Insertion Radioactive Transplant
- What is Insertion Radioactive Transplant
- Effects of Insertion Radioactive Transplant
- Candidates for Insertion Radioactive Transplant
- Your Consultation
- The Insertion Radioactive Transplant Procedure
What is Insertion Radioactive Transplant?
Brachytherapy is a radiation therapy that can be used as a prostate cancer treatment. Sometimes referred to as interstitial radiation therapy, seed therapy, or seed treatment, prostate brachytherapy is capable of delivering high and concentrated doses of radiation to the prostate gland.
Effects of Insertion Radioactive Transplant
Candidates for Insertion Radioactive Transplant
Before the procedure patients usually start antibiotics to help prevent an infection and undergo mechanical bowel preparation. Not eating anything after midnight or taking enemas or laxatives are all examples of bowel preparation. Fecal matter could interfere with the treatment. Before beginning, an anesthesiologist puts a patient under general or spinal anesthesia that numbs him from the waist down. Patients who remain awake should not laugh, cough, or talk because these activities could upset the precision of the treatment.
The Insertion Radioactive Transplant Procedure
Patients who pursue temporary brachytherapy as their prostate cancer treatment will undergo a planning stage. A radiation oncologist, an urologist, and a physics team will carefully plan the minimally invasive surgery to ensure the seed is put in the correct location. The radiation oncologist and the physics team design a map for the flexible plastic catheters. The oncologist uses the transrectal ultraound (TRUS) to take pictures of the prostate and surrounding organs every five millimeters. After imaging, which takes about 15 minutes, the oncologist writes a prescription for the amount of radiation needed, then gives the prescription and images to the physics team. The physics team arranges a pattern for the small and flexible catheters that will be inserted into the prostate gland.
During the minimally invasive surgery, only one iridium-194 seed is used. The seed is inserted through the catheters one at a time. Because they are flexible plastic instead of rigid steel, the catheters can be guided to wherever the medical team plans for them to go. An urologist can maneuver around an enlarged prostate gland or an interfering pubic arch. Patients therefore do not need to undergo neoadjuvant hormone therapy.
Most patients move around freely as soon as the catheters are removed and the anesthesia wears off. Doctors will prescribe antibiotics and possibly an alpha-blocker, which relaxes the neck of the bladder and decreases the severity of urinary side effects. Patients may also take over-the-counter medications to alleviate soreness in the perineum. Some patients will use ice packs the next day or two to reduce swelling.
Temporary brachytherapy leaves no radioactive seeds inside the body, therefore, there is no risk for seed migration. Some researchers are also finding that high dose rate brachytherapy has a lower incidence of cold and hot spots. A cold spot occurs when an area is not adequately irradiated, while a hot spot occurs when an area is over-irradiated. Cold spots may lead to prostate cancer recurrence while hot spots may lead to damage of the rectum or bladder.
What is Brachytherapy?
Brachytherapy, sometimes referred to as implants or intracavitary radiation is a radiation treatment method capable of delivering higher dose than external beam radiation can deliver. Brachytherapy involves insertion of sealed radioactive sources either directly into the patient’s tumor (known as the interstitial method) or into a body cavity close to the tumor (the intracavitary method). Radiation oncologists use either interstitial catheters or intracavitary containers to place the radioactive material.
What are the treatments available?
Prostate Cancer may be treated with IMRT or one of two types of brachytherapy- Permanant Seed Implants (PSI) and Temporary High Dose Rate Implants. Prostate seed implantation, in which tiny radioactive “seeds” of iodine-125 are implanted into the prostate. Ultrasound imagery, computed tomography and advanced computerized implant dosimetry enable placement of radioactive seeds with a high degree of accuracy. Once a patient is approved for seed implant by the brachytherapy team, a set of ultrasound images of the prostate is obtained with a rectal probe. These images are used to plan the distribution of radioactive seeds in the prostate. The radiation oncologist, a medical physicist and a dosimetrist determine the optimal seed distribution to deliver an appropriate dose to the cancer in the prostate while minimizing radiation exposure for the urethra, rectum, bladder and other critical structures. The procedure itself is relatively painless.
What is permanent low dose radiation (LDR)?
LDR brachytherapy is uses iodine-125 and palladium-103 stored in titanium cases usually referred to as brachytherapy seeds. As the name permanent brachytherapy suggest, the seeds are permanently left inside the prostate gland. Over the course of their radioactive lives, the seeds will continuously emit low levels of radiation.
What is temporary high dose radiation (HDR)?
HDR brachytherapy uses a single radioactive seed made of iridium-194 which is sometimes referred to as an iridium wire. Soft flexible plastic catheters are inserted through the perineum and into the prostate gland. HDR brachytherapy entails an overnight stay in the hospital during which a patient undergoes two or three treatments with the wire through each catheter.
What happens during the procedure?
A hospital stay for temporary brachytherapy lasts 24 to 36 hours because a patient receives two or three treatments. He is placed in the lithotomy position, meaning his feet are put into stirrups and his legs are lifted to 90 degrees. This position gives the doctor a clear view of the perineum, which is cleaned and then possibly shaved according to the practice of the center. The doctor inserts an ultrasound probe into the rectum and attaches it to a stabilizing device which holds the tool for the duration of the treatment.