Clinical impact of implementing the recommendations of AAPM Task Group 43 on permanent prostate brachytherapy using 125I. American Association of Physicists in Medicine.

Purpose: To determine the clinical impact upon permanent interstitial prostate 125I brachytherapy after conversion to AAPM Task Group 43 (TG 43) guidelines.

Methods: The value of quantities used in the calculation of dose from two institutions, Northwest Tumor Institute (NWTI) and Memorial Sloan-Kettering Cancer Center (MSKCC), which pioneered interstitial techniques for prostate brachytherapy were compared to those recently determined and published by TG 43 of the American Association of Physicists in Medicine (AAPM). Using two different weighting schemes, the change in the commonly prescribed reference dose of 160 Gy was determined and found to be in agreement with that recently suggested. Volumes encompassed by the reference isodose surface were determined from a single source implant and a regularly distributed implant to show the effect of change in reference dose. A comparative analysis on 10 patients was performed to show how this change affected common implant quality descriptors and the effect of changing the calculation formalism without changing the reference dose.

Results: Both weighting schemes suggested a change in reference dose from 160 to 144 Gy. Single-source and distributed-source volumetric analysis confirmed this value. The effect on commonly used conformity and uniformity quantifiers for 10 implant patients was tabulated.

Conclusion: Upon adopting the recommendations suggested by TG 43, institutions that perform permanent 125I prostate implants using calculation methods adapted from the NWTI or MSKCC should revise their treatment prescriptions from 160 to 144 Gy so that the doses delivered to patients remain unaffected. Institutions using other techniques to calculate dose should conduct an analysis similar to the one detailed here.