title: ACR Appropriateness Criteria high-dose-rate brachytherapy for prostate cancer.
abstract: OBJECTIVE
  High-dose-rate (HDR) brachytherapy plays a potential curative role in the treatment of prostate cancer. An expert panel was convened to review the recent literature and reach a consensus on its appropriate clinical applications.
  
  
  METHODS
  The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
  
  
  RESULTS
  A summary of HDR brachytherapy's clinical applications and recent literature review was completed. Three clinical variants were developed to address common HDR dose, fractionations, and indications for its use in definitive therapy for primary and local recurrent prostate cancer. The panel reached a consensus on the specific treatment approaches with numerical rating and commentary.
  
  
  CONCLUSIONS
  In combining available medical literature and expert opinion, this manuscript may serve as an aid for other practitioners in the appropriate application of HDR brachytherapy for prostate cancer.
authors.affiliation: Depart of Radiation Oncology, University of California San Francisco, San Francisco, CA. Electronic address: IHsu@radonc.ucsf.edu.
authors.forename: I-Chow Joe
authors.initials: IC
authors.lastname: Hsu
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: University of Alabama at Birmingham School of Medicine, American Urological Association, Birmingham, AL.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Assimos
authors.affiliation: Joint Center for Radiation Therapy, American Society of Clinical Oncology, Boston, MA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Davis
authors.affiliation: MD Anderson Cancer Center, Houston, TX.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.affiliation: Depart of Radiation Oncology, University of California San Francisco, San Francisco, CA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Gottschalk
authors.affiliation: William Beaumont Hospital, Troy, MI.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Gustafson
authors.affiliation: University of Michigan, Novi, MI.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: McLaughlin
authors.affiliation: Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Radiological Associates of Sacramento and Sutter Cancer Center, Sacramento, CA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Rosenthal
authors.affiliation: Western Radiation Oncology, Mountain View Oncology, Mountain View, CA.
authors.forename: Al V
authors.initials: AV
authors.lastname: Taira
authors.affiliation: University of Pennsylvania Medical Center, Philadelphia, PA.
authors.forename: Neha
authors.initials: N
authors.lastname: Vapiwala
authors.affiliation: Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV.
authors.forename: Gregory
authors.initials: G
authors.lastname: Merrick
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011882:Radiotherapy, High-Energy / Q000379:methods*; D014481:United States
keywords: Appropriateness criteria; Brachytherapy; HDR; Prostate cancer