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The Anderson nomograms for permanent interstitial prostate implants: a briefing for practitioners
Gil'ad N Cohen1, Howard I Amols, Michael J Zelefsky
1Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. coheng@mskcc.org
Summary
Anderson nomograms remain useful for predicting total activity and as a backup in permanent prostate implant planning. However, computer optimization provides superior, less variable treatment plans.
Area of Science:
- Medical Physics
- Radiation Oncology
- Urologic Oncology
Background:
- Anderson nomograms are traditionally used for permanent prostate implant treatment planning.
- Current practice shows varied use of nomograms, with some centers using them for ordering seeds but not planning.
- Peripheral seed loading is now common to reduce toxicity, diverging from nomogram design.
Purpose of the Study:
- To re-evaluate the role of Anderson nomograms in permanent prostate implant treatment planning.
- To compare nomogram planning with computer optimization (genetic algorithm) regarding activity prediction, target coverage, and reproducibility.
- To assess the impact of user variability on nomogram-based planning.
Main Methods:
- Comparison of nomogram planning versus genetic algorithm (GA) optimization for total activity prediction (n=20) and target coverage (n=5).
- Retrospective analysis of dosimetry for 61 prostate implants planned with GA (n=27) and Anderson nomograms (n=34).
- Computer optimization system used as the gold standard for comparison.
Main Results:
- Nomogram predictions for total activity closely agreed (within 10%) with GA-planned activity.
- Computer-optimized plans consistently demonstrated superior outcomes in pre- and postimplant analyses.
- User implementation variability significantly impacted nomogram planning, a challenge less prominent in computer optimization.
Conclusions:
- Anderson nomograms are valuable for predicting total activity and serve as a quality assurance tool for computer-generated plans.
- Computer optimization remains the preferred method for permanent prostate implant planning due to superior dose delivery and reduced variability.
- Nomograms offer a dependable backup planning method and are useful for ordering seeds, but generally do not incorporate structures beyond the treatment volume.