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First 100 cases at a low volume prostate brachytherapy institution: learning curve and the importance of continuous quality improvement
Bockholt A. Nathan ; DeRoo M. Eric ; Nepple G. Kenneth ; Modrick M. Joseph ; Smith C. Mark ; Fallon Bernard ; Hass Curtis A. ; Tracy R. Chad ; Brown A. James ; University of Iowa, Iowa City, Iowa, USA
Oct 2013 (Vol. 20, Issue 5, Pages( 6907 - 6912)
PMID: 24128827


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  • INTRODUCTION: We report the first 100 patients who underwent prostate brachytherapy as monotherapy with 125I at an institution with moderate volume radical prostatectomy but low volume brachytherapy (<2 cases per month). Learning curve and quality improvement was assessed by way of achieving prescription dose targets. MATERIALS AND METHODS: From May 2002 to August 2006, 100 patients underwent prostate 125I brachytherapy monotherapy via preplanned approach. Preoperative planned dose to 100% of prostate gland (D100) was 145 Gy and postoperative confirmed dose was assessed by computed tomography. The cohort was divided into quartiles and recurrence was assessed using Kaplan-Meier analysis. RESULTS: Patient quartiles were of similar age and Gleason grade, while PSA was slightly higher in the first group. Postoperative D90 increased after the first quartile (p = < 0.0001) reaching targeted values. Kaplan-Meier survival analysis revealed that 5 year recurrence-free survivals by Phoenix definition was 96%-100% in all groups while by ASTRO definition there was a decrease in recurrence for later cases. CONCLUSIONS: At our low volume institution during the first 100 brachytherapy cases, a learning curve for radiation dosimetry was evident, which improved after 25 patients. Preplanned dose-volume parameters were adjusted, enabling the achievement of post-implant goals emphasizing the importance of continuous quality improvement. Although recurrence data is limited by sample size and moderate follow up, there was a discrepancy between the Phoenix and ASTRO definition when evaluating recurrence.

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