TY - JOUR
T1 - The impact of trainee involvement on outcomes in low-dose-rate brachytherapy for prostate cancer
AU - Shaikh, Talha
AU - Wang, Lora
AU - Ruth, Karen
AU - Hallman, Mark
AU - Chen, David Y.
AU - Greenberg, Richard E.
AU - Li, Jinsheng
AU - Crawford, Kevin
AU - Horwitz, Eric M.
N1 - Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Purpose: 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.
AB - Purpose: 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.
KW - Aged
KW - Brachytherapy/standards
KW - Clinical Clerkship
KW - Clinical Competence
KW - Fellowships and Scholarships
KW - Humans
KW - Internship and Residency
KW - Iodine Radioisotopes/therapeutic use
KW - Male
KW - Middle Aged
KW - Prostate-Specific Antigen/blood
KW - Prostatic Neoplasms/blood
KW - Radiation Dosage
KW - Radiotherapy Dosage
KW - Treatment Outcome
KW - Urethra/radiation effects
UR - http://www.scopus.com/inward/record.url?scp=84960342883&partnerID=8YFLogxK
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=purepublist2023&SrcAuth=WosAPI&KeyUT=WOS:000386867700004&DestLinkType=FullRecord&DestApp=WOS
U2 - 10.1016/j.brachy.2015.12.009
DO - 10.1016/j.brachy.2015.12.009
M3 - Article
C2 - 26832675
SN - 1538-4721
VL - 15
SP - 156
EP - 162
JO - Brachytherapy
JF - Brachytherapy
IS - 2
ER -