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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 assess 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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