SP-0024: GEC-ESTRO guidelines for target definition in breast brachytherapy

Abstract

GEC ESTRO first published guidelines for HDR prostate brachytherapy in 2005. Since then there has been a considerable expansion in knowledge and use of the technique as a result of which an update has now been produced by the UROGEC group of GEC ESTRO, published in Radiotherapy and Oncology. These are evidence-based consensus guidelines from the group resulting from rigorous appraisal of the literature and discussions between experienced practitioners in this area. Recommendations for patient selection, treatment facility, implant technique, dose prescription and dosimetry reporting are given. The indications for HDRBT in dose escalation schedules with external beam are wide ranging with all patients having localized disease eligible for this technique.Exclusion criteria are few encompassing patients medically unfit for the procedure and those with significant urinary outflow symptoms. It is recognised that both single step ultrasound based and two step CT or MR-based technique scan be used. There remain areas of uncertainty in prostate HDR brachytherapy reflected in the guidelines. These include the optimal dose prescription, organ at risk constraints, PTV definition, evaluation of implant quality and the role of HDR monotherapy and salvage in prostate cancer. The use of these guidelines will ensure that HDR brachytherapy in prostate cancer can be practiced effectively and safely. The main indication at present is dose escalation with external beam but in the future HDR monotherapy, focal therapy and treatment of recurrence will be important areas of development.