Radioactive Implant Migration in Patients Treated for Localized Prostate Cancer With Interstitial Brachytherapy

Older, Robert A.; Synder, Bernard; Krupski, Tracey L.; Glembocki, David J.; Gillenwater, J. A. Y. Y.

doi:10.1016/s0022-5347(05)66354-9

Cited by 57 publications

(8 citation statements)

References 6 publications

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“…1,2 Despite various advantages of transperineal implantation over the suprapublic approach, pulmonary embolization of implanted seeds is a concern of under-dose in the implanted target and potential damage to the lungs. [3][4][5][6][7][8][9][10][11][12][13] Steinfeld and colleagues are among the early investigators to report their findings of the pulmonary embolization of iodine-125 ͑I-125͒ seeds. 3 Nag and colleagues described seed migration of palladium-103 ͑Pd-103͒ with transperineal implantation.…”

Section: Introductionmentioning

confidence: 99%

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Accurate and efficient detection of pulmonary seed embolization in prostate iodine-125 permanent brachytherapy with a collimated gamma scintillation survey meter

Chen

Blair

2003

Med. Phys.

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Pulmonary seed embolization is frequently observed in permanent prostate brachytherapy. Postoperative chest radiographic examination does not always detect seed embolization. To overcome this deficiency, a low energy gamma scintillation survey meter was converted to a seed-migration detector by adding a cone-shaped single-hole collimation cap to the window end of the scintillation probe. The response functions of the seed-migration detector to iodine-125 (I-125) for different source-to-detector distances in air and in water were measured. The spatial discrimination power of the survey meter, represented by the full width at half maximum measured in water, is typically improved from more than 7 cm to about 3 cm. Seventy-nine patients with I-125 implantation were scanned with the seed-migration detector at the patients' 30-day postevaluation visit. Fifteen patients showed single-seed embolization to the chest region and four patients displayed two-seed embolization. In other words, 24% of the patients present with embolized seeds. The detection accuracy of each patient was validated by a comprehensive investigation procedure. The comprehensive investigation consists of reviewing the patient's treatment history, orally questioning the patient for possible seed loss via the urethra route outside the hospital, examining all available chest radiographs before and after the seed implantation, and counting the seeds on the postevaluation CT scans. In comparison, examinations relying only on the analysis of postoperative chest radiographs yielded a false-positive detection in four patients and a false-negative detection in two patients. Another advantage of the seed-migration detector is that multiple seed-migration scans can be performed without exposing the patient to any additional radiation, for this device is a passive detector. Our clinical implementation also demonstrated that the seed-migration detector is a convenient and cost-effective method. As a result of this study, we stopped ordering the postoperative chest radiographs in a patient's regular postevaluation visit. Only if the detector shows radioactivity outside a patient's pelvis are a pair of anteroposterior and lateral chest radiographs of the patient ordered to document the location of the embolized seeds.

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Section: Introductionmentioning

confidence: 99%

“…However, a long term follow-up is recommended if a pulmonary seed embolization is detected. 12,13 Currently, seed migration detection is based on review of postoperative chest radiographs. Nevertheless, detection accuracy has not yet been adequately evaluated.…”

Section: Introductionmentioning

confidence: 99%

Accurate and efficient detection of pulmonary seed embolization in prostate iodine-125 permanent brachytherapy with a collimated gamma scintillation survey meter

Chen

Blair

2003

Med. Phys.

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“…The strategic placement of these seeds throughout the tumor mass can provide prolonged irradiation to the tumor while limiting the radiation burden on healthy tissues. Although the success of current approaches to prostate brachytherapy is exemplified by excellent disease-free survival (2–4), its implementation is plagued by a number of significant limitations, including the need for general anesthesia, complicated placement procedures, seed migration to other organs, and the need for post-treatment excision for seed removal (5). We speculated that many of these limitations might be overcome by engineering a biodegradable material that a) can form injectable depots with a life span in vivo that is compatible with the half-life of the radionuclide used for treatment; and b) degrades into non-toxic products that are resorbed by the body after the radioactivity has decayed to a level that no longer poses a threat of systemic toxicity, thereby obviating the need for surgical implantation and re-excision.…”

Section: Introductionmentioning

confidence: 99%

Brachytherapy Using Injectable Seeds That Are Self-Assembled from Genetically Encoded Polypeptides In Situ

Liu

McDaniel

et al. 2012

Cancer Research

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Brachytherapy is a common clinical technique involving implantation of sealed radioactive "seeds" within a tumor to selectively irradiate the tumor mass while minimizing systemic toxicity. To mitigate the disadvantages associated with complex surgical implantation and subsequent device removal procedures, we have developed an alternative approach using a genetically-encoded peptide polymer solution composed of a thermally responsive elastin-like polypeptide (ELP) radiolabeled with 131I that self-assembles into radionuclide seeds upon intratumoral (i.t.) injection. The formation of these non-toxic and biodegradable polymer seeds led to prolonged intratumoral retention (~85% ID/tumor 7 days post-injection) of the radionuclide, elicited a tumor growth delay in 100% of the tumors in two human xenografts (FaDu and PC-3), and cured more than 67% of tumor-bearing animals after a single administration of labeled ELP. These results suggest that in situ self-assembly of biodegradable and injectable radionuclide-containing polypeptide seeds could be a promising therapeutic alternative to conventional brachytherapy.

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“…Authors have reported 21%-29% of LDR patients will have loose seeds migrate to the lungs. 3,4 These seeds may be seen on chest radiographs. It is thought that seeds implanted near the exterior of the prostate migrate into the prostatic veins, which carry them from the prostate into the lungs.…”

Section: Introductionmentioning

confidence: 99%

Investigating the dosimetric and tumor control consequences of prostate seed loss and migration

et al. 2012

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Radioactive Implant Migration in Patients Treated for Localized Prostate Cancer With Interstitial Brachytherapy

Cited by 57 publications

References 6 publications

Accurate and efficient detection of pulmonary seed embolization in prostate iodine-125 permanent brachytherapy with a collimated gamma scintillation survey meter

Accurate and efficient detection of pulmonary seed embolization in prostate iodine-125 permanent brachytherapy with a collimated gamma scintillation survey meter

Brachytherapy Using Injectable Seeds That Are Self-Assembled from Genetically Encoded Polypeptides In Situ

Investigating the dosimetric and tumor control consequences of prostate seed loss and migration

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