Brachytherapy seed migration to the lung
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At the time the article was created Maria Ana Serrado had no recorded disclosures.View Maria Ana Serrado's current disclosures
At the time the article was last revised Ashesh Ishwarlal Ranchod had no financial relationships to ineligible companies to disclose.View Ashesh Ishwarlal Ranchod's current disclosures
Regarding staging, nearly 79% of the cases are localized, 12% are regional and 5% present with distant disease 1. Currently, there are several management options for prostate cancer, including active surveillance, radical prostatectomy and radiation therapy (external beam and brachytherapy).
The most frequent site of seed migration is the lung. Sugawara et al. reported 0.36% of implanted seed migration to the chest in 20% of patient population 2.
The proposed migration route is via the periprostatic veins to the iliac veins, right heart and then the lungs 3. Migration to the heart, coronary arteries, liver, bladder, renal arteries and testicular vein has also been reported 4-11.
The majority of the cases are asymptomatic and incidentally found.
Usually, only one or two seeds migrate, and therefore it has no significant effect on postimplant dosimetry 2.
On CT the migrated seed appears as a linear hyperdense structure, with extreme beam and streak artifacts relative to their small size.
Treatment and prognosis
The latest consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy by the American Brachytherapy Society no longer recommends the use of imaging methods for the detection of seed migration 13. The American College of Radiology appropriateness criteria follows the same recommendations as the American Brachytherapy Society 14.
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