Control charts for evaluation of quality of low-dose-rate brachytherapy for prostate cancer

被引:3
作者
Nasser, Nicola J. [1 ]
Saibishkumar, Elantholi P. [2 ]
Wang, Yinkun [3 ]
Chung, Peter W. M. [4 ]
Breen, Stephen L. [5 ]
机构
[1] NYC Hlth Hosp, Elmhurst Hosp Ctr, Dept Radiat Oncol, Queens, NY 11432 USA
[2] British Columbia Canc Agcy, Victoria, BC, Canada
[3] Princess Margaret Canc Ctr, Dept Radiat Phys, Radiat Med Program, Toronto, ON, Canada
[4] Princess Margaret Canc Ctr, Dept Radiat Oncol, Radiat Med Program, Toronto, ON, Canada
[5] Sunnybrook Hlth Sci Ctr, Odette Canc Ctr, Toronto, ON, Canada
关键词
statistical process control; brachytherapy; prostate; quality control; dosimetry; RADIATION-THERAPY; AMERICAN-BRACHYTHERAPY; I-125; SEEDS; INTERMEDIATE; RISK; DOSIMETRY; VOLUME;
D O I
10.5114/jcb.2022.119513
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: Variations in dosimetric outcomes among patients treated with low-dose-rate brachytherapy for prostate cancer exist, even when implants are within dose constraints. Here, we used control charts to investigate reasons for intra-patient dosimetric variability. Material and methods: Univariate and multivariate control charts for prostate V-100 (percentage of prostate volume that received 100% of prescribed radiation dose), D-90 (radiation dose to 90% of prostate volume), and RV100 (rectal wall volume that received 100% of prescribed radiation dose) were generated for 212 consecutive prostate cancer patients implanted with iodine-125 (I-125) radioactive seeds at the Princess Margaret Cancer Centre. Control limits were calculated based on the first fifty implants. Data points that were out of control were identified, and their pre-treatment and post-treatment dosimetric and clinical parameters were compared to data points that were in-control, using Student's t-test. Results: All implants were clinically acceptable. Twelve data points exceeded multivariate control limits. Ten of those points fell below the lower control limit of V-100 control chart. Average prostate edema in the 10 out-of-control patients on both multivariate and V(100 )charts was 8.3%, as compared to 0.4% for in-control patients (p < 0.04). Two patients were observed to be out-of-control on multivariate control chart, but not on V-100 control chart, and were found to have a reduction in prostate volume of 19.1% and 20.1% at one month after seed implant, compared to prostate volumes of pre-implantation evaluations. Conclusions: Control charts helped in identifying cases with out-of-control variability in post-plan prostate dosimetry. Post-treatment prostatic edema and contraction are important factors predicting variability in patients treated with I-125 permanent seed brachytherapy.
引用
收藏
页码:354 / 363
页数:10
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