title: Impact of experience and technical changes on acute urinary and rectal morbidity in low-dose prostate brachytherapy using loose seeds real-time implantation.
abstract: OBJECTIVE
  To assess the impact of experience and technical changes on morbidity during the first year after permanent prostate brachytherapy.
  
  
  METHODS
  From July 2003 to May 2010, 150 patients with prostate cancer underwent low-dose iodine-125 prostate brachytherapy as a monotherapy by the same medical team (one urologist and one radiation oncologist). Patients were divided into three periods: P1 (n = 64), P2 (n = 45), and P3 (n = 41) according to technical changes: use of an automatic stepper from P2, use of a high-frequency ultrasound probe in P3. Urinary toxicity was analyzed according to the incidence of acute urinary retention (AUR), Delta International Prostate Symptom Score (Δ IPSS) defined as IPPS maximal - IPSS at baseline, and proportion of patients with Δ IPSS ≥5 and IPSS total >15. The Radiation Therapy Oncology Group classification was used to evaluate the rectal morbidity.
  
  
  RESULTS
  The incidence of AUR (6% overall) decreased significantly with time: 12.5% (8/64) during P1, 2.2% (1/45) in P2, and 0% in P3 (p = 0.014). Mean Δ IPSS (11.6) remained stable during the three periods. Patients with Δ IPSS ≥5 and IPSS total >15 were 58.7%, 58.1%, and 56.1% for P1, P2, and P3 (p = 0.96), respectively. Grade 1 and 2 proctitis were observed in 15.3% and 9.3% of the patients without any significant difference between the three periods.
  
  
  CONCLUSIONS
  The incidence of AUR decreased significantly with time. This was probably because of the experience of the practitioner and the use of an automatic stepper that allowed reducing prostatic traumatism. Experience and technical changes did not seem to affect rectal morbidity.
authors.affiliation: Radiation Therapy Department, Centre Hospitalier Universitaire Morvan, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; Inserm U650, Laboratoire de Traitement de l'Information Médicale, Brest, France. Electronic address: emmanuelle.lefur@chu-brest.fr.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Le Fur
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Malhaire
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nowak
authors.forename: Benoit
authors.initials: B
authors.lastname: Rousseau
authors.forename: Antoine
authors.initials: A
authors.lastname: Erauso
authors.forename: Dominique
authors.initials: D
authors.lastname: Pene-Baverez
authors.forename: Grégory
authors.initials: G
authors.lastname: Papin
authors.forename: Francky
authors.initials: F
authors.lastname: Delage
authors.forename: Marie-Aimée
authors.initials: MA
authors.lastname: Perrouin-Verbe
authors.forename: Georges
authors.initials: G
authors.lastname: Fournier
authors.forename: Olivier
authors.initials: O
authors.lastname: Pradier
authors.forename: Antoine
authors.initials: A
authors.lastname: Valeri
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000295:instrumentation*; D003248:Constipation / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D003672:Defecation; D004307:Dose-Response Relationship, Radiation; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007457:Iodine Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011829:Radiation Dosage; D012007:Rectum / Q000503:physiopathology / Q000528:radiation effects*; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000503:physiopathology / Q000528:radiation effects*; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014554:Urination; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes
keywords: Brachytherapy; Learning curve; Morbidity; Prostate cancer