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Outpatient Brachytherapy
Outpatient Center Offer In-and-Out Treatment for Prostate Cancer Patients

Outpatient Care Technology, June/July 2005
By Laura Thill

The success of high dose rate (HDR) prostate brachytherapy in hospitals has opened new doors for this treatment – namely the doors of outpatient centers looking to offer more options in a patient-friendly environment.

In addition to saving patients time and money, HDR prostate brachytherapy treatment at an outpatient center can be less frightening than a hospital stay, according to Saiyid M. Shah, Ph.D., physicist, Tri-State Prostate Center, also known as the Evansville Cancer Center (Evansville, IN). Shah’s facility began performing HDR prostate brachytherapy about four years ago and presently completes about three or four procedures each week. Prior to adopting this technique, all prostate brachytherapy was performed using I-131 or Pd-103 seeds.

High dose rate brachytherapy has become much more acceptable in hospitals over the past five year, noted Shah. “But, only a few prostate brachytherapy procedures are done in outpatient centers,” he said.

Part of the reason is a reluctance to try new things on the part of outpatient centers, said Shah, whose facility has an active program. Some physicians lack information regarding this treatment on an outpatient basis. “But, we at the Tri-State Prostate Center/Evansville Cancer Center feel it is the best way to go,” he said. Outpatient HDR prostate brachytherapy candidates must have localized (T1, 2N0) disease and be apprised of all other treatment options.

Essentially, HDR prostate brachytherapy procedures at outpatient centers are similar to those performed in hospitals. Flexible or stainless steel interstitial afterloading catheters are placed in the patient’s prostate gland. The needles are directed via a template and grid. After the placement of the catheters, the template is removed. Following this part of treatment, the patient is moved to a CT scanner. A conformal optimized isodose treatment plan is generated and approved by a radiation oncologist, after which the patient is brought to the HDR remote afterloader room for the last leg of treatment. Once the catheters are removed and the patient is in the recovery room, has urinated and been observed thoroughly, he is released to go home.

When prostate brachytherapy is performed in a hospital, the patient sometimes must stay overnight because needles are inserted and treatment is performed every six hours, three or four times. In comparison, the Tri-State Prostate Center/Evansville Cancer Center employs a technique initiated in Germany by Dr. Gyoergy Kovacs at Christian Albrechts University in Kiel, Germany. The patient is treated once and sent home after the needles are removed. A second treatment is given two weeks later. “Patients arrive at [the center] early in the morning and stay until we think they are ready to be released,” said Shah.

The physician’s and patient’s responsibility before and after leaving the outpatient center is not much different than it would be when treatment is done at a hospital. Because brachytherapy is a team effort involving a urologist, radiologist, oncologist, physicist, nurse and anesthesiologist, a specialist is always on hand at the hospital or outpatient center to oversee any potential problem.

“Because of short term urinary or rectal problems with seed implants, patients used to call their urologists with their complaints,” said Shah. “Now, with HDR radiation, they rarely have that need.”

“We would not release a patient if there was [any sign of] a problem,” Shah stated. “And while we never have had to do so, if it were necessary, the attending physician would admit the patient to the hospital.”

Available Tools

As outpatient centers grow to accommodate more specialties, it will become increasingly common to see HDR prostate brachytherapy performed in these settings. “The tools we need are here,” said Shah. True, not every center can run out and purchase a high-end CT scanner or a high dose rate remote afterloader. But, those centers that are properly equipped can successfully and efficiently perform controlled dose distribution, depending on the CT slices, the number of needles used and any restrictions imposed by the radiation oncologist, Shah noted.

“At this point, our data supporting the success of prostate brachytherapy in outpatient centers is qualitative,” according to Shah. “It will take us at least five year to produce quantitative data.”

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