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Brachytherapy. 2014 Jan-Feb;13(1):27-31. doi: 10.1016/j.brachy.2013.11.007. Epub 2013 Dec 22.

ACR Appropriateness Criteria high-dose-rate brachytherapy for prostate cancer.

Author information

  • 1Depart of Radiation Oncology, University of California San Francisco, San Francisco, CA. Electronic address: IHsu@radonc.ucsf.edu.
  • 2Memorial Sloan Kettering Cancer Center, New York, NY.
  • 3University of Alabama at Birmingham School of Medicine, American Urological Association, Birmingham, AL.
  • 4Joint Center for Radiation Therapy, American Society of Clinical Oncology, Boston, MA.
  • 5Mayo Clinic, Rochester, MN.
  • 6MD Anderson Cancer Center, Houston, TX.
  • 7Depart of Radiation Oncology, University of California San Francisco, San Francisco, CA.
  • 8William Beaumont Hospital, Troy, MI.
  • 9University of Michigan, Novi, MI.
  • 10Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA.
  • 11Radiological Associates of Sacramento and Sutter Cancer Center, Sacramento, CA.
  • 12Western Radiation Oncology, Mountain View Oncology, Mountain View, CA.
  • 13University of Pennsylvania Medical Center, Philadelphia, PA.
  • 14Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV.



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.


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.


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.


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.

Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.


Appropriateness criteria; Brachytherapy; HDR; Prostate cancer

[PubMed - indexed for MEDLINE]
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