The impact of trainee involvement on outcomes in low-dose-rate brachytherapy for prostate cancer

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• 作者：Talha Shaikh¹ ; Lora Wang¹ ; Karen Ruth² ; Mark Hallman¹ ; David Y. Chen³ ; Richard E. Greenberg³ ; Jinsheng Li¹ ; Kevin Crawford¹ ; Eric M. Horwitz¹ ; ^{eric.horwitz@fccc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：LDR ; Prostate cancer ; Resident ; Medical student ; Training ; Brachytherapy
• 刊名：Brachytherapy
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：15
• 期：2
• 页码：156-162
• 全文大小：244 K

文摘

To determine the impact of fellow, resident, or medical student (MS) involvement on outcomes in patients undergoing permanent ¹²⁵I prostate seed implant.

Methods and Materials

The study population consisted of men with clinically localized low/intermediate-risk prostate cancer treated with low-dose-rate permanent interstitial brachytherapy. Cases were stratified according to resident, fellow, MS, or attending involvement. Outcomes were compared using analysis of variance, logistic regression, and log rank tests.

Results

A total of 291 patients were evaluated. Fellows, residents, and MS were involved in 47 (16.2%), 231 (79.4%), and 34 (11.7%) cases, respectively. Thirteen (4.4%) cases were completed by an attending physician alone. There was no difference in freedom from biochemical failure when comparing the resident, fellow, or attending alone groups (p = 0.10). There was no difference in V₁₀₀ (volume of the prostate receiving 100% of the prescription dose) outcomes when comparing resident cases to fellow cases (p = 0.72) or attending alone cases (p = 0.78). There was no difference in D₉₀ (minimum dose covering 90% of the postimplant volume) outcomes when comparing resident cases to fellow cases (p = 0.74) or attending alone cases (p = 0.58). When examining treatment toxicity, fellow cases had higher rates of acute Grade 2 + GU toxicity (p = 0.028). With the exception of higher urethra D₉₀ among PGY 2–3 cases (p = 0.02), dosimetric outcomes were similar to cases with PGY 4–5 resident participation. There was no difference in outcomes for cases with and without MS participation.

Conclusions

Interstitial prostate seed implants can be safely performed by trainees with appropriate supervision. Hands-on brachytherapy training is effective and feasible for trainees.