The Journal of Biblical Integration in Business, 2016
This paper references research done on Servant Leadership theories across a span of some 45 years... more This paper references research done on Servant Leadership theories across a span of some 45 years since Greenleaf ’s first work on the subject. It catalogs 15 Servant Leadership theories based on Scripture. In doing so, it identifies a perceived gap in these theories using theological and hermeneutical arguments. It also is a reference point for further research to consider where the redemptive work of Christ fits into leadership models that draw upon His life and work as their source.
The dosimetric quality of seed implants is a crucial part of the prostate brachytherapy treatment... more The dosimetric quality of seed implants is a crucial part of the prostate brachytherapy treatment procedure. Incorrect seed placement during or after deployment leads to both short and long term complications, including urethral and rectal toxicity. The BrachyView system is a fast intraoperative planning system, providing real-time dosimetric information by acting as an in-body gamma camera. It incorporates three tiled
The AIDS virus of cat species, feline immunodeficiency virus (FIV), has been used extensively as ... more The AIDS virus of cat species, feline immunodeficiency virus (FIV), has been used extensively as an animal model of HIV-1 infection. This felid lentivirus shares many molecular and biochemical traits with HIV-1 and causes similar immunologic and clinical perturbations, most notably CD4 + cell loss, impaired cell-mediated immunity and increased susceptibility to opportunistic pathogens. Previous reports have shown that FIV is transmitted horizontally by biting and vertically in utero and through nursing. Our objective was to determine whether FIV could be venereally transmitted in domestic cats. In the first experiment, susceptibility of the female reproductive tract to mucosal transmission of the FIV isolate, NCSU 1 , was demonstrated via intravaginal inoculation with infected cultured cells. We next identified virus in electroejaculates from asymptomatic, chronically FIV-NCSU 1-infected, adult males. A fragment of FIV gag provirus DNA was detected by nested polymerase chain reaction (PCR) in nonfractionated seminal cells and in swim-up sperm preparations. Additionally, replication-competent virus was isolated from cell-free seminal plasma and seminal cells by co-cultivation with a feline CD4 + T-cell line. In the third study, queens were artificially inseminated via an intrauterine laparoscopic technique with electroejaculates from FIV-NCSU 1-infected males. Of six inseminations carried out with fresh semen, three resulted in infection of queens. Lastly, immunohistochemical studies identified
The acute stage of feline immunodeficiency virus (FIV) infection is characterized by a CD8 / anti... more The acute stage of feline immunodeficiency virus (FIV) infection is characterized by a CD8 / anti-FIV response that parallels the appearance of a CD8 / subpopulation with reduced expression of the b chain (CD8a / b lo). The relationship between the CD8a / b lo phenotype and CD8 / anti-FIV activity was examined. Flow cytometric analysis of peripheral blood mononuclear cells with anti-CD8 b chain monoclonal antibody 117 revealed that the CD8a / b lo phenotype expanded throughout the asymptomatic infection, constituting 80%-90% of the CD8b / cells in long-term-infected cats. Purified CD8a / b hi and CD8a / b lo subpopulations were analyzed for anti-FIV activity in an acute infection assay. Anti-FIV activity resided principally in the CD8a / b lo population and was demonstrated in acute FIV infections, as well as in long-term asymptomatic infections. These data suggest that a unique CD8a / b lo anti-FIV phenotype arises early in infection and may play a major role in eliminating virus and maintaining the asymptomatic infection.
International Journal of Radiation Oncology*Biology*Physics, 2006
To evaluate the incidence and factors predictive of acute urinary retention (AUR) in 805 consecut... more To evaluate the incidence and factors predictive of acute urinary retention (AUR) in 805 consecutive patients treated with prostate brachytherapy monotherapy and to examine the possible effect of a learning curve. Between July 1998 and November 2002, 805 patients were treated with prostate brachytherapy. Low-risk patients (Gleason Score (GS) < or = 6; prostate specific antigen (PSA) < or = 10, and < or = T2b [UICC 1997]) received implant alone. Patients with prostate volume of 50 cc or more, GS = 7, or PSA = 10 to 15 received 6 months of androgen suppression (AS) with brachytherapy. Patient, treatment, and dosimetric factors examined include baseline prostate symptom score (IPSS), diabetes, vascular disease, PSA, Gleason score, clinical stage, AS, ultrasound planning target volume (PUTV), postimplant prostate volume (obtained with "Day 30" postimplant CT), CT:PUTV ratio (surrogate for postimplant edema), number of seeds, number of needles, number of seeds per needle, dosimetric parameters (V100, V150, and D90), date of implant (learning curve), and implanting oncologists. Univariate and multivariate analyses were carried out. Acute urinary retention in the first 200 patients was 17% vs. 6.3% in the most recently treated 200 patients (p = 0.002). Overall AUR was 12.7%, and prolonged urinary obstruction incidence…
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: To evaluate the incidence and duration of urinary retention requiring catheterization an... more Purpose: To evaluate the incidence and duration of urinary retention requiring catheterization and the factors predictive for these end points. Methods and Materials: Two hundred eighty-two patients treated with prostate brachytherapy alone were evaluated. Clinical and treatment-related factors examined included: age, baseline International Prostate Symptom Score (IPSS), presence of comorbidity, planning ultrasound target volume (PUTV), postimplant prostate CT scan volume, the CT:PUTV ratio, number of seeds inserted, number of needles used, use of neoadjuvant hormones, procedural physician, clinical stage, Gleason score, and pretreatment PSA. Dosimetric quality indicators were also examined. Results: Urinary obstruction after prostate brachytherapy developed in 43 (15%) patients. The median duration of catheter insertion was 21 days (mean 49, range 1-365). Univariate analysis demonstrated that presence of diabetes, preimplant volume, postimplant volume, CT:PUTV ratio, number of needles, and dosimetric parameters were predictive for catheterization. However, in multivariate analysis, only the baseline IPSS, CT:PUTV ratio, and presence of diabetes were significant independent predictive factors for catheterization. Conclusion: Baseline IPSS was the most important predictive factor for postimplantation catheterization. The extent of postimplant edema, as reflected by the CT:PUTV ratio, predicted for need and duration of catheterization. The presence of diabetes was predictive for catheterization, but may relate to the absence of prophylactic steroids, and therefore requires further evaluation.
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: To assess and compare two models for a surrogate urethra to be used for postimplant dosi... more Purpose: To assess and compare two models for a surrogate urethra to be used for postimplant dosimetry in prostate brachytherapy. Methods and Materials: Twenty men with a urinary catheter present at the time of postimplant computed tomographic imaging were studied. Urethral and periurethral volumes were defined as 5-mm and 10-mm diameter volumes, respectively. Three contours of each were used: one contour of the true urethra (and periurethra), and two surrogate models. The true volumes were centered on the catheter center. One surrogate model used volumes centered on the geometrical center of each prostate contour (centered surrogate). The other surrogate model was based on the average deviation of the true urethra from a reference line through the geometrical center of the axial midplane of the prostate (deviated surrogate). Maximum point doses and the D 10 , D 25 , D 50 , D 90 , V 100 , V 120 , and V 150 of the true and surrogate volumes were measured and compared (D n is the minimum dose [Gy] received by n% of the structure, and V m is the volume [%] of the structure that received m% of the prescribed dose) as well as the distances between the surrogate urethras and the true urethra. Results: Doses determined from both surrogate urethral and periurethral volumes were in good agreement with the true urethral and periurethral doses except in the superior third of the gland. The deviated surrogate provided a physically superior likeness to the true urethra. Certain dose-volume histogram (DVH)-based parameters could also be predicted reasonably well on the basis of the surrogates. Correlation coefficients >0.85 were seen for D 25 , D 50 , V 100 , V 120 , and V 150 for both models. All the other parameters had correlation coefficients in the range of 0.73-0.85. Conclusions: Both surrogate models predicted true urethral dosimetry reasonably well. It is recommended that the simpler deviated surrogate would be a more suitable surrogate for routine clinical practice.
International Journal of Radiation Oncology*Biology*Physics, 2004
To the Editor: Anagnostopoulos et al. address a most important point in their paper. Clearly, fro... more To the Editor: Anagnostopoulos et al. address a most important point in their paper. Clearly, from a clinical aspect, accurate and precise dose verification is essential when large hypofractionated treatments are used. We would like to draw the attention of the readers of IJROBP to the fact that a different type of thermoluminescence dosimetry material may even be more suitable for the in vivo dosimetry measurements as our group has proposed about 1 year ago (1). We would suggest that LiF:Mg,Cu,P, a relatively new material in medical radiation dosimetry, is significantly better for the propose application for the following reasons: 1. LiF:Mg,Ti thermoluminescence dosimeters (TLDs) as used by Anagnostopoulos et al. are known to overrespond to low-energy X-rays by up to 50% (2, 3). Although in the published study, this overresponse effect is not likely to dominate close to an iridium source, it would be significant if measurements are taken in other clinically relevant regions, for example, periphery of the planning target volume, urethra, and rectum, where the distance from the source is further and the energy spectrum may change. LiF:Mg,Cu,P has a more uniform response to different photon energies (2, 4) and can therefore be used with less concern for variations in effective photon energy at the point of measurement. 2. LiF:Mg,Cu,P is also approximately 20 to 30 times more sensitive than LiF:Mg,Ti (4, 5). This allows for better precision in the measurements and a wider choice of measurement locations. An example is Patient 2 of the publication (Fig. 3b), where there appears to be an uncertainty of at least 4Gy (20% of predicted). We believe that additional precision and accuracy could be achieved by using miniature LiF:Mg,Cu,P TLDs as investigated by Hood et al. (1) and Duggan (5). LiF:Mg,Cu,P does not require a complex correction for dose or energy response (linear dose response to 20Gy) (2) as well as allowing improved spatial resolution (0.5 mm diameter ϫ 3 mm long, MCP-Np; TLD, Krakow, Poland). Miniature LiF:Mg,Cu,P TLDs (1, 5, 6) in combination with a real-time dosimeter (7) might lead to further optimization of dose delivery and accurate monitoring of urethral and rectal doses in prostate brachytherapy. As a consequence, miniature LiF:Mg,Cu,P TLDs are being applied to prostate cancer brachytherapy in an Australia-wide quality assurance intercomparison of prostate brachytherapy treatment delivery in conjunction with the Trans Tasman Radiation Oncology Group (TROG) RADAR trial.
International Journal of Radiation Oncology*Biology*Physics, 2009
To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and &a... more To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and "low-tier" intermediate-risk prostate cancer and explore the relationship between the traditional dosimetric values, V100 (volume of prostate receiving 100% of the prescribed dose) and D90 (minimum dose to 90% of the prostate), and risk of biochemical failure. A total of 1,006 consecutive patients underwent implantation between July 20, 1998, and Oct 23, 2003. Most (58%) had low-risk disease; the remaining 42% comprised a selected low-tier subgroup of intermediate-risk patients. The prescribed minimum peripheral dose (MPD) was 144 Gy. All implants used 0.33 mCi 125I sources using a preplan technique featuring right-left symmetry and a strong posterior-peripheral dose bias. Sixty-five percent of patients had 6 months of androgen deprivation therapy. Postimplantation dosimetry was calculated using day-28 CT scans. With a median follow-up of 54 months, the actuarial 5-year rate of freedom from biochemical recurrence (bNED) was 95.6% +/- 1.6%. Median D90 was 105% of MPD, median V100 was 92%, median V150 was 58%, and median V200 was 9%. Dosimetric values were not predictive of biochemical recurrence on univariate or multivariate analysis. Analysis of dosimetric values by implantation number showed statistically significant increases in all values with time (D90, V100, V150, and V200; p…
The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation... more The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation treatment for ovarian cancer patients treated with primary surgery and chemotherapy, followed by second-look laparotomy (SLL). Overall survival and acute and late toxicity of treated patients were assessed. Patients were recruited between April 1981 and June 1994. All patients had SLL performed at Royal Prince Alfred Hospital after completion of primary chemotherapy. Data collected included demographic details, diagnosis, tumor stage, histology, grade, adjuvant chemotherapy, and radiotherapy. Radiation dose and fractionation, field size, boost volume and dose, failure to complete treatment and treatment interruptions, renal dose, and acute and late toxicity were recorded. Fifty-one patients were evaluated; the median age was 51 years. Median follow-up for patients still alive was 62 months. Prior to 1988, chemotherapy comprised oral chlorambucil, with or without cisplatin (n = 25), while after this date all patients (n = 26) received primary cisplatin-based therapy. A radiation dose of 22. 5 Gy over 22 fractions was planned to the whole abdomen followed by a pelvic boost of 22 Gy in 11 fractions. Radiotherapy was completed in 37 (73%) patients. Treatment interruptions were necessary in 12 (24%) patients. Thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea were the main causes of incomplete or interrupted treatment. Late bowel toxicity was seen in 6 (12%) patients, 2 of whom required laparotomy to relieve obstruction. There were no treatment-related deaths. Seven of the 51 patients are alive and free of disease, 2 died from other causes, and 2 are alive with evidence of recurrent or progressive disease. Mean follow-up time for surviving patients is 78.5 months. Overall survival at 2, 5, and 10 years was 65, 27, and 10%, respectively. Residual disease after primary surgery, smaller preirradiation tumor residuum, and completion of radiotherapy were independently associated with improved overall survival. In this poor-prognosis group of patients, a combined approach of surgery, chemotherapy, and radiotherapy, while associated with acceptable toxicity, may not afford a prolongation of survival.
Comparison of intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IV... more Comparison of intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IVF) in patients with non-male factor infertility.
OBJECTIVE: To determine if a difference exists in pregnancy rate in natural and synthetic FET cyc... more OBJECTIVE: To determine if a difference exists in pregnancy rate in natural and synthetic FET cycles. DESIGN: Retrospective analysis of FET cycles. MATERIALS AND METHODS: From December 2002 to April 2008, 612 FET cycles were performed. In natural FET cycles, no exogenous follicular phase estrogens were given. In synthetic FET cycles, exogenous estradiol was given until endometrial thickness was R7mm in diameter, by transvaginal ultrasonography. When necessary, GnRH down-regulation was used to prevent a premature LH surge in synthetic FET cycles. Embryo transfer occurred 7 days after evidence of a spontaneous LH surge or 5 days after administration of exogenous progesterone. In natural cycles, the luteal phase was supplemented with vaginal and/or oral progesterone; in synthetic cycles, intramuscular progesterone was used. Cycles were excluded from analysis if embryo transfer was not performed in the fresh embryo cycle, endometrial growth was poor (maximum thickness <7mm) or subjects had diminished ovarian reserve (day 3 FSH>13 mIU/mL), to reduce confounding. 167 natural FET cycles were matched by age, number of embryos cryopreserved, and source of oocyte (autologous or donor) to 167 synthetic FET cycles. Top-quality embryos were expanded blastocysts with cohesive inner cell mass and trophectoderm. Analyze It and Microsoft Excel were used to perform the Student's t-test, Kruskal-Wallis test, and c 2 test. RESULTS: There were no differences (meanAESD) between groups in age (32.8AE4.4 vs. 32.8AE4.3 years, p¼0.97) or number of embryos cryopreserved (3.4AE2.0 vs. 3.4AE2.3, p¼0.81). There were no differences in number of topquality embryos cryopreserved (p¼0.75), endometrial thickness before transfer (9.7AE2.0 vs. 9.6AE1.7mm, p¼0.44), number of embryos transferred (2.2AE0.8 vs. 2.1AE0.9, p¼0.60) or duration of storage (340AE367 vs. 348AE350days, p¼0.84). There was no significant difference in implantation rate (25.1 vs. 30.1%, p¼0.14); however, a significant difference in clinical pregnancy rate, defined by the presence of at least one intrauterine gestational sac, was observed (37.7 vs. 53.3%, p¼0.004). CONCLUSIONS: Although use of natural cycle FET may be appealing due to its ease and decreased requirement for medication, these cycles may not result in comparable outcomes. Use of exogenous steroids and/or method of administration may contribute to observed differences. Patient-friendly treatment should include maximizing pregnancy rate, not only minimizing administration of medication and hormonal supplementation. Supported by: None.
Group B (2 h) No. of cycles 14 No. of oocytes 102 No. (%) of fertilized oocytes 89 (87.3) 2PN (%)... more Group B (2 h) No. of cycles 14 No. of oocytes 102 No. (%) of fertilized oocytes 89 (87.3) 2PN (%) 68 (66.7) 92 1PN (%) 9 (8.8) 79 (85.9) Ն3PN (%) 11 (10.8) 73 (79.3) No. (%) of cleaved embryos per 2PNs 59 (86.8) 3 (3.3) P-353 The Distribution of Mitochondria in Human Oocytes at Different Stages of
High-dose-rate (HDR) brachytherapy is an invasive and anxiety-provoking procedure. We sought to d... more High-dose-rate (HDR) brachytherapy is an invasive and anxiety-provoking procedure. We sought to determine the subjective experience of patients undergoing inpatient treatment. METHODS AND MATERIALS: Men undergoing HDR prostate brachytherapy at Royal Prince Alfred and St George Hospitals were invited to complete a questionnaire (the Prostate Brachytherapy Questionnaire) for 3 days to assess their perceptions and attitudes during the brachytherapy treatment. RESULTS: Fifty-eight eligible men participated. The aspects rated that the most troublesome were ''being stuck in bed'' and ''discomfort,'' with mean scores (0e10) over 3 days of 4.2 and 3.8, respectively; 44% and 34% of men rated these aspects of the procedure as severe (score 7 or more) at any time. The whole experience was rated as mildly troublesome (mean score over 3 days 5 3.2). The overall experience was rated better than expected by most men (60%), and only 9% found it worse than expected. CONCLUSIONS: By using the Prostate Brachytherapy Questionnaire, the patients provided our centers with subjective feedback of the procedure from a consumer's perspective, enabling us to customize and enhance current educational interventions before treatment, to provide patients with a better understanding of the treatment experience, and to ensure continued support for the patients. These results have prompted us to modify the HDR boost to two fractions, and, at one of the centers, to perform them on an outpatient basis.
PURPOSE: We report a case of prostate brachytherapy seed migration to the vertebral venous plexus... more PURPOSE: We report a case of prostate brachytherapy seed migration to the vertebral venous plexus and subsequently to the renal artery with corresponding dosimetry analysis describing nerve doses. METHODS AND MATERIALS: A 52-year-old male with low-risk prostate carcinoma (clinical stage T1c; Gleason score 5 6; prostate-specific antigen level of 5.5) underwent transperineal permanent prostate seed implant. Postimplantation routine imaging had failed to locate the missing seed, but he subsequently presented with back pain and parathesia with radiation down the leg. RESULTS: CT with bony windows and MRI had located the seed in the left L5 vertebral venous plexus. Neurosurgical intervention failed to locate and remove the migrated seed. Postsurgery, the left lower limb parathesia persisted but had normal nerve conduction studies. Dose to the spinal nerve roots and nearby structures were estimated using a GEANT4 Monte Carlo simulation. Serial X-ray imaging and CT had found that the seed had further migrated to left renal hilum. CONCLUSIONS: Seed migration to vertebral venous plexus is uncommon and to our knowledge this is the third reported case. Its subsequent migration to the renal hilum is most unusual. CT with bony windows or MRI are required if this is suspected. There is risk of spinal or nerve root damage and dose to these structures has to be estimated using GEANT4, although the tissue tolerance in the setting of low-dose rates are unknown and long-term followup of this patient is required.
The Journal of Biblical Integration in Business, 2016
This paper references research done on Servant Leadership theories across a span of some 45 years... more This paper references research done on Servant Leadership theories across a span of some 45 years since Greenleaf ’s first work on the subject. It catalogs 15 Servant Leadership theories based on Scripture. In doing so, it identifies a perceived gap in these theories using theological and hermeneutical arguments. It also is a reference point for further research to consider where the redemptive work of Christ fits into leadership models that draw upon His life and work as their source.
The dosimetric quality of seed implants is a crucial part of the prostate brachytherapy treatment... more The dosimetric quality of seed implants is a crucial part of the prostate brachytherapy treatment procedure. Incorrect seed placement during or after deployment leads to both short and long term complications, including urethral and rectal toxicity. The BrachyView system is a fast intraoperative planning system, providing real-time dosimetric information by acting as an in-body gamma camera. It incorporates three tiled
The AIDS virus of cat species, feline immunodeficiency virus (FIV), has been used extensively as ... more The AIDS virus of cat species, feline immunodeficiency virus (FIV), has been used extensively as an animal model of HIV-1 infection. This felid lentivirus shares many molecular and biochemical traits with HIV-1 and causes similar immunologic and clinical perturbations, most notably CD4 + cell loss, impaired cell-mediated immunity and increased susceptibility to opportunistic pathogens. Previous reports have shown that FIV is transmitted horizontally by biting and vertically in utero and through nursing. Our objective was to determine whether FIV could be venereally transmitted in domestic cats. In the first experiment, susceptibility of the female reproductive tract to mucosal transmission of the FIV isolate, NCSU 1 , was demonstrated via intravaginal inoculation with infected cultured cells. We next identified virus in electroejaculates from asymptomatic, chronically FIV-NCSU 1-infected, adult males. A fragment of FIV gag provirus DNA was detected by nested polymerase chain reaction (PCR) in nonfractionated seminal cells and in swim-up sperm preparations. Additionally, replication-competent virus was isolated from cell-free seminal plasma and seminal cells by co-cultivation with a feline CD4 + T-cell line. In the third study, queens were artificially inseminated via an intrauterine laparoscopic technique with electroejaculates from FIV-NCSU 1-infected males. Of six inseminations carried out with fresh semen, three resulted in infection of queens. Lastly, immunohistochemical studies identified
The acute stage of feline immunodeficiency virus (FIV) infection is characterized by a CD8 / anti... more The acute stage of feline immunodeficiency virus (FIV) infection is characterized by a CD8 / anti-FIV response that parallels the appearance of a CD8 / subpopulation with reduced expression of the b chain (CD8a / b lo). The relationship between the CD8a / b lo phenotype and CD8 / anti-FIV activity was examined. Flow cytometric analysis of peripheral blood mononuclear cells with anti-CD8 b chain monoclonal antibody 117 revealed that the CD8a / b lo phenotype expanded throughout the asymptomatic infection, constituting 80%-90% of the CD8b / cells in long-term-infected cats. Purified CD8a / b hi and CD8a / b lo subpopulations were analyzed for anti-FIV activity in an acute infection assay. Anti-FIV activity resided principally in the CD8a / b lo population and was demonstrated in acute FIV infections, as well as in long-term asymptomatic infections. These data suggest that a unique CD8a / b lo anti-FIV phenotype arises early in infection and may play a major role in eliminating virus and maintaining the asymptomatic infection.
International Journal of Radiation Oncology*Biology*Physics, 2006
To evaluate the incidence and factors predictive of acute urinary retention (AUR) in 805 consecut... more To evaluate the incidence and factors predictive of acute urinary retention (AUR) in 805 consecutive patients treated with prostate brachytherapy monotherapy and to examine the possible effect of a learning curve. Between July 1998 and November 2002, 805 patients were treated with prostate brachytherapy. Low-risk patients (Gleason Score (GS) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 6; prostate specific antigen (PSA) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 10, and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = T2b [UICC 1997]) received implant alone. Patients with prostate volume of 50 cc or more, GS = 7, or PSA = 10 to 15 received 6 months of androgen suppression (AS) with brachytherapy. Patient, treatment, and dosimetric factors examined include baseline prostate symptom score (IPSS), diabetes, vascular disease, PSA, Gleason score, clinical stage, AS, ultrasound planning target volume (PUTV), postimplant prostate volume (obtained with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Day 30&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; postimplant CT), CT:PUTV ratio (surrogate for postimplant edema), number of seeds, number of needles, number of seeds per needle, dosimetric parameters (V100, V150, and D90), date of implant (learning curve), and implanting oncologists. Univariate and multivariate analyses were carried out. Acute urinary retention in the first 200 patients was 17% vs. 6.3% in the most recently treated 200 patients (p = 0.002). Overall AUR was 12.7%, and prolonged urinary obstruction incidence…
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: To evaluate the incidence and duration of urinary retention requiring catheterization an... more Purpose: To evaluate the incidence and duration of urinary retention requiring catheterization and the factors predictive for these end points. Methods and Materials: Two hundred eighty-two patients treated with prostate brachytherapy alone were evaluated. Clinical and treatment-related factors examined included: age, baseline International Prostate Symptom Score (IPSS), presence of comorbidity, planning ultrasound target volume (PUTV), postimplant prostate CT scan volume, the CT:PUTV ratio, number of seeds inserted, number of needles used, use of neoadjuvant hormones, procedural physician, clinical stage, Gleason score, and pretreatment PSA. Dosimetric quality indicators were also examined. Results: Urinary obstruction after prostate brachytherapy developed in 43 (15%) patients. The median duration of catheter insertion was 21 days (mean 49, range 1-365). Univariate analysis demonstrated that presence of diabetes, preimplant volume, postimplant volume, CT:PUTV ratio, number of needles, and dosimetric parameters were predictive for catheterization. However, in multivariate analysis, only the baseline IPSS, CT:PUTV ratio, and presence of diabetes were significant independent predictive factors for catheterization. Conclusion: Baseline IPSS was the most important predictive factor for postimplantation catheterization. The extent of postimplant edema, as reflected by the CT:PUTV ratio, predicted for need and duration of catheterization. The presence of diabetes was predictive for catheterization, but may relate to the absence of prophylactic steroids, and therefore requires further evaluation.
International Journal of Radiation Oncology*Biology*Physics, 2002
Purpose: To assess and compare two models for a surrogate urethra to be used for postimplant dosi... more Purpose: To assess and compare two models for a surrogate urethra to be used for postimplant dosimetry in prostate brachytherapy. Methods and Materials: Twenty men with a urinary catheter present at the time of postimplant computed tomographic imaging were studied. Urethral and periurethral volumes were defined as 5-mm and 10-mm diameter volumes, respectively. Three contours of each were used: one contour of the true urethra (and periurethra), and two surrogate models. The true volumes were centered on the catheter center. One surrogate model used volumes centered on the geometrical center of each prostate contour (centered surrogate). The other surrogate model was based on the average deviation of the true urethra from a reference line through the geometrical center of the axial midplane of the prostate (deviated surrogate). Maximum point doses and the D 10 , D 25 , D 50 , D 90 , V 100 , V 120 , and V 150 of the true and surrogate volumes were measured and compared (D n is the minimum dose [Gy] received by n% of the structure, and V m is the volume [%] of the structure that received m% of the prescribed dose) as well as the distances between the surrogate urethras and the true urethra. Results: Doses determined from both surrogate urethral and periurethral volumes were in good agreement with the true urethral and periurethral doses except in the superior third of the gland. The deviated surrogate provided a physically superior likeness to the true urethra. Certain dose-volume histogram (DVH)-based parameters could also be predicted reasonably well on the basis of the surrogates. Correlation coefficients >0.85 were seen for D 25 , D 50 , V 100 , V 120 , and V 150 for both models. All the other parameters had correlation coefficients in the range of 0.73-0.85. Conclusions: Both surrogate models predicted true urethral dosimetry reasonably well. It is recommended that the simpler deviated surrogate would be a more suitable surrogate for routine clinical practice.
International Journal of Radiation Oncology*Biology*Physics, 2004
To the Editor: Anagnostopoulos et al. address a most important point in their paper. Clearly, fro... more To the Editor: Anagnostopoulos et al. address a most important point in their paper. Clearly, from a clinical aspect, accurate and precise dose verification is essential when large hypofractionated treatments are used. We would like to draw the attention of the readers of IJROBP to the fact that a different type of thermoluminescence dosimetry material may even be more suitable for the in vivo dosimetry measurements as our group has proposed about 1 year ago (1). We would suggest that LiF:Mg,Cu,P, a relatively new material in medical radiation dosimetry, is significantly better for the propose application for the following reasons: 1. LiF:Mg,Ti thermoluminescence dosimeters (TLDs) as used by Anagnostopoulos et al. are known to overrespond to low-energy X-rays by up to 50% (2, 3). Although in the published study, this overresponse effect is not likely to dominate close to an iridium source, it would be significant if measurements are taken in other clinically relevant regions, for example, periphery of the planning target volume, urethra, and rectum, where the distance from the source is further and the energy spectrum may change. LiF:Mg,Cu,P has a more uniform response to different photon energies (2, 4) and can therefore be used with less concern for variations in effective photon energy at the point of measurement. 2. LiF:Mg,Cu,P is also approximately 20 to 30 times more sensitive than LiF:Mg,Ti (4, 5). This allows for better precision in the measurements and a wider choice of measurement locations. An example is Patient 2 of the publication (Fig. 3b), where there appears to be an uncertainty of at least 4Gy (20% of predicted). We believe that additional precision and accuracy could be achieved by using miniature LiF:Mg,Cu,P TLDs as investigated by Hood et al. (1) and Duggan (5). LiF:Mg,Cu,P does not require a complex correction for dose or energy response (linear dose response to 20Gy) (2) as well as allowing improved spatial resolution (0.5 mm diameter ϫ 3 mm long, MCP-Np; TLD, Krakow, Poland). Miniature LiF:Mg,Cu,P TLDs (1, 5, 6) in combination with a real-time dosimeter (7) might lead to further optimization of dose delivery and accurate monitoring of urethral and rectal doses in prostate brachytherapy. As a consequence, miniature LiF:Mg,Cu,P TLDs are being applied to prostate cancer brachytherapy in an Australia-wide quality assurance intercomparison of prostate brachytherapy treatment delivery in conjunction with the Trans Tasman Radiation Oncology Group (TROG) RADAR trial.
International Journal of Radiation Oncology*Biology*Physics, 2009
To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and &amp;a... more To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;low-tier&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; intermediate-risk prostate cancer and explore the relationship between the traditional dosimetric values, V100 (volume of prostate receiving 100% of the prescribed dose) and D90 (minimum dose to 90% of the prostate), and risk of biochemical failure. A total of 1,006 consecutive patients underwent implantation between July 20, 1998, and Oct 23, 2003. Most (58%) had low-risk disease; the remaining 42% comprised a selected low-tier subgroup of intermediate-risk patients. The prescribed minimum peripheral dose (MPD) was 144 Gy. All implants used 0.33 mCi 125I sources using a preplan technique featuring right-left symmetry and a strong posterior-peripheral dose bias. Sixty-five percent of patients had 6 months of androgen deprivation therapy. Postimplantation dosimetry was calculated using day-28 CT scans. With a median follow-up of 54 months, the actuarial 5-year rate of freedom from biochemical recurrence (bNED) was 95.6% +/- 1.6%. Median D90 was 105% of MPD, median V100 was 92%, median V150 was 58%, and median V200 was 9%. Dosimetric values were not predictive of biochemical recurrence on univariate or multivariate analysis. Analysis of dosimetric values by implantation number showed statistically significant increases in all values with time (D90, V100, V150, and V200; p…
The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation... more The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation treatment for ovarian cancer patients treated with primary surgery and chemotherapy, followed by second-look laparotomy (SLL). Overall survival and acute and late toxicity of treated patients were assessed. Patients were recruited between April 1981 and June 1994. All patients had SLL performed at Royal Prince Alfred Hospital after completion of primary chemotherapy. Data collected included demographic details, diagnosis, tumor stage, histology, grade, adjuvant chemotherapy, and radiotherapy. Radiation dose and fractionation, field size, boost volume and dose, failure to complete treatment and treatment interruptions, renal dose, and acute and late toxicity were recorded. Fifty-one patients were evaluated; the median age was 51 years. Median follow-up for patients still alive was 62 months. Prior to 1988, chemotherapy comprised oral chlorambucil, with or without cisplatin (n = 25), while after this date all patients (n = 26) received primary cisplatin-based therapy. A radiation dose of 22. 5 Gy over 22 fractions was planned to the whole abdomen followed by a pelvic boost of 22 Gy in 11 fractions. Radiotherapy was completed in 37 (73%) patients. Treatment interruptions were necessary in 12 (24%) patients. Thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea were the main causes of incomplete or interrupted treatment. Late bowel toxicity was seen in 6 (12%) patients, 2 of whom required laparotomy to relieve obstruction. There were no treatment-related deaths. Seven of the 51 patients are alive and free of disease, 2 died from other causes, and 2 are alive with evidence of recurrent or progressive disease. Mean follow-up time for surviving patients is 78.5 months. Overall survival at 2, 5, and 10 years was 65, 27, and 10%, respectively. Residual disease after primary surgery, smaller preirradiation tumor residuum, and completion of radiotherapy were independently associated with improved overall survival. In this poor-prognosis group of patients, a combined approach of surgery, chemotherapy, and radiotherapy, while associated with acceptable toxicity, may not afford a prolongation of survival.
Comparison of intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IV... more Comparison of intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IVF) in patients with non-male factor infertility.
OBJECTIVE: To determine if a difference exists in pregnancy rate in natural and synthetic FET cyc... more OBJECTIVE: To determine if a difference exists in pregnancy rate in natural and synthetic FET cycles. DESIGN: Retrospective analysis of FET cycles. MATERIALS AND METHODS: From December 2002 to April 2008, 612 FET cycles were performed. In natural FET cycles, no exogenous follicular phase estrogens were given. In synthetic FET cycles, exogenous estradiol was given until endometrial thickness was R7mm in diameter, by transvaginal ultrasonography. When necessary, GnRH down-regulation was used to prevent a premature LH surge in synthetic FET cycles. Embryo transfer occurred 7 days after evidence of a spontaneous LH surge or 5 days after administration of exogenous progesterone. In natural cycles, the luteal phase was supplemented with vaginal and/or oral progesterone; in synthetic cycles, intramuscular progesterone was used. Cycles were excluded from analysis if embryo transfer was not performed in the fresh embryo cycle, endometrial growth was poor (maximum thickness <7mm) or subjects had diminished ovarian reserve (day 3 FSH>13 mIU/mL), to reduce confounding. 167 natural FET cycles were matched by age, number of embryos cryopreserved, and source of oocyte (autologous or donor) to 167 synthetic FET cycles. Top-quality embryos were expanded blastocysts with cohesive inner cell mass and trophectoderm. Analyze It and Microsoft Excel were used to perform the Student's t-test, Kruskal-Wallis test, and c 2 test. RESULTS: There were no differences (meanAESD) between groups in age (32.8AE4.4 vs. 32.8AE4.3 years, p¼0.97) or number of embryos cryopreserved (3.4AE2.0 vs. 3.4AE2.3, p¼0.81). There were no differences in number of topquality embryos cryopreserved (p¼0.75), endometrial thickness before transfer (9.7AE2.0 vs. 9.6AE1.7mm, p¼0.44), number of embryos transferred (2.2AE0.8 vs. 2.1AE0.9, p¼0.60) or duration of storage (340AE367 vs. 348AE350days, p¼0.84). There was no significant difference in implantation rate (25.1 vs. 30.1%, p¼0.14); however, a significant difference in clinical pregnancy rate, defined by the presence of at least one intrauterine gestational sac, was observed (37.7 vs. 53.3%, p¼0.004). CONCLUSIONS: Although use of natural cycle FET may be appealing due to its ease and decreased requirement for medication, these cycles may not result in comparable outcomes. Use of exogenous steroids and/or method of administration may contribute to observed differences. Patient-friendly treatment should include maximizing pregnancy rate, not only minimizing administration of medication and hormonal supplementation. Supported by: None.
Group B (2 h) No. of cycles 14 No. of oocytes 102 No. (%) of fertilized oocytes 89 (87.3) 2PN (%)... more Group B (2 h) No. of cycles 14 No. of oocytes 102 No. (%) of fertilized oocytes 89 (87.3) 2PN (%) 68 (66.7) 92 1PN (%) 9 (8.8) 79 (85.9) Ն3PN (%) 11 (10.8) 73 (79.3) No. (%) of cleaved embryos per 2PNs 59 (86.8) 3 (3.3) P-353 The Distribution of Mitochondria in Human Oocytes at Different Stages of
High-dose-rate (HDR) brachytherapy is an invasive and anxiety-provoking procedure. We sought to d... more High-dose-rate (HDR) brachytherapy is an invasive and anxiety-provoking procedure. We sought to determine the subjective experience of patients undergoing inpatient treatment. METHODS AND MATERIALS: Men undergoing HDR prostate brachytherapy at Royal Prince Alfred and St George Hospitals were invited to complete a questionnaire (the Prostate Brachytherapy Questionnaire) for 3 days to assess their perceptions and attitudes during the brachytherapy treatment. RESULTS: Fifty-eight eligible men participated. The aspects rated that the most troublesome were ''being stuck in bed'' and ''discomfort,'' with mean scores (0e10) over 3 days of 4.2 and 3.8, respectively; 44% and 34% of men rated these aspects of the procedure as severe (score 7 or more) at any time. The whole experience was rated as mildly troublesome (mean score over 3 days 5 3.2). The overall experience was rated better than expected by most men (60%), and only 9% found it worse than expected. CONCLUSIONS: By using the Prostate Brachytherapy Questionnaire, the patients provided our centers with subjective feedback of the procedure from a consumer's perspective, enabling us to customize and enhance current educational interventions before treatment, to provide patients with a better understanding of the treatment experience, and to ensure continued support for the patients. These results have prompted us to modify the HDR boost to two fractions, and, at one of the centers, to perform them on an outpatient basis.
PURPOSE: We report a case of prostate brachytherapy seed migration to the vertebral venous plexus... more PURPOSE: We report a case of prostate brachytherapy seed migration to the vertebral venous plexus and subsequently to the renal artery with corresponding dosimetry analysis describing nerve doses. METHODS AND MATERIALS: A 52-year-old male with low-risk prostate carcinoma (clinical stage T1c; Gleason score 5 6; prostate-specific antigen level of 5.5) underwent transperineal permanent prostate seed implant. Postimplantation routine imaging had failed to locate the missing seed, but he subsequently presented with back pain and parathesia with radiation down the leg. RESULTS: CT with bony windows and MRI had located the seed in the left L5 vertebral venous plexus. Neurosurgical intervention failed to locate and remove the migrated seed. Postsurgery, the left lower limb parathesia persisted but had normal nerve conduction studies. Dose to the spinal nerve roots and nearby structures were estimated using a GEANT4 Monte Carlo simulation. Serial X-ray imaging and CT had found that the seed had further migrated to left renal hilum. CONCLUSIONS: Seed migration to vertebral venous plexus is uncommon and to our knowledge this is the third reported case. Its subsequent migration to the renal hilum is most unusual. CT with bony windows or MRI are required if this is suspected. There is risk of spinal or nerve root damage and dose to these structures has to be estimated using GEANT4, although the tissue tolerance in the setting of low-dose rates are unknown and long-term followup of this patient is required.
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Papers by Joe Bucci