The robustness of dose distributions to displacement and migration of 125I permanent seed implants over a wide range of seed number, activity, and designs

Purpose: To investigate the robustness of permanent prostate implant dosimetry for various 1251 seed activities and various seed models. The dosimetric impact of seed misplacement and seed migration (seed loss) is also taken into account using various standard dose indices. Methods and Materials: A dose-based inverse planning algorithm is used for automated dosimetric plan creation (45-60 s per plan) and provides an unbiased way to compare the robustness of various optimal dosimetric plans. Seed misplacement and seed migration are simulated by way of Monte Carlo, based on the measured displacement distributions from clinical postimplant cases. Plans were generated for seed activities between 0.2 and 1.4 mCi (0.25 to 1.78 U) and for 11 different seed models. Results: The numbers of seeds and needles are shown to decrease rapidly for a seed activity between 0.3 mCi and 0.6 mCi (0.38 and 0.76 U). The loss in V100, from 100%, because of seed misplacement is below 10% for an apparent activity ranging from 0.2 to 0.9 mCi (0.25 to 1.14 U). A minimum degradation in V100 is observed around 0.6-0.7 mCi (0.76-0.89 U). D90 increases from 150 to 170 Gy between 0.3 and 0.7 mCi (0.38 and 0.89 U) and decreases afterward to fall below 140 Gy at higher activity. V200 and D10 to the target volume both show an increase in hot spots up to 0.7 mCi, and then decrease linearly at higher activities for all seed models. V200 and D10 to the urethra remain about constant for all seed activities up to 0.8 mCi (1.02 U), at which point they start to decrease. All seed models follow this general trend. Conclusions: Plans were shown to be robust to misplacement and migration of seeds over a wide range of seed activity and for various seed models. With a properly tuned inverse planning algorithm able to ensure the dose coverage and protection for the organs at risk in the presence of placement errors (displacement and migration), the choice of a preferred seed activity, in a range up to about 0.7 mCi (0.89 U), is open. The upper part of this range offers the opportunity to significantly reduce the number of seeds and needles, thus reducing surgical trauma to the patient, saving time in an operating room planning setting, and reducing the cost of a permanent prostate implant procedure. (C) 2004 Elsevier Inc.