PALM BEACH, Fla--The increased use of prostate brachytherapy has prompted the American Brachytherapy Society to establish a group to formulate standards and treatment guidelines, Peter D. Grimm, DO, said at the Society's 19th annual meeting.
"It's clear to us that if we don't do this, it will be very difficult to compare results and may result in some poor treatments," said Dr. Grimm, of the Northwest Tumor Institute, Seattle.
The Prostate Brachytherapy Quality Assurance Group (PBQAG), which includes 21 experts from various US medical centers and universities, is seeking to establish guidelines in seven areas (see table ).
ISSUES IN PROSTATE BRACHYTHERAPY
Under review by the American Brachytherapy Society's Prostate Brachytherapy Quality Assurance Group (PBQAG).
1. Postoperative dosimetry--The group will attempt to set standards on how and by whom the radioactive dose is calculated after seed implantation.
2. Implant planning guidelines will focus on all three members of the implant team--the urologist, radiation oncolo-gist, and physicist. By looking at the size and shape of the prostate, as well as other factors such as whether TURP (transure-thral resection of the prostate) has already been done, the group will try to set standards for prescribing how the brachytherapy procedure is performed.
One question to be examined is the value of pre-planning vs decision making in the operating room. Dr. Grimm's personal prejudice is for pre-planning. "It gives all of the team time to think about the best course of action," he said. "In the operating room, it becomes expensive thinking."
3. Physician, physicist, and nurse training. Here, the main question is whether there should be minimum education standards to qualify people for brachy-therapy use and follow-up care. The panel will look at what this might entail in terms of course programs and collateral educational materials. Dr. Grimm said that the Prostate Institute at the Swedish Medical Center, Seattle, is currently training about 30 physicians a month in prostate brachytherapy.
4. Radiation safety guidelines will establish protocols and safety standards for handling the radioactive seeds.
5. Patient selection. The panel will review clinical trials in an attempt to define which patients are most likely to benefit from brachytherapy alone or various combinations of brachytherapy, external beam radiation therapy, and hormonal blockade.
6. Quality assurance monitoring. The panel will set protocols as to how often quality assurance monitoring should be done and by whom.
7. Intraoperative quality assurance. The committee will also establish guidelines for monitoring quality in the operating room, including the best method (ultrasound, fluoroscope, or some other method) for guiding and assessing the placement of the radioactive seeds.
"The standards set today will help to project the future," Dr. Grimm said in an interview. "It will be a fluid, ongoing effort that is constantly improved upon as more information becomes available."
Dr. Grimm and his colleagues are encouraging members of the Society and other physicians in the field to publish papers that address the questions raised by the PBQAG. Dr. Grimm is adamant that randomized trials are needed along with assessments of the procedure as it is currently used.
He said that the group hopes to have a rough set of guidelines and a clearer definition of goals for prostate brachytherapy available for review by the Society's next annual meeting.