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Prostate HDRB vs seed implant
>Date: Wed, 25 Feb 1998 11:44:58 -0600
>Reply-To: Medical Physics Mailing List <MEDPHYS@LISTS.WAYNE.EDU>
>Sender: Medical Physics Listserver <medphys@lists.wayne.edu>
>From: "Alecu, Rodica" <RAAlecu@PRNINC.COM>
>Subject: Prostate HDRB vs seed implant
>To: Multiple recipients of list MEDPHYS <MEDPHYS@LISTS.WAYNE.EDU>
>
>
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>Sorry for the delay in answering your requests and questions. Because of
>the extensive number of messages, I decided to follow your advice and
>send the response to the MedPhys server.
>
>Here are the answers:
>1. Yes, it is a good idea to bring your radiation oncologist to courses
>on HDRB for prostate cancer, so they can discuss themselves with the
>physicians performing the technique.
>
>2. No, there are no more openings for the course on HDRB for prostate
>cancer organized by us here in February (we limit the number of
>participants because we want everybody to have the chance to actually
>perform the whole procedure).
>I can send you a registration form for the next course (the 3rd one),
>which will be held in May immediately after the conference on New and
>Future Developments in HDRB (May 2-3, 1998, Dallas, TX). That course
>still has a few openings.
>
>3. Here are some references advocating HDRB :
>* A.M. Nisar Syed et al, "High Dose Rate Brachytherapy in the
>treatment of carcinoma of the prostate: preliminary results", J
>Brachytherapy intl 13, 315-331 (1997)
>* T. P. Mate et al, "High Dose Rate Brachytherapy of the
>prostate", in High Dose Rate Brachytherapy: a Textbook; edited by S. Nag
>(Futura Publishing Co., Inc., NY, 1994)
>
>In addition to the advantages already mentioned by some of our
>colleagues such as:
>* reduced radiation exposure to the staff
>* no need to worry about:
> * obtaining the seeds
> * training staff which does not work in the
>radiation therapy department
> * seeds eliminated by the patient
> * patient's death with radioactive sources within
>the body, etc.
>I think that HRDB offers the benefit of the most conformal irradiation
>(using 3D treatment planning otimization of dwell times and positions)
>and I like the idea that it is " not permanent", i.e. it can be
>adjusted even after the implant has been performed (some of the needles
>might not be "loaded", etc.), while with the seed implants, once the
>seeds have been introduced it is "difficult" to remove them... For
>prostate implants, conformal treatment is critical due to the pear -like
>shape of the prostate with internal (urethra) and adjacent (bladder and
>rectum) radiosensitive structures. Differential loading is a desirable
>feature because the bulky portions of the tumors typically lie at
>peripheral locations within the prostate - and it is difficult to load
>with seeds only the periphery of the gland. Even if the seed implant was
>perfect, it was shown that seeds migrate...
>There are at least two papers on pulmonary embolization of permanently
>implanted radioactive seeds for carcinoma of the prostate:
>S. Gupta et al, Endocurietherapy, 9, 27-31 (1993) and S. Nag et al, Int.
>J. Radiation oncology Biol. Phys, vol.39, 3, 667-670 (1997)
>
>An interesting paper is written by Andy Grove, ("Taking on prostate
>cancer"). The Intel's CEO describes how, after he was diagnosed with
>prostate cancer, did his own literature search for choosing the
>treatment modality. By day he was setting up appointments with doctors
>and by night he was reading scientific papers, plotting and
>cross-plotting the data (he did the same think years ago in the field of
>semiconductor devices). He published his results, comparing the
>treatment options, in the Fortune magazine/ Health, May, 1996 for
>allowing any potential patient to benefit of his research. He chose
>HDRB.
>