title: The impact of trainee involvement on outcomes in low-dose-rate brachytherapy for prostate cancer.
abstract: OBJECTIVE
  To determine the impact of fellow, resident, or medical student (MS) involvement on outcomes in patients undergoing permanent (125)I prostate seed implant.
  
  
  METHODS
  The study population consisted of men with clinically localized low/intermediate-risk prostate cancer treated with low-dose-rate permanent interstitial brachytherapy. Cases were stratified according to resident, fellow, MS, or attending involvement. Outcomes were compared using analysis of variance, logistic regression, and log rank tests.
  
  
  RESULTS
  A total of 291 patients were evaluated. Fellows, residents, and MS were involved in 47 (16.2%), 231 (79.4%), and 34 (11.7%) cases, respectively. Thirteen (4.4%) cases were completed by an attending physician alone. There was no difference in freedom from biochemical failure when comparing the resident, fellow, or attending alone groups (p = 0.10). There was no difference in V100 (volume of the prostate receiving 100% of the prescription dose) outcomes when comparing resident cases to fellow cases (p = 0.72) or attending alone cases (p = 0.78). There was no difference in D90 (minimum dose covering 90% of the postimplant volume) outcomes when comparing resident cases to fellow cases (p = 0.74) or attending alone cases (p = 0.58). When examining treatment toxicity, fellow cases had higher rates of acute Grade 2 + GU toxicity (p = 0.028). With the exception of higher urethra D90 among PGY 2-3 cases (p = 0.02), dosimetric outcomes were similar to cases with PGY 4-5 resident participation. There was no difference in outcomes for cases with and without MS participation.
  
  
  CONCLUSIONS
  Interstitial prostate seed implants can be safely performed by trainees with appropriate supervision. Hands-on brachytherapy training is effective and feasible for trainees.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Talha
authors.initials: T
authors.lastname: Shaikh
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Lora
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Karen
authors.initials: K
authors.lastname: Ruth
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Mark
authors.initials: M
authors.lastname: Hallman
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Chen
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Greenberg
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Jinsheng
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Crawford
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA. Electronic address: eric.horwitz@fccc.edu.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horwitz
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000592:standards*; D002982:Clinical Clerkship; D002983:Clinical Competence; D005257:Fellowships and Scholarships; D006801:Humans; D007396:Internship and Residency; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D014521:Urethra / Q000528:radiation effects
chemical_list: D007457:Iodine Radioisotopes; D017430:Prostate-Specific Antigen
keywords: Brachytherapy; LDR; Medical student; Prostate cancer; Resident; Training
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