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

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

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

Journal article

Peer reviewed

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

Nathan A Bockholt, Eric M DeRoo, Kenneth G Nepple, Joseph M Modrick, Mark C Smith, Bernard Fallon, A Curtis Hass, Chad R Tracy and James A Brown

Canadian journal of urology, Vol.20(5), pp.6907-6912

10/2013

PMID: 24128827

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Abstract

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. 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. 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. 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.

Prostatic Neoplasms - radiotherapy

Humans

Middle Aged

Brachytherapy - methods

Kaplan-Meier Estimate

Quality Improvement - standards

Male

Survival Rate

Treatment Outcome

Hospitals, Low-Volume - trends

Prostatic Neoplasms - mortality

Quality Improvement - trends

Quality of Health Care - trends

Aged

Quality of Health Care - standards

Retrospective Studies

Learning Curve

Dose-Response Relationship, Radiation

Cohort Studies

Details

Title: Subtitle: First 100 cases at a low volume prostate brachytherapy institution: learning curve and the importance of continuous quality improvement
Creators: Nathan A Bockholt - University of Iowa, Iowa City, Iowa, USA
Eric M DeRoo
Kenneth G Nepple
Joseph M Modrick
Mark C Smith
Bernard Fallon
A Curtis Hass
Chad R Tracy
James A Brown
Resource Type: Journal article
Publication Details: Canadian journal of urology, Vol.20(5), pp.6907-6912
Publisher: Canada
PMID: 24128827
ISSN: 1195-9479
Language: English
Date published: 10/2013
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Radiation Oncology; Urology
Record Identifier: 9984047756502771

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8 Times Cited - Web of Science