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Prostate brachytherapy in New South Wales: patterns of care study and impact of caseload on treatment quality.

Thompson SR, Delaney GP, Gabriel GS, Izard MA, Hruby G, Jagavkar R, Bucci J, Barton MB - J Contemp Brachytherapy (2014)

Bottom Line: We performed the first comprehensive, population-based brachytherapy (BT) Patterns of Care Study in the Australian setting.Quality was compared between higher and lower caseload departments.Rates of concordance with quality benchmarks were high (85-99%) with no consistent caseload effect identified.

View Article: PubMed Central - PubMed

Affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney ; Department of Radiation Oncology, Prince of Wales Hospital, Sydney ; University of New South Wales, Faculty of Medicine, Sydney.

ABSTRACT

Purpose: We performed the first comprehensive, population-based brachytherapy (BT) Patterns of Care Study in the Australian setting. Herein we report on prostate BT and assess the technical quality of BT practice, focusing on whether a caseload effect could be identified in New South Wales (NSW).

Material and methods: Site visits were made to all radiation oncology departments in NSW that delivered prostate BT, collecting relevant data on NSW residents treated with prostate BT in 2003. Overall quality of NSW prostate BT treatment was assessed using benchmarks including treatment of appropriate prostate cancer disease risk category, absence of (relative) physical contraindications, optimal planned and treated dosimetry, and pre-/post-implant planning/CT. Quality was compared between higher and lower caseload departments.

Results: One hundred and fifty-seven (67%) patients underwent temporary BT and 79 (33%) permanent seed BT. Prostate BT was concentrated in five departments, with three of four departments with active programmes treating greater than the recommended 25 cases. Rates of concordance with quality benchmarks were high (85-99%) with no consistent caseload effect identified.

Conclusions: Prostate BT in NSW in 2003 was generally of high quality and a caseload effect on quality could not be identified. This may be because the number of departments was insufficient to determine a caseload effect, or because the prostate BT was largely concentrated in a small number of high caseload departments.

No MeSH data available.


Related in: MedlinePlus

Permanent seed brachytherapy. Prescribed and received dose parameters. Column graph indicates mean and whiskers indicate range, y-axis reprepresents Gray for D90 and % for V200/150/100
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Figure 0001: Permanent seed brachytherapy. Prescribed and received dose parameters. Column graph indicates mean and whiskers indicate range, y-axis reprepresents Gray for D90 and % for V200/150/100

Mentions: Post-implant CT to calculate dosimetry is recommended for all patients [4, 5] and was performed on 69 (87%) of 79 patients with no difference by caseload. Prescribed and received doses are shown in Figure 1. The data indicate that prescribed dosimetry was superior in terms of prostate coverage and dose homogeneity compared to that actually achieved. Optimal implant is one, in which D90 (dose in Gy covering > 90% of target) > 140 Gy [5], this was prescribed in all cases and 71% received at least this dose, with no difference by caseload. Mean prescribed D90 was greater in lower SBT caseload departments (185 Gy vs. 177 Gy, p < 0.001) with less variation (p = 0.01) and prescribed V150 (% target volume covered by 150% of prescribed dose) was greater in lower SBT departments (62% vs. 56% of prostate, p = 0.01) with less variation (p = 0.01). There was no significant difference by caseload in received D90 and V150 and in prescribed/received V200 and V100.


Prostate brachytherapy in New South Wales: patterns of care study and impact of caseload on treatment quality.

Thompson SR, Delaney GP, Gabriel GS, Izard MA, Hruby G, Jagavkar R, Bucci J, Barton MB - J Contemp Brachytherapy (2014)

Permanent seed brachytherapy. Prescribed and received dose parameters. Column graph indicates mean and whiskers indicate range, y-axis reprepresents Gray for D90 and % for V200/150/100
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300355&req=5

Figure 0001: Permanent seed brachytherapy. Prescribed and received dose parameters. Column graph indicates mean and whiskers indicate range, y-axis reprepresents Gray for D90 and % for V200/150/100
Mentions: Post-implant CT to calculate dosimetry is recommended for all patients [4, 5] and was performed on 69 (87%) of 79 patients with no difference by caseload. Prescribed and received doses are shown in Figure 1. The data indicate that prescribed dosimetry was superior in terms of prostate coverage and dose homogeneity compared to that actually achieved. Optimal implant is one, in which D90 (dose in Gy covering > 90% of target) > 140 Gy [5], this was prescribed in all cases and 71% received at least this dose, with no difference by caseload. Mean prescribed D90 was greater in lower SBT caseload departments (185 Gy vs. 177 Gy, p < 0.001) with less variation (p = 0.01) and prescribed V150 (% target volume covered by 150% of prescribed dose) was greater in lower SBT departments (62% vs. 56% of prostate, p = 0.01) with less variation (p = 0.01). There was no significant difference by caseload in received D90 and V150 and in prescribed/received V200 and V100.

Bottom Line: We performed the first comprehensive, population-based brachytherapy (BT) Patterns of Care Study in the Australian setting.Quality was compared between higher and lower caseload departments.Rates of concordance with quality benchmarks were high (85-99%) with no consistent caseload effect identified.

View Article: PubMed Central - PubMed

Affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, Sydney ; Department of Radiation Oncology, Prince of Wales Hospital, Sydney ; University of New South Wales, Faculty of Medicine, Sydney.

ABSTRACT

Purpose: We performed the first comprehensive, population-based brachytherapy (BT) Patterns of Care Study in the Australian setting. Herein we report on prostate BT and assess the technical quality of BT practice, focusing on whether a caseload effect could be identified in New South Wales (NSW).

Material and methods: Site visits were made to all radiation oncology departments in NSW that delivered prostate BT, collecting relevant data on NSW residents treated with prostate BT in 2003. Overall quality of NSW prostate BT treatment was assessed using benchmarks including treatment of appropriate prostate cancer disease risk category, absence of (relative) physical contraindications, optimal planned and treated dosimetry, and pre-/post-implant planning/CT. Quality was compared between higher and lower caseload departments.

Results: One hundred and fifty-seven (67%) patients underwent temporary BT and 79 (33%) permanent seed BT. Prostate BT was concentrated in five departments, with three of four departments with active programmes treating greater than the recommended 25 cases. Rates of concordance with quality benchmarks were high (85-99%) with no consistent caseload effect identified.

Conclusions: Prostate BT in NSW in 2003 was generally of high quality and a caseload effect on quality could not be identified. This may be because the number of departments was insufficient to determine a caseload effect, or because the prostate BT was largely concentrated in a small number of high caseload departments.

No MeSH data available.


Related in: MedlinePlus