Open Access

ARTICLE

First 100 cases at a low volume prostate brachytherapy institution: learning curve and the importance of continuous quality improvement

Nathan A. Bockholt¹, Eric M. DeRoo¹, Kenneth G. Nepple¹, Joseph M. Modrick², Mark C. Smith², Bernard Fallon¹, A. Curtis Hass², Chad R. Tracy¹, James A. Brown¹

1 Department of Urology, University of Iowa, Iowa City, Iowa, USA
2 Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
Address correspondence to Dr. James A. Brown, Department of Urology, University of Iowa, 200 Hawkins Drive, 3 RCP, Iowa City, IA52242-1089 USA

Canadian Journal of Urology 2013, 20(5), 6907-6912.

Abstract

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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