Comparison between the Use of Loose and Stranded Seeds in Prostate Brachytherapy in Brazil


Cancer is a leading cause of death worldwide. In 2030, 26.4 million new cases will be diagnosed, with 17 million deaths accounted worldwide. Prostate cancer is the sixth most common type in the world, and the second most commom in men. For Brazil, the number of new cases of prostate cancer in 2010 is estimated to 52,350. Treatment of prostate cancer may be by surgery, radiation or even vigilant observation. A method of radiotherapy which has been extensively used is brachytherapy, where Iodine-125 seeds are placed inside or next to the area requiring treatment. Iodine seeds can be introduced loose seeds or stranded in bioabsorbable polymers in order to increase the dosimetric coverage of the prostate and reducing the chance of seed migration. Data were gathered concerning the commercialization of loose seeds and stranded seeds, between 2005 and 2011, in Brazil. It was noted that the number of stranded seeds commercialized in Brazil (around 80%) has always been much greater than the number of loose seeds, reaching 90% last year. The main reason is the reduction of the seed migration events into other parts of the body, since there is a potential hazard even considering that no harmful effect has been observe. The data regarding dosimetry are still controversial, since the seeds that migrate is normally no more than 1%.

Share and Cite:

F. S. Peleias Jr., C. A. Zeituni, E. C. M. Rostelato, C. D. Souza, F. R. Mattos and M. A. G. Benega, "Comparison between the Use of Loose and Stranded Seeds in Prostate Brachytherapy in Brazil," Open Journal of Urology, Vol. 2 No. 3A, 2012, pp. 206-209. doi: 10.4236/oju.2012.223036.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Brasil. Ministério da Saúde, “Estimativa 2010: Incidência de Cancer no Brasil/Instituto Nacional de Cancer,” 2009.
[2] World Health Organization (WHO), “Cancer,” 2010.
[3] International Agency For Research On Cancer (IARC), “World Cancer Report 2008”, 2008.
[4] Brasil. Ministério da Saúde, “Cancer de Próstata.”
[5] L. J. E. S. Vieira, et al., “Preven??o do Cancer de Próstata na ótica do Usuário Portador de Hipertens?o e Diabetes,” Ciência & Saúde Coletiva, Vol. 13, No. 1, 2008.
[6] R. Gomes, et al., “A Preven??o do Cancer de Próstata: Uma Revis?o da Literatura,” Ciência & Saúde Coletiva, Vol. 13, No. 1, 2008, pp. 235-246.
[7] P. A. Balter; J. F. Aguirre and W. F. Hanson, “Practical Considerations for the Calibration of Low Energy/Low Activity Seeds,” World Congress On Medical Physics and Biomedical Engineering, Vol. 4, 23-28 July 2000, pp. 2761-2764.
[8] L. Zuofeng, “Monte Carlo Calculations of Dosimetry Parameters of the Urocor Prostaseed I-125 Source,” Med. Phys., Vol. 29, No. 6, 2002, pp. 1029-1034.
[9] T. Romero, “Radioterapia Para Cancer de Próstata Ganha Prêmio International,” 2009.
[10] C. A. Zeituni, “Dosimetria de Braquiterapia,” Ph.D Thesis, University of Sao Paulo, S?o Paulo, 2010.
[11] M. E. C. M. Rostelado, “Estudo e Desenvolvimento de uma Nova Metodologia para Confec??o de Sementes de Iodo-125 Para Aplica??o em Braquiterapia,” Ph.D Thesis, University of Sao Paulo, Sao Paulo, 2005.
[12] J. F. Williamson, “On the Dosimetric Influences of Air-Kerma Strength Calibration Geometry and Internal Source Structure for Pd-103 and I-125 Brachytherapy Sources,” World Congress on Medical Physics and Bio- medical Engineering, Vol. 1, 23-28 July 2000, pp. 368-371.
[13] J. J. Blasko, M. J. Datolli and K. Wallner, “Prostate Brachytherapy,” Smart Medicine, 1997.
[14] C. A. Franca, et al., “The Seven-Year Preliminary Results of Brachytherapy with Iodine-125 Seeds for Localized Prostate Cancer Treated at a Brazilian Single-Center,” International Brazilian Journal of Urolpgy, Vol. 33, No. 6, 2007, pp. 752-762.
[15] J. Varregoso, “Braquiterapia Prostática,” Acta Urológica, Vol. 23, 2006, pp. 21-30.
[16] J. J. Batterman, et al., “Results of Permanent Prostate Brachytherapy, 13 Years of Experience at a Single Institution,” Radiotherapy and Oncology, Vol. 71, No. 1, 2004, pp. 23-28.
[17] C. M. Agrawal and J. E. Lin, “Synthetic Bioabsorbable Polymers for Implants,” ASTM Special Technical Publications, Pensilvania, 2000.
[18] Inion Ltd., “Sport Medicine: General FAQ,” Inion Ltd., London, 2012.
[19] D. Fuller, J. J. Koziol and A. C. Feng, “Prostate Brachytherapy Seed Migration and Dosimetry: Analysis of Stranded Sources and Other Potential Predictive Factors,” Brachytherapy, Vol. 3, 2004, pp. 10-19.
[20] R. Lee, et al., “Radioactive Sources Embedded in Suture Are Associated with Improved Post-Implant Dosimetry in Men Treated with Prostate Brachytherapy,” Radiotherapy and Oncology, Vol. 65, No. 2, 2002, pp. 123-127.
[21] H. Fagundes, et al., “Transperineal TRUS-Guided Prostate Brachytherapy Using Loose Seeds versus Rapid Strand: A Dosimetric Analysis,” Brachytherapy, Vol. 3, 2004, pp. 136-140.
[22] I. Kaplan, et al., “A Comparison of the Precision of Seeds Deposited as Loose Seeds versus Suture Embedded Seeds: A Randomized Trial,” Brachytherapy, Vol. 3, No. 1, pp. 7-9.
[23] V. R. Heysek, et al., “A Dosimetric Analysis of Unstranded Seeds versus Customized Stranded Seeds in Transperineal Nterstitial Permanent Prostate Seed Brachytherapy,” Brachytherapy, Vol. 5, 2005, pp. 244-250.
[24] K. A. Hinnen, et al., “Loose Seeds versus Stranded Seeds in I-125 Prostate Brachytherapy: Differences in Clinical Outcome,” Radiotherapy and Oncolology, Vol. 96, No. 1, 2010, pp. 30-33.
[25] C. C. Goulet, et al., “Comparison of Seed Migration to the Chest after Permanent Prostate Brachytherapy with Loose Seeds, Stranded Seeds, or Both,” International Journal of Radiation Oncology, Vol. 66, No. 3, 2006, p. 391.
[26] E. M. Tapen, et al., “Reduction of Radioactive Seed Embolization to the Lung Following Prostate Brachytherapy,” International Journal of Radiation Oncology, Vol. 42, No. 5, 1998, pp. 1063-1067.
[27] B. J. Davis, et al., “Prostate Brachytherapy Seed Migration to a Coronary Artery Found during Angiography,” The Journal of Urology, Vol. 168, No. 3, 2002, p. 1103.
[28] B. J. Davis, et al., “Prostate Brachytherapy Seed Migration to the Right Ventricle Found at Autopsy Following Acute Cardiac Dysrhythmia,” The Journal of Urology, Vol. 164, No. 5, 2000, p. 1661.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.