**Brachytherapy and Intraoperative Radiation Treatments**

132 Modern Practices in Radiation Therapy

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**8** 

 *USA* 

**Prostate Seed Brachytherapy – Methods to** 

Mark E. Smolkin, Stanley H. Benedict and Bernard F. Schneider

Prostate cancer is diagnosed in over 230,000 men each year in the United States (Jemel, et al, 2006), and with the use of screening prostate specific antigen (PSA) the majority is diagnosed with locally confined prostate cancer. Many of these patients are good candidates for prostate brachytherapy. With the development of transperineal implantation using trans-rectal ultrasound guidance the number of patients undergoing permanent radioactive seed implants for prostate cancer has increased significantly over the past ten years.

A variety of techniques have been used to deliver transperineal prostate brachytherapy, using Pd-103, I-125 and, more recently, Cs -131(Sommerkamp, et al 1988, Reed, et al, 2007, Spadlinger, et al, 2006, Meigooni, et al, 2004, Yue, et al, 2005). These sources are typically implanted as individual seeds, or as seeds that are stranded together or held together using plastic linking devices (Sommerkamp, et al 1988, Reed, et al, 2007, Spadlinger, et al, 2006). Stranded or linked seeds have the advantage that they are less likely to migrate from their implant position than individually implanted seeds (Sommerkamp, et al 1988, Reed, et al, 2007, Spadlinger, et al, 2006). Additionally, implants can be either performed via pre-plans, in which a planning ultrasound is performed before the surgery, or with intra-operative

While a linear brachytherapy source in the form of a coiled 103Pd wire was developed, it never became available clinically (Meigooni, et al, 2004). The possibility of using a continuous linear source led to the consideration of continuously linked seeds in an implant rather than the normal use of seeds separated by spacers. The elimination of spacers would allow the same number of seeds to be implanted into the prostate with fewer needles. The number of needles used in prostate seed implants has been shown to be correlated with acute urinary morbidity after seed implantation. (Eapen, et al, 2004, Ohashi, et al, 2006, Bucci, et al, 2002, Lee, et al, 2000, Buskirk, et al, 2004, Bottomley, et al, 2007, Keyer, et al, 2009, Thomas, et al, 2008). Also, the use of fewer needles should cause less trauma to the base of the penis, which may help preserve erectile function (Macdonald, et al, 2005,

**1. Introduction** 

(Cooperberg, et al, 2004).

planning (Matzkin, et al, 2003).

Steggerda, et al, 2010).

**Improve Implant Characteristics** 

Bruce Libby, Matthew D. Orton, Haidy Lee,

*University of Virginia Health System,* 

 *Charlottesville, Virginia,* 
