brachytherapy for prostate cancer: Real-time [115] Lin K, Lee SP, Cho JS, et al. Improvements in prostate brachyther- three-dimensional interactive seed implantation. Tech Urol 1995;1: apy dosimetry due to seed stranding. Brachytherapy 2007;6:44e48.
[116] Fagundes HM, Keys RJ, Wojcik MF, et al. Transperineal TRUS- [95] Fogh S, Doyle L, Yu A, et al. A comparison of preplan transrectal guided prostate brachytherapy using loose seeds versus RAPID- ultrasound with preplan-CT in assessing volume and number of Strand: A dosimetric analysis. Brachytherapy 2004;3:136e140.
seeds needed for real-time ultrasound-based intra-operative plan- [117] Crook J. Commentary on ‘‘a comparison of the precision of seeds ning in prostate (125)I seed implantation. Brachytherapy 2010;9: deposited as loose seeds vs. suture-embedded seeds: A randomized trial’’ and ‘‘prostate brachytherapy seed migration and dosimetry: B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 analysis of stranded sources and other potential predictive factors’’: [136] Michalski J, Mutic S, Eichling J, et al. Radiation exposure to family to strand or not to stranddis this really the question? Brachytherapy and household members after prostate brachytherapy. Int J Radiat [118] Usmani N, Chng N, Spadinger I, et al. Lack of significant intrapro- [137] Kleinberg L, Wallner K, Roy J, et al. Treatment-related symptoms static migration of stranded iodine-125 sources in prostate brachy- during the first year following transperineal 125I prostate implanta- therapy implants. Brachytherapy 2011;10:275e285.
tion. Int J Radiat Oncol Biol Phys 1994;28:985e990.
[119] Rivard MJ, Coursey BM, DeWerd LA, et al. Update of AAPM Task [138] Huyghe E, Delannes M, Wagner F, et al. Ejaculatory function after Group No. 43 Report: A revised AAPM protocol for brachytherapy permanent 125I prostate brachytherapy for localized prostate dose calculations. [Erratum appears in Med Phys. 2004 Dec;31(12): cancer. Int J Radiat Oncol Biol Phys 2009;74:126e132.
3532e3533]. Med Phys 2004;31:633e674.
[139] Yorozu A, Toya K, Ohashi T, et al. Seed loss through the urinary [120] Al-Qaisieh B, Witteveen T, Carey B, et al. Correlation between pre- tract and retrieval after prostate seed implant. Nippon Igaku Hosha- and postimplant dosimetry for iodine-125 seed implants for localized prostate cancer. Int J Radiat Oncol Biol Phys 2009;75:626e630.
[140] Elshaikh MA, Ulchaker JC, Reddy CA, et al. Prophylactic tamsulo- [121] Williamson JF, Butler W, Dewerd LA, et al. Recommendations of sin (Flomax) in patients undergoing prostate 125I brachytherapy for the American Association of Physicists in Medicine regarding the prostate carcinoma: Final report of a double-blind placebo- impact of implementing the 2004 task group 43 report on dose spec- controlled randomized study. Int J Radiat Oncol Biol Phys 2005; ification for 103Pd and 125I interstitial brachytherapy. Med Phys [141] Blasko JC, Ragde H, Grimm PD. Transperineal ultrasound-guided [122] Li Z, Das RK, DeWerd LA, et al. Dosimetric prerequisites for implantation of the prostate: Morbidity and complications. Scand routine clinical use of photon emitting brachytherapy sources with J Urol Nephrol Suppl 1991;137:113e118.
average energy higher than 50 kev. Med Phys 2007;34:37e40.
[142] Hu K, Wallner K. Urinary incontinence in patients who have [123] Beyer D, Nath R, Butler W, et al. American brachytherapy society a TURP/TUIP following prostate brachytherapy. Int J Radiat Oncol recommendations for clinical implementation of NIST-1999 stan- dards for (103)palladium brachytherapy. The clinical research [143] Kollmeier MA, Stock RG, Cesaretti J, et al. Urinary morbidity and committee of the American Brachytherapy Society. Int J Radiat incontinence following transurethral resection of the prostate after brachytherapy. J Urol 2005;173:808e812.
[124] Stock RG, Stone NN, Tabert A, et al. A dose-response study for I-125 [144] Lee WR, Roach M 3rd, Michalski J, et al. Interobserver variability prostate implants. Int J Radiat Oncol Biol Phys 1998;41:101e108.
leads to significant differences in quantifiers of prostate implant [125] Papagikos MA, Deguzman AF, Rossi PJ, et al. Dosimetric quanti- adequacy. Int J Radiat Oncol Biol Phys 2002;54:457e461.
fiers for low-dose-rate prostate brachytherapy: Is V(100) superior [145] Crook J, Milosevic M, Catton P, et al. Interobserver variation in to D(90)? Brachytherapy 2005;4:252e258.
postimplant computed tomography contouring affects quality [126] Orio P, Wallner K, Merrick G, et al. Dosimetric parameters as assessment of prostate brachytherapy. Brachytherapy 2002;1: predictive factors for biochemical control in patients with higher risk prostate cancer treated with Pd-103 and supplemental beam [146] Dubois DF, Prestidge BR, Hotchkiss LA, et al. Intraobserver and radiation. Int J Radiat Oncol Biol Phys 2007;67:342e346.
interobserver variability of MR imaging- and CT-derived prostate [127] Morris WJ, Keyes M, Palma D, et al. Evaluation of dosimetric volumes after transperineal interstitial permanent prostate brachy- parameters and disease response after 125 iodine transperineal therapy. Radiology 1998;207:785e789.
brachytherapy for low- and intermediate-risk prostate cancer. Int J [147] Dogan N, Mohideen N, Glasgow GP, et al. Effect of prostatic edema Radiat Oncol Biol Phys 2009;73:1432e1438.
on CT-based postimplant dosimetry. Int J Radiat Oncol Biol Phys [128] Morris WJ, Halperin R, Spadinger I. Point: The relationship between postimplant dose metrics and biochemical no evidence of [148] Waterman FM, Dicker AP. Impact of postimplant edema on disease following low dose rate prostate brachytherapy: Is there V(100) and D(90) in prostate brachytherapy: Can implant quality an elephant in the room? Brachytherapy 2010;9:289e292.
be predicted on day 0? Int J Radiat Oncol Biol Phys 2002;53: [129] Merrick GS, Butler WM, Wallner KE, et al. Variability of prostate brachytherapy pre-implant dosimetry: A multi-institutional analysis.
[149] Waterman FM, Dicker AP. Effect of post-implant edema on the rectal dose in prostate brachytherapy. Int J Radiat Oncol Biol Phys [130] Gomez-Iturriaga Pina A, Crook J, Borg J, et al. Biochemical disease-free rate and toxicity for men treated with iodine-125 pros- [150] Waterman FM, Yue N, Corn BW, et al. Edema associated with I-125 tate brachytherapy with d(90) $180 Gy. Int J Radiat Oncol Biol or Pd-103 prostate brachytherapy and its impact on post-implant dosimetry: An analysis based on serial CT acquisition. Int J Radiat [131] Aronowitz JN, Crook JM, Michalski JM, et al. Inter-institutional variation of implant activity for permanent prostate brachytherapy.
[151] Merrick GS, Butler WM, Dorsey AT, et al. Influence of timing on the dosimetric analysis of transperineal ultrasound-guided, pros- [132] Aronowitz JN, Michalski JM, Merrick GS, et al. Optimal equations tatic conformal brachytherapy. Radiat Oncol Investig 1998;6: for describing the relationship between prostate volume, number of sources, and total activity in permanent prostate brachytherapy. Am [152] Yue N, Chen Z, Peschel R, et al. Optimum timing for image-based dose evaluation of 125I and 103PD prostate seed implants. Int J [133] Bice WS, Prestidge BR, Kurtzman SM, et al. Recommendations for Radiat Oncol Biol Phys 1999;45:1063e1072.
permanent prostate brachytherapy with (131)Cs: A consensus report [153] Ohashi T, Yorozu A, Toya K, et al. Comparison of intraoperative from the Cesium Advisory Group. Brachytherapy 2008;7:290e296.
ultrasound with postimplant computed tomographyddosimetric [134] Fox KE, Choe J, Radivoyevitch T, et al. Urinary retention following values at Day 1 and Day 30 after prostate brachytherapy. Brachy- prostate seed implant brachytherapy following rigid cystoscopy. Int J Radiat Oncol Biol Phys 2010;78:S354.
[154] Crook J, McLean M, Yeung I, et al. MRI-CT fusion to assess post- [135] Smathers S, Wallner K, Korssjoen T, et al. Radiation safety param- brachytherapy prostate volume and the effects of prolonged edema eters following prostate brachytherapy. Int J Radiat Oncol Biol Phys on dosimetry following transperineal interstitial permanent prostate brachytherapy. Brachytherapy 2004;3:55e60.
B.J. Davis et al. / Brachytherapy 11 (2012) 6e19 [155] Polo A, Cattani F, Vavassori A, et al. MR and CT image fusion for [161] Reed D, Wallner K, Merrick G, et al. Clinical correlates to PSA postimplant analysis in permanent prostate seed implants. Int J spikes and positive repeat biopsies after prostate brachytherapy.
Radiat Oncol Biol Phys 2004;60:1572e1579.
[156] Tanaka O, Hayashi S, Matsuo M, et al. Comparison of MRI-based [162] Chiu-Tsao S-T, Duckworth TL, Hsiung C-Y, et al. Thermolumines- and CT/MRI fusion-based postimplant dosimetric analysis of pros- cent dosimetry of the SourceTech Medical model STM1251 125I tate brachytherapy. Int J Radiat Oncol Biol Phys 2006;66: [163] Morris WJ, Berthelet E, Duncan G, et al. ASCENDE-RT*, [157] Gillan C, Kirilova A, Landon A, et al. Radiation dose to the internal a randomized trial of brachytherapy: First report of the pilot with pudendal arteries from permanent-seed prostate brachytherapy as a median 52m followup: Cancer outcomes, treatment-related determined by time-of-flight MR angiography. Int J Radiat Oncol toxicity and patient-reported QOL. Brachytherapy 2008;7:123.
[164] Lee WR, deGuzman AF, Bare RL, et al. Postimplant analysis of [158] Merrick GS, Butler WM, Wallner KE, et al. The importance of radi- ation doses to the penile bulb vs. crura in the development of postbra- Evidence for a learning curve in the first year at a single institution.
chytherapy erectile dysfunction. Int J Radiat Oncol Biol Phys 2002; Int J Radiat Oncol Biol Phys 2000;46:83e88.
[165] Acher P, Popert R, Nichol J, et al. Permanent prostate brachyther- [159] Buyyounouski MK, Horwitz EM, Uzzo RG, et al. The radiation apy: Dosimetric results and analysis of a learning curve with doses to erectile tissues defined with magnetic resonance imaging a dynamic dose-feedback technique. Int J Radiat Oncol Biol Phys after intensity-modulated radiation therapy or iodine-125 brachy- therapy. Int J Radiat Oncol Biol Phys 2004;59:1383e1391.
[166] Merrick GS, Grimm PD, Sylvester J, et al. Initial analysis of Pro- [160] Roach M 3rd, Hanks G, Thames H Jr, et al. Defining biochemical Qura: A multi-institutional database of prostate brachytherapy failure following radiotherapy with or without hormonal therapy dosimetry. Brachytherapy 2007;6:9e15.
in men with clinically localized prostate cancer: Recommendations [167] Loiselle CR, Waheed M, Sylvester J, et al. Analysis of the Pro-Qura of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Database: Rectal dose, implant quality, and brachytherapist’s expe-

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