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Jiang H, Li A, Ke K, Wu Z, Huang J, Huang N, Shen Q, Ji Z, Yang W, Lin J. Three-dimensional treatment-planning-based prediction of seed migration to chest after 125I seed brachytherapy for hepatic malignancy. Brachytherapy 2024:S1538-4721(24)00007-2. [PMID: 38811274 DOI: 10.1016/j.brachy.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/12/2023] [Accepted: 01/05/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To develop and validate risk models incorporating clinical and/or imaging parameters based on three-dimensional treatment-planning systems (3D-TPS) to predict the occurrence of 125I seed migration and the number of migrated seeds <2/≥2 to the chest after brachytherapy for patients with malignant hepatic tumors. METHODS AND MATERIALS A total of 480 patients diagnosed with malignant liver tumors receiving 125I seed brachytherapy from July 2010 to May 2020 were retrospectively enrolled. Variables included 3D-TPS-based CT parameters, that is, the distance from the seed to the inferior vena cava (DSI), the distance from the seed to the second hepatic portal (DSP) and the angle from the seed to the second hepatic portal (ASP), and patients' clinical characteristics, that is, the number of seed implantation procedures (NSP), the maximum number of implanted seeds one time (MAX) and laboratory parameters within 1 week before treatment. Two sets of logistic regression models incorporating clinical and/or imaging variables were developed to predict the occurrence of seed migration and the number of migrated seeds <2/≥2. Model performance was assessed by ROC analysis and decision curve analysis. RESULTS Compared with the clinical models, the combined model showed a higher discriminative ability for both the prediction of migration occurrence and number of migrated seeds ≥ 2/<2 to the chest (AUC, 0.879 vs. 0.668, p < 0.05; 0.895 vs. 0.701, p < 0.05). The decision curve analysis results indicated higher net benefits of combined models than clinical models. Variables, including DSI, NSP and pretreatment lymphocyte-to-neutrophil ratio, acted as the most important predictors in combined models. CONCLUSIONS The proposed combined models based on 3D-TPS improved discriminative abilities for predicting 125I seed migration and number of migrated seeds <2/≥2 to the chest after hepatic brachytherapy, being promising to aid clinical decision-making.
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Affiliation(s)
- Han Jiang
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Ang Li
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Kun Ke
- Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Zhengzhong Wu
- Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Jingyao Huang
- Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Ning Huang
- Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Quan Shen
- Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Zhongyou Ji
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Weizhu Yang
- Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies)
| | - Junqing Lin
- Department of Interventional Radiology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University); Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies).
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Zhang M, Liu G, He X, Chu C. Dosimetric evaluation of iodine-125 brachytherapy for brain tumors using MR guidance combined with a three-dimensional non co-planar template. Brachytherapy 2023; 22:242-249. [PMID: 36628801 DOI: 10.1016/j.brachy.2022.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/13/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the consistency between preoperative and postoperative dosimetry when 125I brachytherapy for brain tumors is performed with magnetic resonance (MR) guidance and a three-dimensional non co-planar template (3DNPT). METHODS AND MATERIALS Thirty patients with brain tumors (metastatic or gliomas) underwent radioactive 125I seed implantation. A preoperative treatment plan was determined with MR imaging, and the operation was done under 3DNPT assistance and MR guidance. The dosimetry was verified postoperatively based on postoperative CT-MR fusion images. Postoperative dosimetric parameters and implant quality indices were defined and compared with those in the preoperative treatment plan. Furthermore, a comparison of preoperative and postoperative doses to normal brain tissues and organs at risk was also performed. RESULTS All mean postoperative dosimetries were calculated. Target coverage parameters D90, D100, %CTV100, %CTV150, and %CTV200 were 143.6 cGy, 76.6 cGy, 88.2%, 63.1%, and 41.4%, respectively. The values of implant quality indices CI, EI, and HI were 0.75, 0.14, and 0.28, respectively. No significant differences between most preoperative and postoperative dosimetric parameters were found (p > 0.05). The differences were also insignificant for organs at risk. Postoperative %CTV150 and %CTV200 were higher than the preoperative, whereas postoperative HI was significantly lower than in the treatment plan. CONCLUSIONS Magnetic resonance guidance combined with 3DNPT allows accurate positioning and direction in 125I brachytherapy for brain tumors. However, seed distribution and dose homogeneity require further improvement.
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Affiliation(s)
- Menglong Zhang
- Department of Minimally Invasive Intervention, Ganzhou People's Hospital, Ganzhou, Jiangxi, China.
| | - Guitao Liu
- Department of Respiratory and Critical Care Medicine, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiangmeng He
- Department of Interventional MRI, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Cunkun Chu
- Library, Shandong First Med Univ & Shandong Acad Med Sci, Tai'an, Shandong, China
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Wei G, Jiang P, Li C, Wei S, Jiang Y, Sun H, Wang J. A review on permanent implants for prostate brachytherapy with comparison between stranded and loose seeds. Jpn J Radiol 2021; 40:135-146. [PMID: 34480718 DOI: 10.1007/s11604-021-01189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
A systematic literature review to validate the conclusions with regard to stranded seeds versus loose seeds. Published data for this review were identified by searching the PubMed databases. PD90, PV100, PV150, UD30, and RV100 acquired during the perioperative period and the postoperative period were analyzed by meta-analysis. Based on these studies, in addition to the reduction of migration and displacement, stranded seeds had some dosimetric advantages, especially in dose homogeneity and coverage of target area due to its connection characteristics. We also noticed implanted seeds usually excessive both in stranded seeds group and loose seed group. Intraoperatively built custom links will prolong operation time, with the proficiency of technology, the prolonged time gradually decreases.
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Affiliation(s)
- Guangchao Wei
- Institute of Medical Technology, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, 100191, Beijing, People's Republic of China.,Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Chunxiao Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Shuhua Wei
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China.
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Bhagavatula S, Thompson D, Dominas C, Haider I, Jonas O. Self-Expanding Anchors for Stabilizing Percutaneously Implanted Microdevices in Biological Tissues. MICROMACHINES 2021; 12:mi12040404. [PMID: 33917289 PMCID: PMC8067345 DOI: 10.3390/mi12040404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
Percutaneously implanted miniaturized devices such as fiducial markers, miniaturized sensors, and drug delivery devices have an important and expanding role in diagnosing and treating a variety of diseases. However, there is a need to develop and evaluate anchoring methods to ensure that these microdevices remain secure without dislodgement, as even minimal migration within tissues could result in loss of microdevice functionality or clinical complications. Here we describe two anchoring methods made from biocompatible materials: (1) a self-expanding nitinol mesh anchor and (2) self-expanding hydrogel particles contained within pliable netting. We integrate these anchors into existing drug-screening microdevices and experimentally measure forces required to dislodge them from varying tissues. We report similar dislodgement forces of 738 ± 37, 707 ± 40, 688 ± 29, and 520 ± 28 mN for nitinol-anchored microdevices, and 735 ± 98, 702 ± 46, 457 ± 47, and 459 ± 39 mN for hydrogel-anchored microdevices in liver, kidney, fat, and muscle tissues, respectively—significantly higher compared with 13 ± 2, 15 ± 3, 15 ± 2, and 15 ± 3 mN for non-anchored microdevices (p < 0.001 in all tissues). The anchoring methods increased resistance to dislodgement by a factor of 30–50× in all tissues, did not increase the required needle gauge for insertion, and were compatible with percutaneous implantation and removal. These results indicate that anchoring significantly improves microdevice stability and should reduce migration risk in a variety of biological tissues.
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O'Sullivan B, Tanner R, Kelly P, Fahy G. Peritricuspid annular prostate pellet. BMJ Case Rep 2021; 14:14/2/e238076. [PMID: 33574044 PMCID: PMC7880090 DOI: 10.1136/bcr-2020-238076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 75-year-old was treated for prostate adenocarcinoma with brachytherapy in September 2018. A routine follow-up chest radiograph 3 months later revealed a metallic object of the same dimensions as a brachytherapy pellet located in the right ventricle. Further imaging showed the brachtherapy pellet was located in the anterobasal right ventricular endocardium close to the tricuspid valve. Frequent asymptomatic premature ventricular contractions were observed with likely origin from the left ventricular outflow tract, an area remote from the site of the pellet. The patient remains asymptomatic and subsequent imaging shows that the position of the pellet has not changed.
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Affiliation(s)
- Bryan O'Sullivan
- Cardiology Department, Cork University Hospital Group, Cork, Ireland
| | - Richard Tanner
- Cardiology Department, Cork University Hospital Group, Cork, Ireland
| | - Peter Kelly
- Cardiology Department, Cork University Hospital Group, Cork, Ireland
| | - Gerard Fahy
- Cardiology Department, Cork University Hospital Group, Cork, Ireland
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Low dose rate permanent seed brachytherapy: tracing its evolution and current status. PRECISION RADIATION ONCOLOGY 2020. [DOI: 10.1002/pro6.1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Yuan D, Gao Z, Zhao J, Zhang H, Wang J. 125I seed implantation for hepatocellular carcinoma with portal vein tumor thrombus: A systematic review and meta-analysis. Brachytherapy 2019; 18:521-529. [DOI: 10.1016/j.brachy.2019.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/08/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023]
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Merrell KW, Davis BJ, Goulet CC, Furutani KM, Mynderse LA, Harmsen WS, Wilson TM, McLaren RH, Deufel CL, Birckhead BJ, Funk RK, McMenomy BP, Stish BJ, Choo CR. Reducing seed migration to near zero with stranded-seed implants: Comparison of seed migration rates to the chest in 1000 permanent prostate brachytherapy patients undergoing implants with loose or stranded seeds. Brachytherapy 2019; 18:306-312. [PMID: 30853392 DOI: 10.1016/j.brachy.2019.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Pulmonary seed emboli to the chest may occur after permanent prostate brachytherapy (PPB). The purpose of this study is to analyze factors associated with seed migration to the chest in a large series of PPB patients from a single institution undergoing implant with either loose seeds (LS), mixed loose and stranded seeds (MS), or exclusively stranded seeds in an absorbable vicryl suture (VS). METHODS AND MATERIALS Between May 1998 and July 2015, a total of 1000 consecutive PPB patients with postoperative diagnostic chest x-rays at 4 months after implant were analyzed for seed migration. Patients were grouped based on seed implant technique: LS = 391 (39.1%), MS = 43 (4.3%), or VS = 566 (56.6%). Univariate and multivariate analysis were performed using Cox proportional hazards regression models to determine predictors of seed migration. RESULTS Overall, 18.8% of patients experienced seed migration to the chest. The incidence of seed migration per patient was 45.5%, 11.6%, and 0.9% (p < 0.0001), for patients receiving LS, MS, or VS PPB, respectively. The right and left lower lobes were the most frequent sites of pulmonary seed migration. On multivariable analysis, planimetry volume (p = 0.0002; HR = 0.7 per 10 cc [0.6-0.8]), number of seeds implanted (p < 0.0001, HR = 2.4 per 25 seeds [1.7-3.4]), LS implant (p < 0.0001, HR = 15.9 [5.9-42.1]), and MS implant (p = 0.001, HR = 7.9 [2.3-28.1]) were associated with seed migration to the chest. CONCLUSIONS In this large series, significantly higher rates of seed migration to the chest are observed in implants using any LS with observed hazard ratios of 15.9 and 7.9 for LS and MS respectively, as compared with implants using solely stranded seeds.
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Affiliation(s)
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
| | | | | | | | - W Scott Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | | | | | - Brandon J Birckhead
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Ryan K Funk
- Department of Radiation Oncology, Minnesota Oncology, Minneapolis, MN
| | | | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - C Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Plan reproducibility of intraoperatively custom-built linked seeds compared to loose seeds for prostate brachytherapy. J Contemp Brachytherapy 2018; 10:291-296. [PMID: 30237812 PMCID: PMC6142649 DOI: 10.5114/jcb.2018.77948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 08/22/2018] [Indexed: 12/14/2022] Open
Abstract
Purpose Few studies have compared the implant quality of linked and loose seeds for prostate brachytherapy. This study aimed to evaluate and compare plan reproducibility of intraoperatively built custom linked seeds and loose seeds for prostate brachytherapy. Material and methods Between December 2010 and March 2014, 76 localized prostate cancer patients received Iodine-125 brachytherapy with external beam radiotherapy. Linked and loose seeds were implanted in 39 and 37 patients, respectively. The primary endpoint was the mean (± standard deviation) of the absolute change in the minimum dose received by 90% of the prostate volume between intraoperative and post-operative planning (ΔD90) to confirm plan reproducibility. Comparisons between the groups were evaluated using 2-sample t tests. Results The ΔD90 values were 6.95 ± 11.6% and –0.41 ± 8.5% for the loose and linked seed groups, respectively (p < 0.01). The linked seed group showed decreased post-operative D90 (118.8% vs. 127.2%), V150 (51.7% vs. 66.7%), and RV100 (0.44 ml vs. 0.61 ml) compared to the loose seed group (p < 0.01), whereas lung migration tended to be reduced (0% vs. 8%). Conclusions The plan reproducibility of the linked seed group was better than that of the loose seed group. Moreover, the linked seed group showed less migration and lower rectal dose.
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McCabe BE, Veselis CA, Goykhman I, Hochhold J, Eisenberg D, Son H. Beyond Pulmonary Embolism; Nonthrombotic Pulmonary Embolism as Diagnostic Challenges. Curr Probl Diagn Radiol 2018; 48:387-392. [PMID: 30232041 DOI: 10.1067/j.cpradiol.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022]
Abstract
Nonthrombotic pulmonary embolism (NTPE) is less well understood and is encountered less frequently than pulmonary embolism from venous thrombosis. NTPE results from embolization of nonthrombotic material to the pulmonary vasculature originating from many different cell types as well as nonbiologic or foreign materials. For many radiologists NTPE is a challenging diagnosis, presenting nonspecific or unusual imaging findings in the setting of few or unusual clinical signs. The aim of this paper is to review the pathophysiology of diverse causes of NTPE, which should aid radiologists to better understand and, more importantly, diagnose these infrequent events.
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Affiliation(s)
| | - Clinton A Veselis
- Temple University Hospital, Department of Radiology, Philadelphia, PA.
| | - Igor Goykhman
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - John Hochhold
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - Daniel Eisenberg
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - Hongju Son
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
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Warrell GR, Xing Y, Podder TK, Traughber BJ, Ellis RJ. Reduction of seed motion using a bio-absorbable polymer coating during permanent prostate brachytherapy using a mick applicator technique. J Appl Clin Med Phys 2018; 19:44-51. [PMID: 29667307 PMCID: PMC5978941 DOI: 10.1002/acm2.12254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The addition of a braided bio-absorbable vicryl coating to the surface of radioactive seeds used for low dose rate (LDR) prostate brachytherapy is intended to reduce the incidence of seed movement and migration. Here, we present a single-institution study of the frequency and severity of seed slippage (initial seed movement) of coated seeds in comparison with uncoated seeds. METHODS Forty-seven patients received permanent prostate brachytherapy, with either coated (n = 26) or uncoated (n = 21) seeds. AgX100 125 I seeds, coated or uncoated, and uncoated Model 200 103 Pd seeds were used. During the ultrasound-guided implantation procedure, each implanted seed was categorized as having remained in the implanted position after being placed, having moved slightly, or having left the ultrasound field of view. RESULTS 3.1% of the coated seeds (AgX100 seeds, n = 70) and 6.9% of the uncoated seeds (AgX100 and Model 200 seeds, n = 128) were observed to have moved at least 2 mm from their initial implant positions, respectively. The difference in incidence of this movement was 54.4% (P = 0.0026). Coated AgX100 seeds demonstrated a 66.7% lower rate of movement of at least 2 mm than that for uncoated AgX100 seeds (P = 0.038), and a 49.0% lower rate than that for Model 200 seeds (P = 0.021). While no significant differences were noted in prescription dose coverage of the prostate or the studied dosimetric parameters for the organs at risk between the coated and uncoated seeds (P > 0.05) in the CT-based Day-0 postoperative plans, the limited sample size and differences in energies between the 125 I and 103 Pd seeds make further analysis of postoperative dosimetric coverage difficult without additional data directly comparing the coated and uncoated 125 I seeds. CONCLUSION When the vicryl coating is used, seeds have a significantly lower propensity to slip from their initial implant locations. This may help maintain dosimetric integrity, warranting further study of postoperative dosimetry.
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Affiliation(s)
- Gregory R. Warrell
- Department of Radiation OncologyUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
| | - Yan Xing
- Case Western Reserve UniversityClevelandOHUSA
| | - Tarun K. Podder
- Department of Radiation OncologyUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
| | - Bryan J. Traughber
- Department of Radiation OncologyUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
| | - Rodney J. Ellis
- Department of Radiation OncologyUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
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Lee H, Sheuka N, El-Kadi O, Murray BP, Fisher HA, Kallakury BVS, Lee EC, Boguniewicz A, Jennings TA. Rectal ulcer and pseudomalignant epithelial changes after prostate seed brachytherapy: A rare complication with a diagnostic pitfall. Ann Diagn Pathol 2018; 34:131-134. [PMID: 29661719 DOI: 10.1016/j.anndiagpath.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/13/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Implant brachytherapy (IBT) is a well-recognized treatment modality for early stage prostate cancer. Rectal ulcer and rectourethral fistula complicating IBT may cause an alteration of the normal anatomic landmarks. In this context, pseudomalignant radiation-induced changes within prostatic epithelium may be misinterpreted as a primary rectal malignancy. Such challenging and misleading findings have not been described, and may not be recognized as such. MATERIALS AND METHODS We present the clinical and pathologic aspects of two patients who underwent IBT for low stage prostate cancer that was complicated by deep rectal ulcer. Both patients underwent extensive palliative surgical resection for disease control. RESULTS The histologic changes in both cases were noteworthy for extensive necrosis and inflammation of the prostate, associated with loss of recto-prostatic anatomical landmarks. Prostatic glands showed striking radiation-induced atypia and pseudomalignant epithelial changes extending to the rectal ulcer bed, with no residual viable tumor. The first patient had undergone a biopsy of the rectal ulcer bed that was misinterpreted as a rectal adenocarcinoma prior to surgery. The similarity between atypical glands of the biopsy and the benign prostatic tissue with radiation-induced atypia in resection specimen confirmed their benign nature. CONCLUSIONS Deep rectal ulcer complicating IBT may lead to distortion of the normal recto-prostatic anatomical landmarks, resulting in detection of pseudo-malignant prostatic glands at the ulcer base. Such findings may be mistaken for a primary rectal malignancy in limited biopsy material if not familiar to the pathologist.
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Affiliation(s)
- Hwajeong Lee
- Anatomic Pathology, Albany Medical College, Albany, NY, USA.
| | - Natallia Sheuka
- Anatomic Pathology, Albany Medical College, Albany, NY, USA.
| | - Osama El-Kadi
- Anatomic Pathology, Albany Medical College, Albany, NY, USA
| | - Brian P Murray
- Urology, St Peter's Health Partner Medical Associates, Albany, NY, USA
| | | | - Bhaskar V S Kallakury
- Anatomic Pathology, Albany Medical College, Albany, NY, USA; Pathology, Georgetown University, Washington, DC, USA.
| | - Edward C Lee
- General Surgery, Albany Medical College, NY, USA.
| | - Ann Boguniewicz
- Anatomic Pathology, Albany Medical College, Albany, NY, USA.
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Vigneault E, Martell K, Taussky D, Husain S, Delouya G, Mbodji K, Piotte J, Magnan S, Després P, Lavallée MC, Aubin S, Beaulieu L, Foster W, Martin AG. Does Seed Migration Increase the Risk of Second Malignancies in Prostate Cancer Patients Treated With Iodine-125 Loose Seeds Brachytherapy? Int J Radiat Oncol Biol Phys 2017; 100:1190-1194. [PMID: 29428250 DOI: 10.1016/j.ijrobp.2017.12.273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/06/2017] [Accepted: 12/19/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the risk of second malignancies after migration of seeds (MS) in prostate cancer patients treated with 125I loose seeds brachytherapy. METHODS AND MATERIALS Data from 2802 prostate cancer patients treated with 125I loose seeds brachytherapy in 3 Canadian centers were reviewed. After seeds implant, all patients underwent postimplant pelvic radiography and computed tomography scan for postimplant dosimetry. These images were used to assess whether seed migration occurred. The incidence of second malignancies was determined through the review of patient charts. The 7- and 10-year cumulative incidences of second malignancies and their 95% confidence intervals (CIs) were calculated. Fine and Gray competing risk regression analysis was used to assess the factors associated with the development of second malignancies. RESULTS Mean age and median follow-up were 63.5 years and 74 (range, 12-246) months, respectively. Migration of seeds occurred in 263 of 2802 patients (9.4%). Second malignancy occurred in 87 patients (3.1%) for the entire cohort and was not different between patients who experienced MS (9, 3.4%) and those who did not (78, 3.1%) (P = .755). The 7-year cumulative incidence rates of second malignancies were 2.95% (95% CI 1.20%-6.00%) (with MS) versus 2.82% (2.10%-3.70%) (without MS) (P = .756). The corresponding values at 10 years were 6.16% (2.20%-12.3%) versus 4.51% (3.20%-5.50%) (P = .570). Migration of seeds did not seem to be a significant predictive factor for second malignancies development (adjusted hazard ratio 1.27 [95% CI 0.63-2.55]; P = .510). In both models, only advanced age was significantly associated with second malignancies development. CONCLUSIONS These results did not show an increased risk of second malignancies associated with MS after 125I loose seeds brachytherapy for prostate cancer patients. Longer follow-up and more events are required to better correlate MS and second malignancies.
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Affiliation(s)
- Eric Vigneault
- Département de radio-oncologie, CHU de Québec Université Laval, Québec, Québec, Canada; Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada.
| | - Kevin Martell
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Daniel Taussky
- Équipe de radio-oncologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Siraj Husain
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Guila Delouya
- Équipe de radio-oncologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Khaly Mbodji
- Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada
| | - Julie Piotte
- Équipe de radio-oncologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sindy Magnan
- Département de radio-oncologie, CHU de Québec Université Laval, Québec, Québec, Canada
| | - Philippe Després
- Département de radio-oncologie, CHU de Québec Université Laval, Québec, Québec, Canada; Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada; Département de physique, de génie physique et d'optique, Université Laval, Québec, Québec, Canada
| | - Marie-Claude Lavallée
- Département de radio-oncologie, CHU de Québec Université Laval, Québec, Québec, Canada
| | - Sylviane Aubin
- Département de radio-oncologie, CHU de Québec Université Laval, Québec, Québec, Canada
| | - Luc Beaulieu
- Département de radio-oncologie, CHU de Québec Université Laval, Québec, Québec, Canada; Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada; Département de physique, de génie physique et d'optique, Université Laval, Québec, Québec, Canada
| | - William Foster
- Département de radio-oncologie, CHU de Québec Université Laval, Québec, Québec, Canada
| | - André-Guy Martin
- Département de radio-oncologie, CHU de Québec Université Laval, Québec, Québec, Canada; Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada
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Lin J, Yang W, Jiang N, Zheng Q, Huang J, Huang N, Li A, Jiang H. Incidence and prediction of seed migration to the chest after iodine-125 brachytherapy for hepatocellular carcinoma. Brachytherapy 2017; 16:1252-1256. [DOI: 10.1016/j.brachy.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 01/09/2023]
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Radioactive seed migration following parotid gland interstitial brachytherapy. Brachytherapy 2017; 16:1219-1224. [PMID: 28927732 DOI: 10.1016/j.brachy.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 08/11/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the incidence and associated factors of pulmonary seed migration after parotid brachytherapy using a novel migrated seed detection technique. METHODS AND MATERIALS Patients diagnosed with parotid cancer who underwent permanent parotid brachytherapy from January 2006 to December 2011 were reviewed retrospectively. Head and neck CT scans and chest X-rays were evaluated during routine follow-up. Mimics software and Geomagic Studio software were used for seed reconstruction and migrated seed detection from the original implanted region, respectively. Postimplant dosimetry analysis was performed after seeds migration if the seeds were still in their emitting count. Adverse clinical sequelae from seed embolization to the lung were documented. RESULTS The radioactive seed implants were identified on chest X-rays in 6 patients. The incidence rate of seed migration in 321 parotid brachytherapy patients was 1.87% (6/321) and that of individual seed migration was 0.04% (6/15218 seeds). All migrated seeds were originally from the retromandibular region. No adverse dosimetric consequences were found in the target region. Pulmonary symptoms were not reported by any patient in this study. CONCLUSIONS In our patient set, migration of radioactive seeds with an initial radioactivity of 0.6-0.7 mCi to the chest following parotid brachytherapy was rare. Late migration of a single seed from the central target region did not affect the dosimetry significantly, and patients did not have severe short-term complications. This study proposed a novel technique to localize the anatomical origin of the migrated seeds during brachytherapy. Our evidence suggested that placement of seeds adjacent to blood vessels was associated with an increased likelihood of seed migration to the lungs.
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Calvert AD, Dyer AW, Montgomery VA. Embolization of prostatic brachytherapy seeds to pulmonary arteries: a case study. Radiol Case Rep 2017; 12:34-38. [PMID: 28228874 PMCID: PMC5310242 DOI: 10.1016/j.radcr.2016.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/21/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022] Open
Abstract
Pulmonary seed embolization is a complication of prostatic brachytherapy with varying incidence rates. Key factors that reportedly influence the incidence of seed embolization include planning volume, quantity of seeds, seed placement, and type of seeds (stranded vs free). The clinical implications of seed migration are unclear because sequelae were not demonstrated in multiple short-term studies yet there have been several reports of long-term complications. We report a case of a 56-year-old patient who presented with dyspnea approximately 6 years after brachytherapy treatment for a very low-risk prostate cancer. Chest radiograph showed multiple linear densities overlying the right suprahilar lung. Computed tomography confirmed the location of the densities within the pulmonary arteries in the right upper lobe.
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Affiliation(s)
- Alexander D Calvert
- Department of Radiology, Methodist University Hospital, 1265 Union Ave, Memphis, TN, USA
| | - Andrew W Dyer
- Department of Radiology, Methodist University Hospital, 1265 Union Ave, Memphis, TN, USA
| | - Van A Montgomery
- Department of Radiology, Methodist University Hospital, 1265 Union Ave, Memphis, TN, USA
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17
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Davis BJ, Taira AV, Nguyen PL, Assimos DG, D'Amico AV, Gottschalk AR, Gustafson GS, Keole SR, Liauw SL, Lloyd S, McLaughlin PW, Movsas B, Prestidge BR, Showalter TN, Vapiwala N. ACR appropriateness criteria: Permanent source brachytherapy for prostate cancer. Brachytherapy 2016; 16:266-276. [PMID: 27964905 DOI: 10.1016/j.brachy.2016.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 10/10/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To provide updated American College of Radiology (ACR) appropriateness criteria for transrectal ultrasound-guided transperineal interstitial permanent source brachytherapy. METHODS AND MATERIALS The ACR appropriateness criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. RESULTS Permanent prostate brachytherapy (PPB) is a treatment option for appropriately selected patients with localized prostate cancer with low to very high risk disease. PPB monotherapy remains an appropriate and effective curative treatment for low-risk prostate cancer patients demonstrating excellent long-term cancer control and acceptable morbidity. PPB monotherapy can be considered for select intermediate-risk patients with multiparametric MRI useful in evaluation of such patients. High-risk patients treated with PPB should receive supplemental external beam radiotherapy (EBRT) along with androgen deprivation. Similarly, patients with involved pelvic lymph nodes may also be considered for such combined treatment but reported long-term outcomes are limited. Computed tomography-based postimplant dosimetry completed within 60 days of PPB is essential for quality assurance. PPB may be considered for treatment of local recurrence after EBRT but is associated with an increased risk of toxicity. CONCLUSIONS Updated appropriateness criteria for patient evaluation, selection, treatment, and postimplant dosimetry are given. These criteria are intended to be advisory only with the final responsibility for patient care residing with the treating clinicians.
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Affiliation(s)
- Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
| | - Al V Taira
- Dorothy Schneider Cancer Center, San Mateo, CA
| | - Paul L Nguyen
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | - Dean G Assimos
- Department of Urology, University of Alabama School of Medicine, Birmingham, AL; American Urological Association, Linthicum, MD
| | - Anthony V D'Amico
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA
| | - Alexander R Gottschalk
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | | | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Phoenix, AZ
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, The University of Chicago Medical Center, Chicago, IL
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, UT
| | | | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI
| | | | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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Sachdeva S, Udechukwu NS, Elbelasi H, Landwehr KP, St. Clair WH, Winkler MA. Prostate brachytherapy seed migration to the heart seen on cardiovascular computed tomographic angiography. Radiol Case Rep 2016; 12:31-33. [PMID: 28228873 PMCID: PMC5310244 DOI: 10.1016/j.radcr.2016.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 11/19/2022] Open
Abstract
Brachytherapy consists of placing radioactive sources into or adjacent to tumors, to deliver conformal radiation treatment. The technique is used for treatment of primary malignancies and for salvage in recurrent disease. Permanent prostate brachytherapy seeds are small metal implants containing radioactive sources of I-125, Pd-103, or Cs-131 encased in a titanium shell. They can embolize through the venous system to the lungs or heart and subsequently be detected by cardiovascular computed tomography. Cardiovascular imagers should be aware of the appearance of migrated seeds, as their presence in the chest is generally benign, so that unnecessary worry and testing are avoided. We report a case of a patient who underwent brachytherapy for prostate cancer and developed a therapeutic seeds embolus to the right ventricle.
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Affiliation(s)
- Shilpa Sachdeva
- Department of Radiation Medicine, University of Kentucky Medical Center, Lexington, KY 40536, USA
| | - Nneka S. Udechukwu
- Department of Radiology, University of Kentucky Medical Center, 805 Rose Street, MN-104G, Lexington, KY 40536-0298, USA
- Corresponding author.
| | - Hossam Elbelasi
- Department of Radiology, University of Kentucky Medical Center, 805 Rose Street, MN-104G, Lexington, KY 40536-0298, USA
| | - Kevin P. Landwehr
- Department of Radiology, University of Kentucky Medical Center, 805 Rose Street, MN-104G, Lexington, KY 40536-0298, USA
| | - William H. St. Clair
- Department of Radiation Medicine, University of Kentucky Medical Center, Lexington, KY 40536, USA
| | - Michael A. Winkler
- Department of Radiology, University of Kentucky Medical Center, 805 Rose Street, MN-104G, Lexington, KY 40536-0298, USA
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Hirose K, Aoki M, Sato M, Akimoto H, Hashimoto Y, Imai A, Kamimura N, Kawaguchi H, Hatayama Y, Fujioka I, Tanaka M, Ohyama C, Takai Y. The retrospective analysis of the relationship between prescribed dose and risk factor for seed migration in iodine-125 prostate brachytherapy. Jpn J Radiol 2016; 34:718-723. [DOI: 10.1007/s11604-016-0578-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/16/2016] [Indexed: 11/24/2022]
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20
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Seed migration to the spinal canal after postresection brachytherapy to treat a large brain metastasis. Brachytherapy 2016; 15:637-41. [DOI: 10.1016/j.brachy.2016.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/04/2016] [Accepted: 06/18/2016] [Indexed: 11/19/2022]
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21
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Birckhead BJ, Fossum CC, Deufel CL, Furutani KM, Merrell KW, Schueler BA, Mynderse LA, Choo R, Davis BJ. Stranded seed displacement, migration, and loss after permanent prostate brachytherapy as estimated by Day 0 fluoroscopy and 4-month postimplant pelvic x-ray. Brachytherapy 2016; 15:714-721. [PMID: 27542893 DOI: 10.1016/j.brachy.2016.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 06/27/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of the study was to determine the incidence of local displacement, distant seed migration to the chest, and seed loss after permanent prostate brachytherapy (PPB) with stranded seeds (SSs) using sequential two-dimensional fluoroscopic pelvic and chest x-rays. METHODS AND MATERIALS Between October 2010 and April 2014, a total of 137 patients underwent PPB and 4-month followup pelvic and chest x-ray imaging. All patients had exclusively SSs placed and an immediate postimplant fluoroscopic image of the seed cluster. Followup x-ray images were evaluated for the number, location, and displacement of seeds in comparison to Day 0 fluoroscopic images. Significant seed displacement was defined as seed displacement >1 cm from the seed cluster. Followup chest x-rays were evaluated for seed migration to the chest. RESULTS Seed migration to the chest occurred in 3 of the 137 patients (2%). Seed loss occurred in 38 of the 137 patients (28%), with median loss of one seed (range, 1-16), and total seeds loss of 104 of 10,088 (1.0%) implanted. Local seed displacement was seen in 12 of the 137 patients (8.8%), and total seeds displaced were 0.15% (15/10,088). CONCLUSIONS SS placement in PPB is associated with low rates of substantial seed loss, local displacement, or migration to the chest. Comparing immediate postimplant fluoroscopic images to followup plain x-ray images is a straightforward method to supplement quality assurance in PPB and was found to be useful in identifying cases where seed loss was potentially of clinical significance.
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Affiliation(s)
- B J Birckhead
- Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN
| | - C C Fossum
- Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN
| | - C L Deufel
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN
| | - K M Furutani
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN
| | - K W Merrell
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN
| | - B A Schueler
- Department of Radiology, Mayo Clinic and Foundation, Rochester, MN
| | - L A Mynderse
- Department of Urology, Mayo Clinic and Foundation, Rochester, MN
| | - R Choo
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN
| | - B J Davis
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN.
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22
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Seed loss in prostate brachytherapy. Strahlenther Onkol 2016; 192:305-11. [DOI: 10.1007/s00066-016-0961-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
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24
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Intracardiac Embolized Prostate Brachytherapy Seeds. J Comput Assist Tomogr 2016; 40:609-11. [DOI: 10.1097/rct.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Ishiyama H, Satoh T, Yorozu A, Saito S, Kataoka M, Hashine K, Nakamura R, Tanji S, Masui K, Okihara K, Ohashi T, Momma T, Aoki M, Miki K, Kato M, Morita M, Katayama N, Nasu Y, Kawanaka T, Fukumori T, Ito F, Shiroki R, Baba Y, Inadome A, Yoshioka Y, Takayama H, Hayakawa K. Multi-institutional retrospective analysis of learning curves on dosimetry and operation time before and after introduction of intraoperatively built custom-linked seeds in prostate brachytherapy. JOURNAL OF RADIATION RESEARCH 2016; 57:68-74. [PMID: 26494116 PMCID: PMC4708919 DOI: 10.1093/jrr/rrv065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/03/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
This multi-institutional retrospective analysis examined learning curves for dosimetric parameters and operation time after introduction of intraoperatively built custom-linked (IBCL) seeds. Data from consecutive patients treated with seed implantation before and after introduction of IBCL seeds (loose seed, n = 428; IBCL seed, n = 426) were collected from 13 centers. Dose-volume histogram parameters, operation times, and seed migration rates were compared before and after introduction of IBCL seeds. At the 1-month CT analysis, no significant differences were seen in dose to 90% of prostate volume between before and after IBCL seed introduction. No learning curve for dosimetry was seen. Prostate and rectal volume receiving at least 150% of prescription dose (V150 and RV150) were higher in the loose-seed group than in the IBCL-seed group. Operation time was extended by up to 10 min when IBCL seeds were used, although there was a short learning curve of about five patients. The percentage of patients with seed migration in the IBCL-seed group was one-tenth that in the loose-seed group. Our study revealed no dosimetric demerits, no learning curve for dosimetry, and a slightly extended operation time for IBCL seeds. A significant reduction in the rate of seed migration was identified in the IBCL-seed group.
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Affiliation(s)
- Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 252-0329, Japan
| | - Takefumi Satoh
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 252-0329, Japan
| | - Atsunori Yorozu
- Department of Radiology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Shiro Saito
- Department of Urology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Masaaki Kataoka
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minamiumemoto-Machi, Matsuyama, Ehime 791-0280, Japan
| | - Katsuyoshi Hashine
- Department of Urology, National Hospital Organization Shikoku Cancer Center, Kou-160, Minamiumemoto-Machi, Matsuyama, Ehime 791-0280, Japan
| | - Ryuji Nakamura
- Department of Radiology, Iwate Medical University School of Medicine, Uchimaru 19-1, Morioka 020-8505, Japan
| | - Susumu Tanji
- Department of Urology, Iwate Medical University School of Medicine, Uchimaru 19-1, Morioka 020-8505, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyoku, Kyoto 602-8566, Japan
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyoku, Kyoto 602-8566, Japan
| | - Toshio Ohashi
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tetsuo Momma
- Department of Urology, National Hospital Organization Saitama National Hospital, 2-1 Suwa, Wakho City, Saitama 351-0102, Japan
| | - Manabu Aoki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo 105-8461, Japan
| | - Masako Kato
- Department of Radiology, Showa University School of Medicine, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu Koto-ku, Tokyo 135-0061, Japan
| | - Masashi Morita
- Department of Urology, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu Koto-ku, Tokyo 135-0061, Japan
| | - Norihisa Katayama
- Department of Radiology, Okayama University School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Takashi Kawanaka
- Department of Radiology, Tokushima University School of Medicine, 3-18-15 Tokushima, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Tomoharu Fukumori
- Department of Urology, Tokushima University School of Medicine, 3-18-15 Tokushima, Kuramoto-cho, Tokushima 770-8503, Japan
| | - Fumitaka Ito
- Department of Radiology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Yuji Baba
- Department of Radiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Higashiku Nagamine Minami, Kumamoto City 861-8520, Japan
| | - Akito Inadome
- Department of Urology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Higashiku Nagamine Minami, Kumamoto City 861-8520, Japan
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hitoshi Takayama
- Department of Urology, Osaka University School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara 252-0329, Japan
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Fan Y, Huang MW, Zheng L, Zhao YJ, Zhang JG. Three-dimensional verification of ¹²⁵I seed stability after permanent implantation in the parotid gland and periparotid region. Radiat Oncol 2015; 10:242. [PMID: 26597296 PMCID: PMC4657216 DOI: 10.1186/s13014-015-0552-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate seed stability after permanent implantation in the parotid gland and periparotid region via a three-dimensional reconstruction of CT data. Material and methods Fifteen patients treated from June 2008 to June 2012 at Peking University School and Hospital of Stomatology for parotid gland tumors with postoperative adjunctive 125I interstitial brachytherapy were retrospectively reviewed in this study. Serial CT data were obtained during follow-up. Mimics and Geomagic Studio software were used for seed reconstruction and stability analysis, respectively. Results Seed loss and/or migration outside of the treated area were absent in all patients during follow-up (23–71 months). Total seed cluster volume was maximized on day 1 post-implantation due to edema and decreased significantly by an average of 13.5 % (SD = 9.80 %; 95 % CI, 6.82–17.68 %) during the first two months and an average of 4.5 % (SD = 3.60 %; 95 % CI, 2.29–6.29 %) during the next four months. Volume stabilized over the subsequent six months. Conclusions 125I seed number and location were stable with a general volumetric shrinkage tendency in the parotid gland and periparotid region. Three-dimensional seed reconstruction of CT images is feasible for visualization and verification of implanted seeds in parotid brachytherapy.
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Affiliation(s)
- Yi Fan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Yi-Jiao Zhao
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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Nakano M, Yorozu A, Saito S, Sugawara A, Maruo S, Kojima S, Kikuchi T, Fukushima M, Dokiya T, Yamanaka H. Seed migration after transperineal interstitial prostate brachytherapy by using loose seeds: Japanese prostate cancer outcome study of permanent iodine-125 seed implantation (J-POPS) multi-institutional cohort study. Radiat Oncol 2015; 10:228. [PMID: 26577301 PMCID: PMC4650265 DOI: 10.1186/s13014-015-0532-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background The incidence and associated factors of loose seed migration were investigated in cohort 1 of the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation (J-POPS). Methods The study subjects were 2160 patients, consisting of 1641 patients who underwent permanent iodine-125 seed implantation (PI) and 519 patients who underwent PI combined with external beam radiation therapy (PI + EBRT). The presence or absence of seed migration to the chest and abdominal/pelvic region was determined. Results Seed migration was observed in 22.7 % of PI group patients and 18.1 % of PI + EBRT group patients (p = 0.0276). Migration to the lungs and abdominal/pelvic region was observed in 14.6 % and 11.1 % of the patients in the PI group, and 11.2 % and 8.5 % of the patients in the PI + EBRT group, respectively. In the PI group, the number of implanted seeds was associated with the seed migration incidence. Neither the PI nor the PI + EBRT group showed any difference in the volume of the prostate receiving 100 % of the prescribed dose (V100 [%]) or the minimal dose received by 90 % of the prostate volume (D90 [Gy]) between the patients with and without seed migration. Conclusions This prospective cohort study investigating the largest number of past cases showed no difference in D90 (Gy) or V100 (%) between seed migration or the absence thereof in both the PI group and PI + EBRT group. Trial registration ClinicalTrials.gov: NCT00534196
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Affiliation(s)
- Masahiro Nakano
- Department of Urology, Gifu University Graduate School of Medicine, 1-1Yanagito, Gifu-shi, Gifu, 501-1194, Japan.
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Shiro Saito
- Department of Urology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
| | - Akitomo Sugawara
- Department of Radiation Oncology, Tokai University, Hachioji Hospital, 1838 Ishikawa-machi, Hachioji-shi, Tokyo, 192-0032, Japan.
| | - Shinichiroh Maruo
- Translational Research Informatics center, 1-5-4 Minatojima-minamimachi Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Shinsuke Kojima
- Translational Research Informatics center, 1-5-4 Minatojima-minamimachi Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Takashi Kikuchi
- Translational Research Informatics center, 1-5-4 Minatojima-minamimachi Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Masanori Fukushima
- Translational Research Informatics center, 1-5-4 Minatojima-minamimachi Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Takushi Dokiya
- Department of Radiology, Kyoundo Hospital, 1-8 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
| | - Hidetoshi Yamanaka
- Institute of Preventive Medicine, Kurosawa Hospital, 187 Yanakamachi, Takasaki-shi, Gunma, 370-1203, Japan.
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Evaluation of the dosimetric impact of loss and displacement of seeds in prostate low-dose-rate brachytherapy. J Contemp Brachytherapy 2015. [PMID: 26207108 PMCID: PMC4499516 DOI: 10.5114/jcb.2015.52127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyze the seed loss and displacement and their dosimetric impact in prostate low-dose-rate (LDR) brachytherapy while utilizing the combination of loose and stranded seeds. MATERIAL AND METHODS Two hundred and seventeen prostate cancer patients have been treated with LDR brachytherapy. Loose seeds were implanted in the prostate center and stranded seeds in the periphery of the gland. Patients were imaged with transrectal ultrasound before implant and with computerized tomography/magnetic resonance imaging (CT/MR) one month after implant. The seed loss and displacement had been analyzed. Their impact on prostate dosimetry had been examined. The seed distribution beyond the prostate inferior boundary had been studied. RESULTS The mean number of seeds per patient that were lost to lung, pelvis/abdomen, urine, or unknown destinations was 0.21, 0.13, 0.03, and 0.29, respectively. Overall, 40.1% of patients had seed loss. Seed migration to lung and pelvis/abdomen occurred in 15.5% and 10.5% of the patients, respectively. Documented seed loss to urine was found in 3% of the patients while 20% of patients had seed loss to unknown destinations. Prostate length difference between pre-plan and post-implant images was within 6 mm in more than 98% of cases. The difference in number of seeds inferior to prostate between pre-plan and post-implant dosimetry was within 7 seeds for 93% of patients. At time of implant, 98% of seeds, inferior to prostate, were within 5 mm and 100% within 15 mm, and in one month post-implant 83% within 9 mm and 96.3% within 15 mm. Prostate post-implant V100, D90, and rectal wall RV100 for patients without seed loss were 94.6%, 113.9%, and 0.98 cm(3), respectively, as compared to 95.0%, 114.8%, and 0.95 cm(3) for the group with seed loss. CONCLUSIONS Seed loss and displacement have been observed to be frequent. No correlation between seed loss and displacement and post-plan dosimetry has been reported.
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Ye AY, Conway J, Peacock M, Clarkson PW, Lee CH, Simmons C, Weir L, McKenzie M. Secondary sarcoma of bone post-prostate brachytherapy: A case report. Can Urol Assoc J 2014; 8:E468-70. [PMID: 25024811 DOI: 10.5489/cuaj.1876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Malignancies associated with brachytherapy for prostate cancer are largely unreported in the literature. We report a case of post-brachytherapy osteogenic sarcoma in the pelvis 6 years after permanent (125)I implant for intermediate-risk prostate cancer. The patient was treated with neoadjuvant chemotherapy, limb-sparing surgical resection and postoperative radiation therapy for unexpected positive margins.
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Affiliation(s)
- Allison Y Ye
- Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Jessica Conway
- Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Michael Peacock
- Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Paul W Clarkson
- Department of Orthopedics, University of British Columbia, Vancouver, BC
| | - Cheng-Han Lee
- Department of Laboratory Medicine and Pathology, University of Alberta and Royal Alexandra Hospital, Edmonton, AB
| | - Christine Simmons
- Department of Medical Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Lorna Weir
- Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Michael McKenzie
- Department of Radiation Oncology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, BC
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30
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Ishiyama H, Satoh T, Kawakami S, Tsumura H, Komori S, Tabata KI, Sekiguchi A, Takahashi R, Soda I, Takenaka K, Iwamura M, Hayakawa K. A prospective quasi-randomized comparison of intraoperatively built custom-linked seeds versus loose seeds for prostate brachytherapy. Int J Radiat Oncol Biol Phys 2014; 90:134-9. [PMID: 24986744 DOI: 10.1016/j.ijrobp.2014.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare dosimetric parameters, seed migration rates, operation times, and acute toxicities of intraoperatively built custom-linked (IBCL) seeds with those of loose seeds for prostate brachytherapy. METHODS AND MATERIALS Participants were 140 patients with low or intermediate prostate cancer prospectively allocated to an IBCL seed group (n=74) or a loose seed group (n=66), using quasirandomization (allocated by week of the month). All patients underwent prostate brachytherapy using an interactive plan technique. Computed tomography and plain radiography were performed the next day and 1 month after brachytherapy. The primary endpoint was detection of a 5% difference in dose to 90% of prostate volume on postimplant computed tomography 1 month after treatment. Seed migration was defined as a seed position >1 cm from the cluster of other seeds on radiography. A seed dropped into the seminal vesicle was also defined as a migrated seed. RESULTS Dosimetric parameters including the primary endpoint did not differ significantly between groups, but seed migration rate was significantly lower in the IBCL seed group (0%) than in the loose seed group (55%; P<.001). Mean operation time was slightly but significantly longer in the IBCL seed group (57 min) than in the loose seed group (50 min; P<.001). No significant differences in acute toxicities were seen between groups (median follow-up, 9 months). CONCLUSIONS This prospective quasirandomized control trial showed no dosimetric differences between IBCL seed and loose seed groups. However, a strong trend toward decreased postimplant seed migration was shown in the IBCL seed group.
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Affiliation(s)
- Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Takefumi Satoh
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shogo Kawakami
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hideyasu Tsumura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shouko Komori
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ken-ichi Tabata
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akane Sekiguchi
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ryo Takahashi
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Itaru Soda
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouji Takenaka
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
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31
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Dedic-Hagan J, Teh AYM, Liang E, Collett N, Woo HH. Migration of a strand of four seeds in low-dose-rate brachytherapy. BMJ Case Rep 2014; 2014:bcr2014204515. [PMID: 24879735 PMCID: PMC4039978 DOI: 10.1136/bcr-2014-204515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 11/04/2022] Open
Abstract
We report a case of stranded-seed migration (one strand of four seeds), via the prostatic venous plexus to the internal pudendal vein, in low-dose-rate (LDR) prostate brachytherapy. A 70-year-old man with low-risk prostate adenocarcinoma underwent transperineal permanent seed implantation. A total of 93 iodine-125 seeds were implanted (91 stranded seeds and 2 loose seeds). Immediate postimplantation fluoroscopic image and day 1 postimplantation CT scan indicated all implanted seeds to be within the vicinity of the prostate as planned. Day 30 pelvic X-ray and CT scan revealed migration of a strand of four seeds to the right pelvis (adjacent to ischial spine). At 2 years postimplantation, the patient continues to have good disease control with prostate specific antigen level of 0.69 μg/L, and asymptomatic. To the best of our knowledge, this is the first report of migration of an entire strand of seeds following LDR prostate brachytherapy.
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Affiliation(s)
- Jasmina Dedic-Hagan
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Amy Y M Teh
- Radiation Oncology Institute, Sydney, New South Wales, Australia
| | - Eisen Liang
- Department of Radiology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Collett
- Radiation Oncology Institute, Sydney, New South Wales, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
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