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. 2012 Sep;4(3):176-81.
doi: 10.5114/jcb.2012.30684. Epub 2012 Sep 29.

Re-implantation of suboptimal prostate seed implantation: technique with intraoperative treatment planning

Laura Doyle  1 , Adam J Hesney, Katherine L Chapman, Haisong Liu, Perry R Weiner, Adam P Dicker, Yan Yu, Timothy N Showalter
Affiliations

Re-implantation of suboptimal prostate seed implantation: technique with intraoperative treatment planning

Laura Doyle et al. J Contemp Brachytherapy. 2012 Sep.

Abstract

Purpose: Post-implant dosimetry following prostate seed implantation (PSI) occasionally reveals suboptimal dosimetric coverage of the gland. Published reports of re-implantation techniques have focused on earlier-generation techniques, including preplanned approaches and stranded seeds. The purpose of this case report is to describe a customizable approach to perform corrective re-implantation using loose seeds and intraoperative planning technique.

Material and methods: This case report describes a 63-year-old male with favorable risk prostate adenocarcinoma receiving PSI. Thirty day post-implant dosimetric evaluation revealed suboptimal coverage of the base of the gland. Using guidance from post-implant CT-images and real-time planning, the patient received a corrective re-implantation with intraoperative planning.

Results: Post-implant dosimetry after re-implantation procedure with intraoperative planning yielded improved target volume coverage that achieved standard dosimetric criteria.

Conclusions: Re-implantation as a salvage treatment technique after sub-optimal PSI is a valid treatment option performed with intraoperative real-time planning.

Keywords: low-dose-rate brachytherapy; prostate cancer; re-implantation; salvage therapy; seeds.

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Figures

Fig. 1
Fig. 1
Needle and seed locations on BK-Standard template for initial implant
Fig. 2
Fig. 2
TRUS image of dosimetry from intra-operative treatment plan. Contours include prostate, urethra and rectum. Isodose lines show coverage of 100%, 125% and 150% of 145 Gy prescription dose
Fig. 3
Fig. 3
Shows inferior coverage at the base of the prostate gland following PSI
Fig. 4
Fig. 4
Mid-sagittal views of intended coveraged indicated by TRUS (upper) and achieved coverage as indicated by 30-day post-operative CT (lower)
Fig. 5
Fig. 5
Shows use of CT images to calculate approximate location and number of seeds needed for supplemental implant. Approximate positions on pre-implant plan served as a guide for seed locations during intra-operative planning
Fig. 6
Fig. 6
Planned needle and seed locations for second implant considering seed locations from first implant
Fig. 7
Fig. 7
Intra-operative plan considering seeds from initial implant
Fig. 8
Fig. 8
Post implant dosimetry from both initial and salvage PSI
See this image and copyright information in PMC

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