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Brachytherapy Seeds May Migrate to the Patient’s Lungs

Brachytherapy Seeds May Migrate to the Patient’s Lungs

NEW ORLEANS—After brachytherapy for prostate cancer, a small
proportion of the radioactive seeds migrate into the lungs of more than a third
of patients, according to a report from the American College of Surgeons 87th
Clinical Congress.

Researchers from the Robert Wood Johnson Medical School, University of
Medicine and Dentistry of New Jersey, New Brunswick, said this occurrence has
not proved harmful, but they recommend that clinicians inform their patients of
the possibility of seed migration and order a follow-up chest x-ray.

Robert E. Weiss, MD, associate professor of urology, said that pulmonary
migration has been reported in the radiology literature but is not commonly
appreciated by urologists. Furthermore, the incidence of pulmonary seed
migration may be greater than previously reported, he said.

While the incidence has been thought to be between 6% and 29%, the current
study documented seed migration in 21 of 58 patients (36%). The tiny seeds (5
mm long and 0.5 mm in diameter) were found by chest radiography 2 weeks to 3
months after ultrasound-guided prostate brachytherapy.

While seed migration was common, only 34 (0.49%) of the 6,878 pellets
actually migrated to the lung. Nine patients had single seed migration to the
right lung, and three patients to the left lung. Nine patients had multiple and
bilateral seed migration, with the most number of seeds per patient being four.

There seemed to be no consistent relationship between seed migration and the
type of seeds used, but migration occurred more often in patients with the most
seeds implanted. Repeated chest radiography in these 21 patients revealed no
delayed migration, at a median follow-up of 16 months.

CT scans of the 21 patients showed that 14 (67%) had extracapsular seed
implantation, and the investigators suspect this may have contributed to the
higher incidence of seed migration in their study.

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