Implications of radioactive seed migration to the lungs after prostate brachytherapy
Implications of radioactive seed migration to the lungs after prostate brachytherapy
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DOI：
10.1016/s0090-4295(01)01660-0
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发表时间：
2002-04-01
期刊：
影响因子：
2.1
通讯作者：
Weiss, RE
中科院分区：
文献类型：
--
作者：
Ankem, MK;DeCarvalho, VS;Weiss, RE
目标.审查前列腺近距离放射治疗后肺粒子迁移的发生率及其对肺功能的影响。已经发表了前列腺近距离放射治疗后粒子迁移到肺部的孤立报告;然而，这种肺部迁移的临床后果尚未得到充分评价。我们对1998年至2000年接受前列腺近距离放射治疗的患者进行了回顾性分析。术后15 - 90天（中位数45天）进行胸部X线肺部成像。由一名放射科医生（V.S.D.）审查胸片，并且由一名肺病学家（A.M.H.）使用问卷调查、胸部X光片和肺功能测试。粒子植入后进行前列腺计算机断层扫描，以检查粒子位置和剂量测定。采用比值比、可信区间、卡方检验和Logistic回归分析，评估所用粒子类型和数量、肺移位发生率以及对肺功能的影响之间的关系。在研究期间，共有83名患者接受了前列腺近距离放射治疗，58名患者接受了胸部X线摄影。58例患者中有21例（36.2%）发生了粒子移位（95%置信区间为23.8%-48.6%）。使用的4755粒种子中有34粒（0.71%）迁移至肺部。9例患者的单个粒子迁移到右肺，3例迁移到左肺。9例患者发生了多次（最多4次）和双侧粒子移位。未发现种子迁移与所用种子类型之间存在一致的关系（P = 0.24）。临界统计学显著性表明，随着植入粒子数量的增加，粒子迁移的发生率增加（P = 0.054）。21例患者的重复胸部X线检查显示，在中位随访16个月时没有延迟移位。临床和肺功能检查显示，没有一致的异常归因于粒子迁移。在我们的系列中，36.2%进行胸部X线片的近距离放射治疗患者发生放射性粒子迁移，肺部粒子迁移可能受植入粒子数量的影响，似乎不受粒子类型的影响。需要对这一观察到的现象进行进一步研究。彻底的肺部检查未能发现任何短期有害副作用;然而，需要长期随访。医疗保健提供者应与考虑前列腺近距离放射治疗的前列腺癌患者讨论肺粒子迁移的可能性。(C)2002年，Elsevier Science Inc.
Objectives. To review the incidence and the impact of pulmonary seed migration after prostate brachytherapy on lung function. Isolated reports of seed migration to the lungs after prostate brachytherapy have been published; however, the clinical consequences of this pulmonary migration have not been adequately evaluated.Methods. We performed a retrospective review of patients undergoing prostate brachytherapy from 1998 to 2000. Pulmonary imaging with chest x-ray was performed 15 to 90 days (median 45) after the procedure. The chest radiographs were reviewed by a single radiologist (V.S.D.), and patients with seed migration to the lungs were evaluated by a single pulmonologist (A.M.H.) using a questionnaire, chest radiography, and pulmonary function tests. Computed tomography of the prostate after seed implantation was performed to check seed position and dosimetry. Odds ratio, confidence intervals, chi-square tests, and logistic regression analysis were performed to evaluate the relationship between the type and number of seeds used, the incidence of pulmonary migration, and the effects on pulmonary function.Results. A total of 83 patients underwent prostate brachytherapy during the study period and 58 patients underwent chest radiography. Seed migration occurred in 21 (36.2%) of 58 patients (95% confidence interval 23.8% to 48.6%). Thirty-four (0.71%) of 4755 seeds used migrated to the lungs. Nine patients had single seed migration to the right lung and three to the left lung. Nine patients had multiple (maximum of 4) and bilateral seed migration. No consistent relationship was found between seed migration and the type of seeds used (P = 0.24). Borderline statistical significance suggested an increased incidence of seed migration with an increasing number of implanted seeds (P = 0.054). Repeat chest radiography in 21 patients revealed no delayed migration at a median follow-up of 16 months. Clinical and pulmonary function testing revealed no consistent abnormality attributable to seed migration.Conclusions. Radioactive seed migration occurred in 36.2% of brachytherapy patients who had chest radiographs done in our series, Pulmonary seed migration may be influenced by the number of implanted seeds and does not appear to be influenced by the seed type. Additional study of this observed phenomenon is required. A thorough pulmonary workup failed to reveal any short-term harmful side effects; however, long-term follow-up is needed. Healthcare providers should discuss the possibility of pulmonary seed migration with patients with prostate cancer considering prostate brachytherapy. (C) 2002, Elsevier Science Inc.