More VA Hospitals Could Suspend Prostate Cancer Treatment

By Katherine McIntire Peters

Nearly six months after a physicist at the Veterans Affairs Medical Center in Philadelphia discovered that a patient being treated for prostate cancer had received lower-than-prescribed radiation doses, inspectors with VA’s National Health Physics Program have found more than 100 similar cases at four facilities.

VA officials have declined repeated requests for information about the department’s brachytherapy programs, in which radioactive seeds are implanted into the prostate. In October, the Nuclear Regulatory Commission, which licenses VA’s radiation programs, announced that the department had suspended treatment at hospitals in Cincinnati; Jackson, Miss., and Washington.

The Philadelphia program was suspended earlier.VA spokeswoman Laurie Tranter said on Oct. 15 that officials would not discuss the program suspensions or any aspect of the investigation until the department issues a press release. VA still had not issued a release by Nov. 3. "It’s not any particular person" delaying the statement, she said. "It’s the process."Nonetheless, reports filed with NRC and recently made public shed some light on the investigation.

VA is required by law to notify the commission whenever it discovers radiation dosing errors that vary by 20 percent or more from the prescribed dose.Reports filed through October show that VA investigators had found 92 cases of improper dosing at the Philadelphia center as of Oct. 2.

Nine cases had been identified at the Jackson Medical Center as of Oct. 30; six cases at the Cincinnati Medical Center as of Oct. 7; and three at the Washington Medical Center as of Sept. 26. NRC records are made public within 30 days of filing.The initial discovery of underdosing at Philadelphia stemmed from a brachytherapy procedure that took place May 5. "Seeds of a lower apparent activity than intended were mistakenly ordered and implanted," according to the initial VA report to NRC on May 16.

As the investigation unfolded, the Philadelphia report was updated as new cases of improper dosing were discovered. The most recent update was Oct. 2, when investigators reported the discovery of an additional 37 patients for whom "medical events" had been identified.

That brought the total number of patients receiving incorrect doses at Philadelphia to 92.According to the report filed with NRC, "35 of the additional medical events involve doses to organs or tissues other than the treatment site." The other two newly identified patients received doses to the treatment site (the prostate) that were below 80 percent of what was prescribed.

None of the reports filed with NRC is considered "emergency events," but NRC has hired an independent consultant to assess the effect of the errors on patients’ health. That assessment is ongoing.Viktoria Mitlyng, a spokeswoman with NRC’s regional office in Lisle, Ill., said the commission is monitoring VA’s investigation of programs at 13 hospitals that perform brachytherapy, including the four whose programs were suspended.

It is possible programs at other hospitals will be suspended, depending on what investigators find there, Mitlyng said."We don’t have a timeline" for the investigation of all 13 hospitals, she said. "We want to make sure it’s done properly."