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mc1
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   Posted 10/31/2006 12:11 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
I have read of brachytherapy seeds that migrated to such sites as a lung. Though the risks may be small,I would like to know what are the worst possibilities if a fiduciary does migrate.

And thanks for answers to all my prior questions.
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Jerome J. Spunberg, M.D.
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   Posted 10/31/2006 1:11 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
Seed migration is well described, and occasionally to the lung. There are no harmful effects from such migration, even though there is resulting radioactivity from the seed to the site of spread. The dose would be quite low. Seeds used for Cyberknife fiducial placement are not radioactive, by the way.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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radsrus
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   Posted 10/31/2006 5:44 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
WE have observed seed migration. One that we placed in the lung migrated south and was found in the pelvis (presumably it was coughed up and swallowed - or perhaps it was just the beginning of winter). There have been a couple of instances elsewhere of seeds actually getting into blood vessels and migrating, but no problems have been reported. The seeds are completely inert, since they are gold, and there should be no problems from any movements they might make. Small movements are quite common, but large movements are distinctly uncommon.


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

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Jerome J. Spunberg, M.D.
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   Posted 10/31/2006 7:32 PM (GMT -8)    Quote This PostAlert An Admin About This Post.
I have to say that I actually did see one patient where a lung cancer developed several years later around a radioactive seed that migrated to the lung from the prostate. It might have been a coincidence but I doubt it. That is a very rare event and probably should have been reported.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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radsrus
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   Posted 11/1/2006 2:51 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
I have never seen it. It was bound to happen sooner or later, but the risk must be vanishingly small, considering the number of implants that are done each year. I suppose patients with radioactive seed migration would be candidates for regular CT scans, but obviously that is not a problem with the gold seeds.


Clinton A. Medbery, III, M.D.
St. Anthony Hospital Cyberknife Center
(405) 272-7311
buddy@swrads.org or cmedbery@coxinet.net

Clinton A. Medbery, III, M.D.
Southwest Radiation Oncology
1011 N. Dewey Ave.
Oklahoma City, OK 73102

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Jerome J. Spunberg, M.D.
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   Posted 11/1/2006 3:38 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
With the new CK approaches to prostate cancer, maybe radioactive seeding will one day be a relic of the past...


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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Donald B. Fuller, M.D.
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   Posted 11/3/2006 8:53 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
That's what I thought too, but curiously, our CK volume AND our seed implant volume both seem to be rising at present. Still, once CK develops more of a track record, I completely agree that it is the "implant killer." My prediction is that CK will have identical efficacy with lower toxicity c/w implants. (Note to patients - This is strictly my opinion, as yet, not validated by peer reviewed medical literature)

Donald B. Fuller, MD
Radiation Oncologist
San Diego CyberKnife Center
5395 Ruffin Rd
Suite 103
San Diego, CA
92123
858-505-4100
www.sdcyberknife.com

Radiation Oncologist
Radiation Medical Group
2466 First Ave
San Diego, CA 92101
619-230-0400
www.rmgmed.com
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Donald B. Fuller, M.D.
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Date Joined Jun 2006
Total Posts : 281
 
   Posted 11/3/2006 9:00 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
Oh - Back to the "What's the worst thing that can happen if a seed migrates?" question - I think the record bad outcome was a reported case of a guy who had two radioactive seeds lodge somewhere near the natural pacemaker of the heart that may have precipitated his cardiac death. I think in the US we've been running an average of 50,000 seed implants per year for about 15 years now - This translates to a risk of one in 750,000 or so. (And those were radioactive seeds, not inert gold ones)

Donald B. Fuller, MD
Radiation Oncologist
San Diego CyberKnife Center
5395 Ruffin Rd
Suite 103
San Diego, CA
92123
858-505-4100
www.sdcyberknife.com

Radiation Oncologist
Radiation Medical Group
2466 First Ave
San Diego, CA 92101
619-230-0400
www.rmgmed.com
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Jerome J. Spunberg, M.D.
Registered Member

Email Address Not AvailablePersonal Homepage Not AvailablePrivate Messaging Not AvailableAIM Not AvailableICQ Not AvailableY! Not AvailableMSN Not Available
Date Joined Feb 2006
Total Posts : 4214
 
   Posted 11/3/2006 9:33 AM (GMT -8)    Quote This PostAlert An Admin About This Post.
If I were the patient myself, and I may one day be one (hope not), I would opt for CK any day over seeds.


Jerome J. Spunberg, M.D., FACR, FACRO
Cyberknife Center Of Palm Beach
jspunberg@radiationoncologyinstitute.com
(561) 799-2828

Radiation Oncology Institute
10335 N. Military Trail, Suite C
Palm Beach Gardens, FL 33410
(561) 624-1717

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