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Radioactive seed migration to the chest after transperineal interstitial prostate brachytherapy: extraprostatic seed
Jeffrey S Eshleman1, Brian J Davis, Thomas M Pisansky
1Division of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
Purpose:
To examine the incidence of seed migration detected on chest X-ray and to identify the predictors associated with its occurrence.
Methods And Materials:
Between May 1998 and April 2000, 102 patients underwent permanent prostate brachytherapy at our institution and 100 were eligible for the study. Chest X-rays obtained at follow-up were examined for the number and location of seeds. The patient and treatment variables potentially associated with the occurrence and number of seed migrations were analyzed.
Results:
One or more seeds were identified on the chest X-rays of 55 (55%) of 100 patients. The mean number of intrathoracic seeds in patients with migration was 2.2 (range, 1-10), and the proportion of seeds that migrated to the thorax was 0.98%. The rate of extraprostatic seeds planned was 43.9%, and postimplant CT identified 37.9% in such a location. The number of seeds planned for extraprostatic placement and below the apex were statistically significant (alpha = 0.05) predictors in univariate logistic analysis. Multivariate analysis revealed the planned number of extraprostatic seeds as the only statistically significant predictor (p = 0.04).
Conclusion:
Extraprostatic placement of loose seeds is associated with an increased likelihood for, and frequency of, seed migration to the thorax. Nonetheless, the small proportion of implanted seeds that migrated (
