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Seed loss in prostate brachytherapy

Operator dependency and impact on dosimetry

Seed-Verlust nach Prostata-Brachytherapy

Einfluss von Operateur und Dosimetrie

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Abstract

Introduction

The aim of our study was to review seed loss and its impact on dosimetry as well as the influence of the treating physician on seed loss and dosimetry in patients treated with prostate brachytherapy using permanent loose 125I implant.

Patients and methods

We analyzed 1087 consecutive patients treated by two physicians between July 2005 and April 2015 at a single institution. Pelvic fluoroscopic imaging was done 30 days post implant and a chest X-ray when seed loss was observed.

Results

Seed loss occurred in 19.4 % of patients: in 20.0 % of implants done by the most experienced physician and in 17.2 % by the less experienced physician (p = 0.4) and migration to the thorax occurred in 5.9 % (6.9 vs. 2.2 %, p = 0.004). The mean seed loss rate was 0.57 % [standard deviation (SD) 1.39] and the mean rate of seeds in the thorax was 0.14 % (SD 0.65). The most experienced physician had a higher mean number of seeds lost: 0.36 versus 0.25 (p = 0.055), and a higher mean number of seed migration to the thorax: 0.1 versus 0.02 (p < 0.001). When at least one seed was lost, a decrease of 4.2 Gy (p < 0.001) in the D90 and a decrease of 3.5 % (p = 0.002) in the V150 was observed.

Conclusion

We found a significant decrease in V150 and D90 with the occurrence of seed loss. Furthermore, we found a difference in seed migration among the physicians demonstrating that seed loss is operator dependant.

Zusammenfassung

Zielsetzung

Wir analysierten den Prozentsatz des Seed-Verlusts sowie den Einfluss von Arzterfahrung und Seed-Abgang auf die Dosimetrie bei Patienten, die mit einer Prostata-Brachytherapie mit permanent beweglichen 125I-Implantaten behandelt wurden.

Patienten und Methode

Eingeschlossen in diese Studie wurden alle zwischen Juli 2005 und April 2015 an unserem Krankenhaus von zwei Ärzten konsekutiv behandelten 1087 Patienten. Anhand fluoroskopischer Bilder wurden noch vorhandene Seeds 30 Tage nach dem Eingriff gezählt. Bei unvollständiger Seed-Anzahl wurde ein Thorax-Röntgenbild angefertigt.

Ergebnisse

In 19% der Patienten ging mindestens ein Seed verloren: 20% der Implantate beim erfahrenen Arzt und 17,2 % beim weniger erfahrenen Arzt (p = 0,4). Eine Migration zum Thorax wurde in 5,9% nachgewiesen (6,9 vs. 2,2 %; p = 0,004). Die durchschnittliche Seed-Verlustrate war 0,57% [Standardabweichung (SD) 1,39] und der Prozentsatz an abgegangenen Seeds pro implantierten Seeds 0,14% (SD 0,65). Der erfahrenere Arzt hatte im Vergleich zum weniger erfahrenen Arzt einen höheren Prozentsatz abgegangener Seeds (0,36% vs. 0,25%; p = 0,055) sowie von Seeds im Thorax (0,1% vs. 0,02%; p < 0,001). Beim Verlust von mindestens einem Seed wurde eine Reduktion der D90 um 4,2 Gy (p < 0,001) und der V150 um 3,5% (p = 0,002) festgestellt.

Schlussfolgerung

Ein Seed-Abgang senkt V150 und D90 signifikant. Ob ein Seed-Abgang nachgewiesen werden kann, hängt vom behandelnden Arzt ab.

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Acknowledgments

We thank David Roberge, MD for his helpful suggestions in preparing this article.

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Authors and Affiliations

  1. Département de Radio-Oncologie, Centre hospitalier de l’Université de Montréal—Hôpital Notre-Dame, 1560 Sherbrooke St. E., H2L 4M1, Montreal, QC, Canada

    Nancy El-Bared M.D., Natanel Sebbag, Dominic Béliveau-Nadeau M.Sc., Yannick Hervieux M.Sc., Renée Larouche M.Sc., Daniel Taussky M.D. & Guila Delouya M.D., M.Sc.

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  1. Nancy El-Bared M.D.
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  2. Natanel Sebbag
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  3. Dominic Béliveau-Nadeau M.Sc.
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  4. Yannick Hervieux M.Sc.
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  5. Renée Larouche M.Sc.
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  6. Daniel Taussky M.D.
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  7. Guila Delouya M.D., M.Sc.
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Corresponding author

Correspondence to Daniel Taussky M.D..

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Conflicts of interest

N. El-Bared, N. Sebbag, D. Béliveau-Nadeau, Y. Hervieux, R. Larouche, and G Delouya state that there are no conflicts of interest. D. Taussky receives an educational grant from Elekta. The department of radiation oncology of the Université de Montréal receives support for a brachytherapy fellowship. We did not receive any direct financial support to conduct this research.

This study was approved by the institutional ethics committee, therefore the study has been performed in accordance with the ethical standards laid down in the 1964.

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El-Bared, N., Sebbag, N., Béliveau-Nadeau, D. et al. Seed loss in prostate brachytherapy. Strahlenther Onkol 192, 305–311 (2016). https://doi.org/10.1007/s00066-016-0961-4

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  • DOI: https://doi.org/10.1007/s00066-016-0961-4

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