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“Intraoperative Planning and Evaluation of Permanent Prostate Brachytherapy: Report of the American Brachytherapy Society”
Subir Nag, M.D., Jay P Ciezki, M.D., Robert Cormack, Ph.D., Stephen Doggett, M.D., Keith DeWyngaert, Ph.D., Gregory K Edmundson, M.S., Richard G Stock, M.D., Nelson N Stone, M.D., Yan Yu, Ph.D., Michael J Zelefsky, M.D. American Brachytherapy Society Report, December 1st 2001, Volume 51, Number 5
For prostate cancer patients that
undergo preplanned
permanent brachytherapy
where certain limitations arise, intraoperative planning
could become a solution. Intraoperative
planning, as implemented in this study,
is a treatment plan made by a physician in the operating
room. The American Brachytherapy Society (ABS) makes
it their mission to access the current intraoperative
planning process and explore potential improvements
that can be made. In order to gain information they
review existing research literature and their own clinical
practice. After this evaluation the American Brachytherapy
Society defined numerous terms in regards to the prostate
planning process. Preplanning occurs when a physician
constructs a plan a few days or weeks in advance. Intraoperative
planning occurs with immediate execution when the physician
constructs a plan during the procedure or just before
the implant. With the use of computerized dose calculations
derived from an image-based needle position feedback,
interactive planning has the ability to refine treatment
plans. With the use of continuous derived seed position
feedback, dynamic dose calculation maintains a constant
dose update. Doctors in this study discovered that intraoperative
and interactive planning as currently feasible and commercially
available procedures may go beyond the restrictions
of preplanning. During the implant, changes in prostate
size, shape, and seed position cannot yet be determined
based on the currently available technology. At present
one problem that has occurred with intraoperative planning
is the inability to localize seeds in relation to the
prostate. However advancements in these methods are
expected, promising increased success. With further
technologic improvements in methods of enhancing seed
identification, imaging techniques, and source delivery
systems, intraoperative planning has the potential to
overcome these limitations and go beyond preplanned
prostate brachytherapy. Further studies in dosimetry,
toxicity, and efficiency outcomes need to be done to
confirm the advantages of intraoperative planning.
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