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Published on: February 6, 2019
Global practice patterns in prostate brachytherapy: Results from the ENCOMPASS survey
Joel Poder1, Mira Keyes2, Alfonso Gomez Iturriaga3
1St. George Hospital Cancer Care Centre, Kogarah, New South Wales, Australia; School of Physics, University of Sydney, Camperdown, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia; St. George & Sutherland Clinical School, University of New South Wales, Kogarah, New South Wales, Australia.
Purpose:
To characterize global practice patterns in prostate brachytherapy (BT) and evaluate variation in practice, identifying alignment with guidelines and opportunities for harmonization.
Methods And Materials:
A 75-item survey was distributed via international BT societies. One response per institution was requested, completed by a radiation oncologist and medical physicist. Domains included departmental characteristics, BT utilization, prescriptions, imaging, planning, verification, and salvage practices. Data were summarized descriptively.
Results:
A total of 116 institutions responded (64.1%), mainly from North America and Europe. Most had >10 years' experience, though case volumes were modest (11-50 de novo; <10 salvage annually). High-dose-rate (HDR) BT was most used for combination and salvage, while HDR and low-dose-rate BT were evenly used for monotherapy. Prescription regimens were heterogeneous, particularly for HDR monotherapy and salvage. Androgen-deprivation therapy duration varied across risk groups. Transrectal ultrasound was the primary planning modality; only 46% used fused diagnostic imaging for intraprostatic lesion definition. Most used ≤3 mm margins and standard coverage metrics, though organ-at-risk constraints varied. Focal BT use was increasing, particularly in salvage settings.
Conclusions:
Substantial international variability exists across BT practice. While core technical principles are consistent, heterogeneity highlights the need for harmonized guidelines, prospective studies, and global collaboration.
