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“Radioactive Seed Migration to the Chest After Transperineal Interstitial Prostate Brachytherapy: Extraprostatic Seed Placement Correlates with Migration”
Jeffrey S. Eshleman, M.D., Brian J. Davis, M.D., PH.D., Thomas M. Pisansky, M.D., Torrence M. Wilson, M.D., Michael G. Haddock, M.D., Bernard F. King, M.D., Charles H. Darby, M.S., Wayne N. Lajoie, B.S., and Ann L. Oberg, PH.D. Int. J. Radiation Oncology Biol. Phys., Vol. 59, No. 2, pp. 419425, 2004
Physicians evaluated 102 patients with stage T1 or T2 prostate cancer that underwent brachytherapy between May 1998 and April 2000. Of those patients only 100 fit the criteria necessary for this study. Chest X-rays (CXR) after treatment were studied for the number and location of radioactive seeds. Doctors then analyzed the link between patients, treatment variables, occurrence, and number of seed migrations. The results of the study found that 55% of the 100 patients had one or more seeds identified on the CXR. Out of 12 patients, 135 seeds were implanted, 119 or .98% were discovered on the CXR. In patients where migration occurred, generally 2.2 intrathoracic seeds were found. The amount of extraprostatic seeds planned was 43.9% and after the operation a CT image found 37.9% actually placed in this region. This study has concluded that extraprostatic placement of loose seeds may predict the likelihood and frequency of seed migration to the thorax.
“The Use of Linked Seeds Eliminates Lung Embolization Following Permanent Seed Implantation for Prostate Cancer”
Basher Al-Qaisieh, M.S.C., Brendan Carey, F.R.C.R., Dan Ash, F.R.C.R., and David Bottomley, F.R.C.R. Int. J. Radiation Oncology Biol. Phys., Vol. 59, No. 2, pp. 397-399, 2004
In an effort to reduce the risk of seed migration to the lungs after brachytherapy, physicians studied whether this side effect can be minimized with the use of stranded seeds alone for brachytherapy. Under this clinical trial 238 patients with early prostate cancer were treated between December 2001 and December 2002 with prostate brachytherapy implementing the stranded seed technique. During this procedure all patients had fluoroscopy and immediately following had radiographs of the pelvis. At an average of 55 days a sample of 100 patients had chest radiographs done. To make the seeds more visible, 4 prostate cancer free patients took part in this study. Since they were having routine chest radiographs for management of other cancers they allowed posteroanterior and lateral radiographs to be performed with inactive seeds attached to their thorax. After review it was revealed that in all 238 cases the number of seeds found on the preceding radiograph matched the number of seeds implanted. The results of this study concluded that with the use of stranded seeds for prostate brachytherapy there is no evidence that seeds migrated to the lung.
“Reduction of Radioactive Seed Embolization to the Lung Following Prostate Brachytherapy”
Elizabeth M. Tappen, M.D., John C. Blasko, M.D., Peter D. Grimm, D.O., Haakon Ragde, M.D., Ray Luse, M.S., Stephanie Clifford, John Sylvester, M.D., and Thomas W. Griffin, M.D. Int. J. Radiation Oncology Biol. Phys., Vol. 42, No. 5, pp. 1063-1067, 1998
This study focused on analyzing the incidence and possible negative effects of seed migration following prostate brachytherapy. Between January 1 and December 31, 1995, 290 consecutive patients were treated with brachytherapy for prostate cancer. Of that group, 154 patients received I-125 and 136 patients received Pd-103. With the exception of one, all patients had routine chest radiographs prior to the procedure, thus leaving 289 patients to evaluate. With respect to the entire group 5.9% exhibited a radioactive seed pulmonary rate with no reported acute symptoms. Those who were implanted with free seeds consisted of 146 patients and those with linked seeds embedded in a vicryl suture consisted of 143 patients. For free seed implants, 11% experienced a radioactive seed embolization rate and .7% of linked seed implants experienced the same. This statistic demonstrates that linked seeds embedded in vicryl sutures under this procedure reduced the occurrence of pulmonary seed embolization.
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