Background
Methods
J-POPS study
Methods to evaluate seed migration
Toxicity scoring and follow-up schedule
Statistical analyses
Ethical considerations
Results
Methods and timeline of checking of seed migration
Incidence and sites of seed migration
PI | PI + EBRT | |||||
---|---|---|---|---|---|---|
Migration (−) | Migration (+) |
p*
| Migration (−) | Migration (+) |
p*
| |
(n = 1269) | (n = 372) | (n = 425) | (n = 94) | |||
Age: mean (median) | 68.0 (69.0) | 67.4 (68.0) | 0.1257 | 69.0 (70.0) | 68.4 (69.0) | 0.3808 |
Range | 45-89 | 51-84 | 52-88 | 53-82 | ||
PSA (ng/mL): mean (median) | 7.1 (6.4) | 7.2 (6.4) | 0.9354 | 10.7 (9.3) | 10.8 (10.4) | 0.7603 |
Range | 1.6-41.8 | 2.0-33.0 | 1.9-42.0 | 3.6-27.2 | ||
BMI: mean (median) | 23.6 (23.4) | 23.7 (23.7) | 0.1524 | 23.5 (23.4) | 23.5 (23.3) | 0.8588 |
Range | 14.7-32.8 | 17.9-32.1 | 15.5-35.7 | 17.3-29.7 | ||
Prostate volume (mL) | ||||||
Mean (median) | 26.2 (25.5) | 27.5 (26.5) | 0.0046 | 24.1 (23.4) | 25.1 (24.1) | 0.2927 |
Range | 7.3-71.0 | 10.4-56.9 | 7.0-61.9 | 11.0-60.9 | ||
Number of seeds | ||||||
Mean (median) | 72.6 (72.0) | 77.4 (75.0) | <0.0001 | 51.5 (50.0) | 53.2 (50.5) | 0.1044 |
Range | 34-120 | 26-120 | 25-85 | 35-85 | ||
Number of migrated seeds | ||||||
Mean (median) | - | 1.6 (1.0) | - | 1.5 (1.0) | ||
Range | - | 1-9 | - | 1-5 | ||
Number of needles | ||||||
Mean (median) | 22.9 (22.0) | 23.3 (23.0) | 0.1913 | 18.1 (17.0) | 18.4 (18.0) | 0.3142 |
Range | 10-45 | 12-41 | 9-36 | 11-32 | ||
Planning methods | ||||||
Preplanning | 320 | 60 | 0.1483 | 59 | 11 | 0.7385 |
Preplanning + intraoperative | 949 | 312 | 366 | 83 | ||
Loading methods | ||||||
Peripheral loading | 229 | 56 | 0.3308 | 35 | 12 | 0.2408 |
Modified peripheral loading | 1033 | 313 | 384 | 82 | ||
Modified uniform loading | 7 | 3 | 6 | - | ||
Androgen deprivation therapy | ||||||
Yes | 699 | 231 | 0.0174 | 117 | 22 | 0.4429 |
No | 569 | 141 | 308 | 72 | ||
Unknown | 1 | - | - | - | ||
Clinical T stage | ||||||
T1 | 965 | 302 | 0.1329 | 252 | 48 | 0.2662 |
T2 | 295 | 70 | 161 | 42 | ||
T3 | 2 | - | 12 | 4 | ||
Unknown | 7 | - | - | - | ||
Gleason score | ||||||
6 or less | 873 | 262 | 0.5907 | 62 | 23 | 0.0028 |
7 | 384 | 108 | 312 | 52 | ||
8 or more | 10 | 1 | 51 | 19 | ||
Unknown | 2 | 1 | - | - | ||
Risk classification (D’Amico) | ||||||
Low | 733 | 220 | 0.9139 | 9 | 4 | 0.0419 |
Intermediate | 505 | 146 | 334 | 63 | ||
High | 17 | 4 | 82 | 27 | ||
Unknown | 14 | 2 | - | - | ||
Period of checking for migration | ||||||
Day 1 | 164 | 42 | 0.4247 | 29 | 9 | 0.3806 |
1-3 months | 1105 | 330 | 396 | 85 |
PI (%) | PI + EBRT (%) |
p*
| |
---|---|---|---|
Migration | |||
Yes | 372 (22.7) | 94 (18.1) | 0.0276 |
No | 1269 (77.3) | 425 (81.9) | |
Site of migration | |||
Lung | 184 (49.5) | 47 (50.0) | |
Lung + pelvis | 48 (12.9) | 10 (10.6) | |
Lung + abdomen | 5 (1.3) | 1 (1.1) | |
Lung + abdomen + pelvis | 2 (0.5) | - | |
Lung + others | 1 (0.3) | - | |
Pelvis | 115 (30.9) | 30 (31.9) | |
Abdomen | 8 (2.2) | 2 (2.1) | |
Abdomen + pelvis | 1 (0.3) | - | |
Spinal venous plexus | - | 1 (1.1) | |
Thigh | 2 (0.5) | - | |
Unknown | 6 (1.6) | 3 (3.2) | |
Number of migrated seeds | |||
1 | 242 (65.1) | 60 (65.2) | |
2 | 84 (22.6) | 21 (22.8) | |
3 | 25 (6.7) | 8 (8.7) | |
4 | 9 (2.4) | 2 (2.2) | |
5 | 5 (1.3) | 1 (1.1) | |
6 | 3 (0.8) | - | |
7 | 3 (0.8) | - | |
8 | - | - | |
9 | 1 (0.3) | - |
Impact on radiation doses
PI | PI + EBRT | |||||
---|---|---|---|---|---|---|
Migration (−) | Migration (+) |
p*
| Migration (−) | Migration (+) |
p*
| |
(n = 1269) | (n = 372) | (n = 425) | (n = 94) | |||
D90 (Gy) | ||||||
Mean (median) | 161.1 (160.9) | 160.7 (159.8) | 0.5866 | 119.9 (120.5) | 117.7 (119.2) | 0.2627 |
Range | 78.0-231.9 | 86.4-223.7 | 60.2-191.6 | 74.3-161.4 | ||
V100 (%) | ||||||
Mean (median) | 93.7 (94.8) | 93.5 (94.9) | 0.7332 | 94.9 (96.2) | 94.1 (95.9) | 0.2491 |
Range | 63.6-100.0 | 56.3-100.0 | 56.5-100.0 | 68.3-99.8 | ||
V150 (%) | ||||||
Mean (median) | 62.6 (63.5) | 60.7 (60.7) | 0.0184 | 63.6 (64.6) | 60.9 (61.1) | 0.0731 |
Range | 20.8-94.6 | 18.4-91.6 | 16.3-90.7 | 30.3-87.0 | ||
UD90 (Gy) | ||||||
Mean (median) | 141.7 (142.5) | 138.2 (136.1) | 0.0258 | 110.3 (111.1) | 106.9 (104.7) | 0.1019 |
Range | 7.9-336.5 | 15.7-255.3 | 40.0-180.0 | 43.5-170.4 | ||
UD5 (Gy) | ||||||
Mean (median) | 228.6 (225.2) | 222.4 (218.7) | 0.0371 | 169.0 (161.5) | 162.6 (160.2) | 0.1570 |
Range | 119.0-427.0 | 125.9-338.2 | 97.6-338.4 | 102.0-251.6 |
Planning and implant methods
Seed migration incidence stratified by methods of chest radiography
Seed migration incidence stratified by the time of study enrollment
Adverse events
Discussion
Definition of seed migration
Seed migration incidence
Percentage of patients with migration | |||||||||
---|---|---|---|---|---|---|---|---|---|
Authors | Year | Number of patients | Numbers of PI/PI + EBRT | Isotope | Lung | Others | Lung + Others | Percentage of total seeds | Time of checking for migration |
Grimm et al. [21] | 1993 | 221 | 221/0 | I-125/Pd-103 (loose) | 17.6 | - | - | - | Day 1 |
Nag et al. [22] | 1997 | 107 | 107/0 | Pd-103 (loose) | 17.8 | - | - | 0.3 (lung) | 1 month |
Tapen et al. [23] | 1998 | 289 | 244/45 | I-125/Pd-103 (loose, linked) | 5.9 (loose 11.0, linked 0.7 ) | - | - | - | Day 1 |
Merrick et al. [10] | 2000 | 175 | 73/102 | I-125/Pd-103 (loose, linked) | 21.8 (loose 22.2, linked 21.4) | - | - | 0.22 (lung) | <14 days, or >30 days |
Older et al. [11] | 2001 | 110 | 110/0 | Pd-103 (loose) | 29.0 | - | - | - | 1-16 months |
Ankem et al. [24] | 2002 | 58 | Unknown | I-125/Pd-103 (loose) | 36.2 | - | - | 0.72 (lung) | 15-90 days (median 45 days) |
Eshleman et al. [19] | 2004 | 100 | 100/0 | I-125/Pd-103 (loose) | 55.0 | - | - | 0.98 (lung) | 2-3 months |
Chauveinc et al. [25] | 2004 | 170 | 170/0 | I-125 (loose) | 16.0 | - | - | 0.26 (lung) | 2 months |
Kunos et al. [26] | 2004 | 120 | 120/0 | I-125/Pd-103 (loose) | 43.0 | - | - | 0.54 (lung), 0.33 (pelvis) | Median 133 days |
Fueller et al. [20] | 2004 | 37 | 37/0 | I-125/Pd-103 (loose) | 24.0 | 5.4 | - | 0.193 (lung), 0.035 (pelvis) | 3-12 months |
23 | 23/0 | I-125/Pd-103 (linked) | 0 | 0 | - | 0 | 3-12 months | ||
Stone et al. [12] | 2005 | 238 | 199/39 | I-125/Pd103 | 1.7 | - | - | - | Median 30 months |
Saibishkumar et al. [13] | 2009 | 20 | 20/0 | I-125 (loose) | 20.0 | - | - | 0.23 | 1 month |
20 | 20/0 | I-125 (linked) | 0 | - | - | 0 | 1 month | ||
Kono et al. [8] | 2010 | 62 | 62/0 | I-125 (loose) | - | - | 69.4 | 0.87 (lung), 1.4 (abdomen + pelvis + thigh) | 1 month (scintigraphy) |
Sugawara et al. [9] | 2011 | 267 | 265/2 | I-125 (loose) | 22.2 | 7.9 | - | 0.36 (lung), 0.11 (abdomen + pelvis) | Median 41 months |
Taussky et al. [7] | 2012 | 495 | 495/0 | I-125 (loose) | 10.3 | - | 22.8 | 0.26 (lung), 0.58 (lung + others) | 1 month |
Miyazawa et al. [29] | 2012 | 121 | 116/5 | I-125 (loose) | - | - | 25.6 | 0.65 (total), 0.28 (lung), 0.34 (others) | 12 months |
Ishiyama et al. [42] | 2014 | 66 | 66/0 | I-125 (loose) | 30.0 | 39.3 (abdominopelvis) | 52* | - | 1 month |
74 | 74/0 | I-125 (linked) | 0 | 0 | 0 | - | 1 month | ||
J-POPS | 2015 | 1641 | 1641/0 | I-125 (loose) | 14.6 | 11.1 | 22.7 | 0.49 (lung+others) | Day 1 to 3 months |
519 | 0/519 | I-125 (loose) | 11.2 | 8.5 | 18.1 | 0.53 (lung+others) | Day 1 to 3 months |