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


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.
Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Kimmel Cancer Center, Philadelphia.
Laura
L
Doyle
Adam J
AJ
Hesney
Katherine L
KL
Chapman
Haisong
H
Liu
Perry R
PR
Weiner
Adam P
AP
Dicker
Yan
Y
Yu
Timothy N
TN
Showalter
low-dose-rate brachytherapy; prostate cancer; re-implantation; salvage therapy; seeds