Transperineal implantation of gold fiducial markers (gold seeds) for prostate image-guided radiation therapy: a feasible technique associated with a low risk of complications.

The purpose is to describe the method, safety and efficacy of transperineal gold seed placement for image-guided radiation therapy.

An ethics committee approved database was used to review records of consecutive patients from October 2008 through December 2013, who underwent transperineal implantation of three gold markers into the prostate using staged local anaesthesia and transrectal ultrasound. Seeds were counted on radiographs from CT simulation, first treatment and last treatment. Retention and use of at least three markers for kV/kV matching was considered a successful implant. A visual analogue scale (VAS) pain assessment was performed. SAS was used for data analysis.

Fiducial marker placement was successful for kV/kV matching in 556/581 patients (95.7%). The procedure was aborted due to pain in two patients. Additional sedation during the procedure was required in two patients. Complications include urinary infections (2 patients, <0.5%) and transient haematuria (2 patients, <0.5%). There were no recorded calls requesting additional pain medication or delays in radiation due to complications. The number of seeds identified at simulation: 4 (2 patients), 3 (554 patients), 2 (21 patients), 1 (1 patient), 0 (1 patient). One patient with three seeds and two patients with <2 seeds had cone beam CT instead of kV/kV imaging for image guidance. No seeds were lost after simulation. The mean visual analogue pain score associated with transperineal gold seed insertion met patients' expectations (respectively 4.1 vs. 4.4 P = 0.19).

Outpatient transperineal insertion of fiducials avoids the rectum, is effective, convenient, well tolerated and has few side effects.

Journal of medical radiation sciences. 2015 Jul 29 [Epub]

Akram Saad, Jeffrey Goldstein, Yaacov Richard Lawrence, Ilana Weiss, Rasha Saad, Benjamin Spieler, Zvi Symon

Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel., Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel., Department of Radiation OncologyChaim Sheba Medical CenterTel Hashomer, Ramat GanIsrael; Sackler School Of MedicineTel Aviv UniversityTel AvivIsrael., Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel., Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel., Department of Radiation Oncology Chaim Sheba Medical Center Tel Hashomer, Ramat Gan Israel., Department of Radiation OncologyChaim Sheba Medical CenterTel Hashomer, Ramat GanIsrael; Sackler School Of MedicineTel Aviv UniversityTel AvivIsrael.

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe