Reducing seed migration to near zero with stranded-seed implants: Comparison of seed migration rates to the chest in 1000 permanent prostate brachytherapy patients undergoing implants with loose or stranded seeds
Autor: | Keith M. Furutani, Brendan P. McMenomy, Ryan K. Funk, Christopher L. Deufel, Kenneth W. Merrell, Bradley J. Stish, Christopher C. Goulet, Torrence M. Wilson, Lance A. Mynderse, Brian J. Davis, Brandon Birckhead, W. Scott Harmsen, C. Richard Choo, Robert H. McLaren |
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Rok vydání: | 2018 |
Předmět: |
Male
medicine.medical_treatment Brachytherapy Stranded Seed Permanent prostate brachytherapy 030218 nuclear medicine & medical imaging Iodine Radioisotopes 03 medical and health sciences 0302 clinical medicine Foreign-Body Migration Cox proportional hazards regression Seed migration Medicine Humans Radiology Nuclear Medicine and imaging Single institution Lung Aged business.industry Hazard ratio food and beverages Prostatic Neoplasms Prostheses and Implants Middle Aged Prosthesis Failure Radiography Oncology 030220 oncology & carcinogenesis Implant business Nuclear medicine |
Zdroj: | Brachytherapy. 18(3) |
ISSN: | 1873-1449 |
Popis: | Pulmonary seed emboli to the chest may occur after permanent prostate brachytherapy (PPB). The purpose of this study is to analyze factors associated with seed migration to the chest in a large series of PPB patients from a single institution undergoing implant with either loose seeds (LS), mixed loose and stranded seeds (MS), or exclusively stranded seeds in an absorbable vicryl suture (VS).Between May 1998 and July 2015, a total of 1000 consecutive PPB patients with postoperative diagnostic chest x-rays at 4 months after implant were analyzed for seed migration. Patients were grouped based on seed implant technique: LS = 391 (39.1%), MS = 43 (4.3%), or VS = 566 (56.6%). Univariate and multivariate analysis were performed using Cox proportional hazards regression models to determine predictors of seed migration.Overall, 18.8% of patients experienced seed migration to the chest. The incidence of seed migration per patient was 45.5%, 11.6%, and 0.9% (p0.0001), for patients receiving LS, MS, or VS PPB, respectively. The right and left lower lobes were the most frequent sites of pulmonary seed migration. On multivariable analysis, planimetry volume (p = 0.0002; HR = 0.7 per 10 cc [0.6-0.8]), number of seeds implanted (p0.0001, HR = 2.4 per 25 seeds [1.7-3.4]), LS implant (p0.0001, HR = 15.9 [5.9-42.1]), and MS implant (p = 0.001, HR = 7.9 [2.3-28.1]) were associated with seed migration to the chest.In this large series, significantly higher rates of seed migration to the chest are observed in implants using any LS with observed hazard ratios of 15.9 and 7.9 for LS and MS respectively, as compared with implants using solely stranded seeds. |
Databáze: | OpenAIRE |
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