Re-implantation of suboptimal prostate seed implantation: technique with intraoperative treatment planning

Abstract

PurposePost-implant dosimetry following prostate seed implantation (PSI) occasionally reveals suboptimal dosimetric coverage of the gland. Published reports of re-implantation techniques have focused on earlier-generation techniques, including preplanned approaches and stranded seeds. The purpose of this case report is to describe a customizable approach to perform corrective re-implantation using loose seeds and intraoperative planning technique.Material and methodsThis case report describes a 63-year-old male with favorable risk prostate adenocarcinoma receiving PSI. Thirty day post-implant dosimetric evaluation revealed suboptimal coverage of the base of the gland. Using guidance from post-implant CT-images and real-time planning, the patient received a corrective re-implantation with intraoperative planning.ResultsPost-implant dosimetry after re-implantation procedure with intraoperative planning yielded improved target volume coverage that achieved standard dosimetric criteria.ConclusionsRe-implantation as a salvage treatment technique after sub-optimal PSI is a valid treatment option performed with intraoperative real-time planning.

Technical and dosimetric aspects of iodine-125 seed reimplantation in suboptimal prostate implants

“…A recent case report has described the salvage reimplantation of a suboptimally implanted prostate cancer patient by employing post-implant CT guidance and real-time intra-operative planning using loose seeds [13]. PID revealed an underdosed base, leading to D 90 592.9 Gy and V 100 571%, which after the addition of 20 seeds increased to D 90 5173.24 Gy and V 100 596.88%.…”