Prostate Brachytherapy Implantation Treatment Techniques

Abstract

Permanent Prostate Brachytherapy Treatment Techniques

Ultrasound-guided perineal seed implantation became the optimal way for placing of permanent I-125 and Pd-109 seeds since the beginning of the 1990s, after the first publication of Holm et al. (1982). A large variety exists in both placing of the seeds and planning of the dose distribution. Seeds can be placed one by one (single-seed technique) or seeds can be introduced in a Vicryl thread (RAPID Strand technique), either through preloaded needles or afterloaded needles. For planning of the dose distribution over the prostate and hence the geometry of the seed placement, one can use a nomogram, preplanning or real-time planning. Seeds can be placed more or less homogeneous over the prostate, with or without sparing of the central part of the gland to reduce the dose to the urethra and to minimise the loss of seeds.

Apart from the I-125 seeds, HDR can be used for prostate brachytherapy. Techniques of the implant procedure are identical. The difference is a single procedure on an outdoor basis versus 1 till 6 fractions of HDR. Preoperative planning is shortly mentioned, as well as pretreatment measures including the materials needed for a proper implant. The procedure is mostly performed under spinal or saddle block anaesthesia and may take 45 till 90 min, depending on the technique. Placing of the seeds can be done with single seeds (Mick applicator) or stranded seeds (Bard, Bebig, Best, Oncura and others) or with afterloading (Nucletron).