Nag S, Vivekanandam S, Martínez-Monge R
Division of Radiation Oncology, Arthur G. James Cancer Hospital and Research Institute, The Ohio State University, Columbus 43210, USA.
Int J Radiat Oncol Biol Phys. 1997 Oct 1;39(3):667-70. doi: 10.1016/s0360-3016(97)00342-8.
It has been reported that permanently implanted iodine-125 seeds can embolize to the lungs. There is little data on the embolization of palladium-103 seeds. The purpose of this study is to collect and evaluate data on the embolization of Pd-103 seeds.
The records of 112 patients implanted with Pd-103 for carcinoma of the prostate were reviewed to systemically study the incidence and dynamics of pulmonary embolism of Pd-103 seeds. Five patients had no postoperative chest radiograph and were thus excluded, leaving 107 patients for review.
Chest radiographs of 19 of the 107 patients showed embolized seeds in the lungs (18%). Two patients had three seeds each, nine patients had two seeds each; and in the remaining eight patients, a single seed migrated to the lungs. The seeds migrated mainly (84%) to the lower lobes. None of the eight patients who had their first postoperative chest radiograph on the day of the implant showed any embolized seeds. The embolized seed appeared only on subsequent chest radiographs taken 27 to 40 days later. Ten of the other 11 patients who had their first radiograph 1 to 97 days after brachytherapy had embolized seeds on their first chest radiograph. In the other patient, the embolized seed appeared only on a subsequent chest radiograph taken after 127 days. There were no clinical pulmonary or cardiac effects evident on routine follow-up of these patients with pulmonary embolized seeds.
Embolization of Pd-103 seeds to the lungs after implantation for carcinoma of the prostate is an unusual event. In this study only 0.3% of the seeds implanted migrated to the lungs. Although it was previously thought that pulmonary seed migration mainly occurred on the day of brachytherapy, our experience shows that seeds usually migrated to the lungs after the day of the implant. There were no clinical pulmonary or cardiac effects attributable to embolized seeds in the lungs on routine follow-up.
据报道，永久植入的碘 - 125种子可栓塞至肺部。关于钯 - 103种子栓塞的数据很少。本研究的目的是收集和评估钯 - 103种子栓塞的数据。
回顾了112例因前列腺癌植入钯 - 103的患者记录，以系统研究钯 - 103种子肺栓塞的发生率和动态变化。5例患者术后未行胸部X线检查，因此被排除，剩余107例患者进行回顾性分析。
107例患者中的19例胸部X线片显示肺部有栓塞种子（18%）。2例患者各有3枚种子，9例患者各有2枚种子；其余8例患者中，有1枚种子迁移至肺部。种子主要（84%）迁移至下叶。8例在植入当天进行首次术后胸部X线检查的患者中，均未显示有栓塞种子。栓塞种子仅出现在随后27至40天拍摄的胸部X线片上。在近距离放射治疗后1至97天进行首次X线检查的其他11例患者中，10例在首次胸部X线片上有栓塞种子。另一例患者的栓塞种子仅出现在127天后拍摄的后续胸部X线片上。这些肺部有栓塞种子的患者在常规随访中未发现明显的临床肺部或心脏影响。
前列腺癌植入术后钯 - 103种子栓塞至肺部是一种不常见的事件。在本研究中，仅0.3%的植入种子迁移至肺部。尽管以前认为肺部种子迁移主要发生在近距离放射治疗当天，但我们的经验表明，种子通常在植入后迁移至肺部。常规随访中，肺部栓塞种子未导致明显的临床肺部或心脏影响。
