The effect of the radial function on I-125 seeds used for permanent prostate implantation

Abstract

The purpose of this study was to evaluate the integrity of eight commercially-available low-activity Iodine-125 ( 125I) seeds for their radial function g(r) and its effect on the dose delivered to the adjacent critical structures when used in permanent prostate implants (PPI). Ten previously treated patients were retrospectively used in this comparison. The Amersham Health Oncura seed was used to peripherally design an isodose distribution with urethral and anterior rectal wall sparing. Plan criteria included minimum coverage of 144 Gy to the planning target volume (PTV), ≤ 70% dose to 150% of the PTV volume (V150-PTV), and the quantity of needles ≤ 70% of the size of the PTV, in cc. Upon completion of the Oncura plan, the seed type was changed and the activity was adjusted until the V100-PTV for each of the other 7 seed types matched the V100-PTV defined by the Oncura seed. Computed tomography (CT)-based postimplant dosimetry was used to determine the dose to 40% (D40) of the bulb of the penis (in Gy). Dose-volume histograms (DVH) were used to evaluate the differences to V100 (in %) and D40 (in Gy) of the anterior rectal wall and bulb of the penis, and V100 (in %) of the urethra. The data was tabulated. Radioactive 125I sources included in this study were 125I Source 2301 (Best); I-Plant (MedTech), IoGold (Mentor), Oncura (Amersham Health), ProstaSeed (UroCor), SelectSeed (Nucletron), SourceTech (Bard), and Symmetra (UroMed). The sizes of the PTV for the 10 patients ranged from 18.82 cc to 48.99 cc. The Oncura seed was used as the reference seed and all other seed types were normalized to it for data comparison. It was determined that the dose rate constant (⋀) and anisotropy factor (φ) contribute to the activity needed to achieve comparable V100-PTV doses, but a strong dependence on the radial function g(r) was found to effect the doses to the critical structures studied. Values of g(r) at 4 cm were calculated and the IoGold and SourceTech seeds were determined to have the highest g(r) values, with ProstaSeed and SelectSeed having the lowest values. 125I Source 2301 and IoGold required less activity per seed to achieve the same dose to the V100-PTV due to the higher dose rate and anisotrophy constants (⋀.φ). The seed types with silver were less penetrating and resulted in the production of characteristic x-rays that modified the energy spectrum and influenced the radial function. The seeds requiring the lowest activity showed the highest dose to the anterior rectal wall, a posterior adjacent structure; the urethra, an interior structure; and the bulb, an inferior structure. This study was designed to investigate the integrity of eight different commercially-available seed types, and their dependence on the g(r) in seed choice. It was determined that the dose rate constant and anisotropy factor determine the activity needed for implantation but a strong dependence on the radial function was found to effect the doses to the adjacent structures.