Decline of dose coverage between intraoperative planning and post implant dosimetry for I-125 permanent prostate brachytherapy: Comparison between loose and stranded seed implants

Abstract Background and purpose In permanent prostate brachytherapy the dose distributions 4 weeks post implant differ from the intraoperative dose distributions. The purpose of this study is to compare intraoperative planning and post implant dosimetry for loose and stranded seed implants. Materials and methods This study investigates prostate dose coverage in 389 patients with stage T1 or T2 prostate cancer treated in the years 2005, 2006 and 2007. The patients received either a loose seed or a stranded seed implant. All patients had US-based intraoperative planning and CT/MRI-based post implant dosimetry after 4 weeks. Results Intraoperative and post implant D90 values amounted 183 ± 13 Gy (mean ± standard deviation) and 161 ± 30 Gy, respectively. Decline of D90 values (mean and 95% confidence interval) between intraoperative planning and post implant dosimetry for RAPID strand ( n = 67), Intersource strand ( n = 136) and loose selectSeeds ( n = 186) implants amounted to −40 (−45 to −34) Gy, −25 (−28 to −21) Gy and −15 (−18 to −21) Gy, respectively. Conclusions The patients treated in the period 2005–2007 with stranded or loose seed implants had on average adequate D90 values of 161 ± 30 Gy. Post implant D90 values were 22 ± 27 Gy lower compared to intraoperative planning. Decline of dose coverage between intraoperative planning and post implant dosimetry was significantly larger for the stranded seed implants.