title: Radioactive implant migration in patients treated for localized prostate cancer with interstitial brachytherapy.
abstract: OBJECTIVE
  In several of the initial patients undergoing brachytherapy at our institution radioactive implants were visible in the thorax on chest radiography. The clinical ramifications of this unanticipated finding were unclear. Thus, we investigated the incidence of brachytherapy seed migration to the chest and whether these seeds were associated with any clinical significance.
  
  
  METHODS
  We retrospectively reviewed the records of all patients who underwent ultrasound or computerized tomography guided brachytherapy of 103palladium seeds from March 1997 to March 1999. This list of patients on brachytherapy was then matched against the radiology computer system to determine those who had undergone chest X-ray after brachytherapy. When the radiology report was unclear regarding brachytherapy seeds, chest x-rays were reviewed by one of us (R. O.) to determine the presence and position of the seeds.
  
  
  RESULTS
  Post-brachytherapy chest x-rays were available in 110 of the 183 patients. In 78 cases no brachytherapy seeds were identified. Radioactive implants were identified on chest radiography in 32 patients (29%), including 1 to 5 seeds in 20, 8, 1, 2 and 1, respectively. No patients complained of any change in pulmonary symptoms after brachytherapy.
  
  
  CONCLUSIONS
  Radioactive implants migrated after brachytherapy for localized prostate cancer in 29% of the patients who underwent post-procedure radiography. There did not appear to be a pattern to the seed distribution. However, while the incidence was not negligible, no patient appeared to have any acute pulmonary symptoms. Therefore, while the migration of radioactive implants to the chest is a real phenomenon, it appears to have no adverse clinical consequences in the early post-procedure period.
authors.affiliation: Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, Virginia, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Older
authors.forename: B
authors.initials: B
authors.lastname: Synder
authors.forename: T L
authors.initials: TL
authors.lastname: Krupski
authors.forename: D J
authors.initials: DJ
authors.lastname: Glembocki
authors.forename: J Y
authors.initials: JY
authors.lastname: Gillenwater
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D010165:Palladium / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D013902:Radiography, Thoracic; D011868:Radioisotopes / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D011868:Radioisotopes; D010165:Palladium