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The impact of trainee involvement on outcomes in low-dose-rate brachytherapy for prostate cancer
Brachytherapy. 2016 Jan 29;15(2) :156-62
PMID: 26832675 PMCID: PMC4789160 URL: http://www.ncbi.nlm.nih.gov/pubmed/26832675
AbstractPURPOSE: 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.
NotesShaikh, Talha Wang, Lora Ruth, Karen Hallman, Mark Chen, David Y Greenberg, Richard E Li, Jinsheng Crawford, Kevin Horwitz, Eric M P30 CA006927/CA/NCI NIH HHS/United States Brachytherapy. 2016 Jan 29. pii: S1538-4721(15)00636-4. doi: 10.1016/j.brachy.2015.12.009.