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. 2023 Jun 17;15(12):3229.
doi: 10.3390/cancers15123229.

The Safe Use of 125I-Seeds as a Localization Technique in Breast Cancer during Pregnancy

Eva Heeling  1 , Jeroen B van de Kamer  2 , Michelle Methorst  3 , Annemarie Bruining  4 , Mette van de Meent  5 , Marie-Jeanne T F D Vrancken Peeters  1 , Christianne A R Lok  3 , Iris M C van der Ploeg  1
Affiliations

The Safe Use of 125I-Seeds as a Localization Technique in Breast Cancer during Pregnancy

Eva Heeling et al. Cancers (Basel). .

Abstract

Introduction: Some aspects of the treatment protocol for breast cancer during pregnancy (PrBC) have not been thoroughly studied. This study provides clarity regarding the safety of the use of 125I-seeds as a localization technique for breast-conserving surgery in patients with PrBC.

Methods: To calculate the exposure to the fetus of one 125I-seed implanted in a breast tumor, we developed a model accounting for the decaying 125I-source, time to surgery, and the declining distance between the 125I-seed and the fetus. The primary outcome was the maximum cumulative fetal dose of radiation at consecutive gestational ages (GA).

Results: The cumulative fetal dose remains below 1 mSv if a single 125I-seed is implanted at a GA of 26 weeks. After a GA of 26 weeks, the fetal dose can be at a maximum of 11.6 mSv. If surgery takes place within two weeks of implantation from a GA of 26 weeks, and one week above a GA of 32 weeks, the dose remains below 1 mSv.

Conclusion: The use of 125I-seeds is safe in PrBC. The maximum fetal exposure remains well below the threshold of 100 mSv, and therefore, does not lead to an increased risk of fetal tissue damage. Still, we propose keeping the fetal dose as low as possible, preferably below 1 mSv.

Keywords: breast cancer; breast-conserving surgery; fetus; iodine-125 seeds; pregnancy; radiation.

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Conflict of interest statement

The authors declare no conflict of interest.

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