GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer Gyo ¨rgy Kova ´cs a, * , Richard Po ¨tter b , Tillmann Loch c , Josef Hammer d , Inger-Karine Kolkman-Deurloo e , Jean J.M.C.H. de la Rosette f , Hagen Bertermann g a Interdisciplinary Brachytherapy Centre, University Hospital Schleswig-Holstein Campus Kiel, Arnold Heller Str 9, D-24105 Kiel, Germany b University Clinic for Radiotherapy and Radiobiology, Vienna General Hospital, Vienna, Austria c Department of Urology, University of the Saarland, Homburg, Germany d Department of Radiotherapy, Barmherzige Schwestern Hospital and St Vincenc Clinic, Linz, Austria e Division of Clinical Physics, Department of Radiation Oncology, Erasmus MC, Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands f Department of Urology, AMC, Amsterdam, The Netherlands g Department of Urology, City Hospital, Kiel, Germany Received 3 August 2004; accepted 2 September 2004 Available online 22 October 2004 Abstract Background and purpose: The aim of this paper is to present the GEC/ESTRO-EAU recommendations for template and transrectal ultrasound (TRUS) guided transperineal temporary interstitial prostate brachytherapy using a high dose rate iridium-192 stepping source and a remote afterloading technique. Experts in prostate brachytherapy developed these recommendations on behalf of the GEC/ESTRO and of the EAU. The paper has been approved by both GEC/ESTRO steering committee members and EAU committee members. Patients and methods: Interstitial brachytherapy (BT) to organ confined prostate cancer can be applied as a boost treatment in combination with external beam radiation therapy (EBRT) using a proper number of BT fractions in curative intent. Temporary transperineal BT alone or in combination with EBRT are feasible as a palliative/salvage treatment modality because of local recurrence, however, without large clinical experience. The use of temporary BT as a monotherapy is subject of ongoing clinical research. Results: Recommendations for pre-treatment investigations, patient selection, equipment and facilities, the clinical team, the implant procedure (treatment planning and needle implantation) dose and fractionation, reporting, management of side effects and follow-up are given. Conclusions: These recommendations are intended to be technically and advisory in nature, but the ultimate responsibility for the medical decision rests with the treating physician. Although, this paper represents the consensus of an interdisciplinary group of experts, TRUS and template guided temporary transperineal interstitial implants in prostate cancer are a constantly evolving field and the recommendations are subject to modifications as new data become available. q 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Prostate cancer; HDR-brachytherapy; Transrectal ultrasound; Stepping source technology; Afterloading; Recommendations 1. Introduction The proportion of patients treated by brachytherapy is rapidly increasing over the past years, and both permanent seed implants and temporary afterloading techniques play an important role in the treatment of localised prostate cancer [2,6,19,30,56]. To achieve an appropriate quality for permanent seed implants and to synchronise activities in this multidisciplinary field GEC-ESTRO/EAU/EORTC rec- ommendations for permanent implants were previously published [2]. The following recommendations on tempor- ary transperineal prostate brachytherapy, contain a sum- mary of the experience in prostate BT of a small group of brachytherapy experts and urologists on behalf of the GEC/ ESTRO-EAU Prostate Brachytherapy Group (PROBATE); 0167-8140/$ - see front matter q 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.radonc.2004.09.004 Radiotherapy and Oncology 74 (2005) 137–148 www.elsevier.com/locate/radonline * Corresponding author.