@Article{,
AUTHOR = {Nathan A. Bockholt, Eric M. DeRoo, Kenneth G. Nepple, 
Joseph M. Modrick, Mark C. Smith, Bernard Fallon, 
A. Curtis Hass, Chad R. Tracy, James A. Brown},
TITLE = {First 100 cases at a low volume prostate brachytherapy institution: learning curve and the importance of continuous quality improvement},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {20},
YEAR = {2013},
NUMBER = {5},
PAGES = {6907--6912},
URL = {http://www.techscience.com/CJU/v20n5/61565},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> 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.<br/>

<b>Materials and methods:</b> 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.<br/>

<b>Results:</b> 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.<br/>

<b>Conclusions:</b> 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.},
DOI = {}
}