Brachytherapy guidance and guidelines
This section provides a series of links to key documents giving guidance or guidelines relating to the use of brachytherapy for prostate cancer.
- BUG/BAUS/BPG
- National Comprehensive Cancer Network
- Department of Health
- National Institute for Health and Clinical Excellence
- American Brachytherapy Society
- ESTRO/EAU/EORTC
- American Urological Association
BUG/BAUS/BPG: MDT (Multi-disciplinary Team) Guidance for Managing Prostate Cancer, November 2009.
The concept of integrated care is becoming increasingly accepted as a way to overcome fragmentation of patient management and to provide a consistent treatment strategy across the MDT. By being familiar with the complete spectrum of management strategies, the MDT can assist patients in making treatment decisions that are specific for their individual disease states, co-morbid conditions, age and lifestyle.
Three British organisations – the British Uro-oncology Group (BUG), British Association of Urological Surgeons (BAUS) and the British Prostate Group (BPG), have collaborated to produce a comprehensive guidance document for MDTs managing patients with prostate cancer in the UK. Click here for your copy.
NCCN Clinical Practice Guidelines in OncologyTM: Prostate Cancer, 2010
The National Comprehensive Cancer Network® (NCCN) guidelines are frequently updated, based on an explicit review of the evidence integrated with expert medical judgement by multi-disciplinary panels. Each NCCN Guideline consists of an algorithm or decision pathway outlining care management, a manuscript discussing important issues related to the algorithm, and references providing data on which recommendations are based
Link to NCCN website
Department of Health
The links below will take you to the Department of Health (DH) document Advice on the Development of Low Dose Rate (Permanent Seed Implant) Brachytherapy Services for Localised Prostate Cancer in England (Gateway Reference 7385, November 2006).
Link to Dept of Health website
DH Gateway Ref 7385The DH advice states that brachytherapy services should take place at one of the 51 existing radiotherapy centres. Key recommendations are given in the framework within which brachytherapy services should be provided (e.g. numbers of procedures done by individual clinicians and by centres, audit arrangements, etc). Of the 51 radiotherapy centres in the UK, approximately 22 offered brachytherapy services in 2005 (Figure 2).
In order to meet recommendations and service levels outlined by the DH, commissioners of care have the following options:
- to support the development of brachytherapy services and provision of care at radiotherapy centres not currently offering this service (costs associated with this are outlined in the DH report).
- to provide support to the 20+ centres that are currently offering brachytherapy, to improve their expertise/provision of BT services
- to discourage unrestricted growth in the number of centres offering brachytherapy, but focus instead on the quality of treatment where most of the expertise is currently found (i.e. those centres undertaking more than 25 procedures per year).
The DH advice also highlights the importance of planning for the level of brachytherapy services that is likely to be needed in 5 years' time, which might be 4000 procedures per year. This would mean centres should be achieving a minimum level of 50 procedures per year at that time.
In order to best implement the DH advice and meet future service levels, the Prostate Brachytherapy Advisory Group recommends that it would be most effective to concentrate efforts on/and commission services from the restricted number of centres that are already up and running and undertaking 25+ procedures per year, and to develop the highest-quality services in these centres. See Section 2.4 UK brachytherapy centres for detailed information and data from each centre.
National Institute for Health and Clinical Excellence
The NICE guideline on the diagnosis and treatment of prostate cancer (ref CG58) was published on 27th February 2008. LDR brachytherapy is positively positioned alongside prostatectomy and external beam radiotherapy as one of the proven, radical treatment options for men with low- or intermediate-risk disease. Follow this link to the NICE website to access the full guidance, and other information for healthcare professionals, patients, carers and the public:
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11924
American Brachytherapy Society (ABS) Recommendations for Transperineal Permanent Brachytherapy of Prostate Cancer (1999)
Guidelines for appropriate patient selection, dose reporting, and improved quality of permanent prostate brachytherapy are presented. These broad recommendations are intended to be technical and advisory in nature, but the ultimate responsibility for the medical decisions rests with the treating physician. This is a constantly evolving field, and the recommendations are subject to modifications as new data become available.
ESTRO/EAU/EORTC Recommendations on Permanent Seed Implantation for Localised Prostate Cancer (2000)
In 2000 ESTRO,in association with the EAU and the EORTC, issued Recommendations on Permanent Seed Implantation for Localised Prostate Cancer. This guidance was intended for those embarking on brachytherapy to identify the factors related to successful outcome.
Tumour and target volumes in permanent prostate brachytherapy: a supplement to the ESTRO/EAU/EORTC recommendations on prostate brachytherapy (2007)
Recently a supplementary paper has been published which focuses on the target (prostate gland) or organ (prostatic urethra, rectum) at risk, contouring, target definition, dosimetric parameters regarding target dosimetry and dosimetric parameters regarding organs at risk.
American Urological Association. Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update
This reports the results of a 5 ½-year effort to update the 1995 AUA Guideline. The online version of the Guideline can be accessed at http://www.auanet.org/guidelines/ It contains appendices that include additional documents used in the conduct of the analysis and the graphics detailing the Panel's findings. The 2007 report was reviewed and re-validated in 2009.