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| ICRP PUBLICATION 98: RADIATION ASPECTS OF BRACHYTHERAPY FOR PROSTATE CANCER, 98
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By
. International Commission on Radiological Protection
Included in series
International Commission on Radiological Protection, 98
Description
ABSTRACT
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The use of permanent radioactive implants (125I or 103Pd seeds) to treat selected localized prostate cancer
patients has been rapidly increasing all over the world in the last fifteen years.
To date, it is estimated that more than 50,000 patients
are treated this way every year in the world, and this number is anticipated to increase in the near future.
Although no accident or
adverse effects involving the medical staff and/or members of the patient family have been reported so far, this brachytherapy technique
raises a number of radiation safety issues which need specific recommendations from ICRP.
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All data concerning the dose received
by the persons approaching the patients after the implantation have been reviewed. Those doses have been either directly measured or
calculated. The available data show that, in the vast majority of cases, the dose to comforters and carers remains well below the 1 mSv/year
limit. Only the (rare) case where the patient's partner is pregnant at the time of implantation may need specific precautions.
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Expulsion
of sources through the urine, the semen or the gastro-instestinal tract is rare.
Specific recommendations should be given to the patient
to allow him to deal adequately with this event. Of note, due to the low activity of an isolated seed, and to its low photon energy,
no incident/accident linked to a seed loss has ever been recorded.
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Cremation of bodies (frequent in some countries) raises, when
it is performed in the first months post-implantation, several issues related to : 1) the activity which remains in the patient's ashes
and 2) the airborne dose, potentially inhaled by the crematorium staff or by the members of the public.
Review of available data shows
that cremation can be allowed if 12 months have elapsed since an implantation with 125I (3 months for 103Pd). If the patient dies before
this delay has elapsed, specific measures must be undertaken.
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Specific recommendations have to be given to the patient to warn his
surgeon in case of subsequent pelvic or abdominal surgery. A "wallet-card" with all relevant information about the implant is useful.
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In most cases, brachytherapy does make the patient infertile, although the therapy-related modifications of the semen reduce fertility.
Patients must be aware of the possibility of fathering children after such a permanent implantation, with a limited risk of genetic effects
for the child.
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Patients with permanent implants must be aware of the possibility of triggering certain types of security radiation
monitors : the "wallet-card" including the main information about the implant (see above) may prove to be helpful in such a case.
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Considering
the available experience after brachytherapy and external irradiation of prostate cancer, the risk of radio-induced secondary tumors
appears to be extremely low. The demonstrated benefit of brachytherapy clearly outweighs, by far, the very limited (mainly theoretical)
increase of the radiation-induced cancer risk.
Keywords: radiological protection, I-125, Pd-103, source expulsion, radiation monitors
Contents
1. INTRODUCTION
2. DOSE FROM THE PATIENTS
2.1. Public and family members, comforters and carers
2.2. Direct measurements from
the patients
2.3. Theoretical calculations
2.4. Direct dose monitoring of family and household members
2.5. Recommendations
3. EXPELLED
SOURCES
3.1. Migrating and expelled sources
3.2. Radiation risks related to an expelled source
3.3. Recommendations
4. CREMATION
4.1. Current national recommendations
4.2. Activity remaining in patient?s ashes
4.3. Potential airborne release
4.4. Recommendations
for cremation
5. SUBSEQUENT PELVIC OR ABDOMINAL SURGERY
6. FATHERING OF CHILDREN
7. TRIGGERING OF SECURITY MONITORS
8.
SECONDARY CANCERS
APPENDIX A : Characteristics of the main permanently implanted radioactive sources
APPENDIX B : Dose measurement
technique after implantation
APPENDIX C : Example recommendations to be given to the patients undergoing prostate brachytherapy
with permanently implanted seeds
APPENDIX D : Personal identification card to be given to patients undergoing a permanent seed implantation
REFERENCES
Bibliographic & ordering Information
Paperback, 50 pages, publication date: JUL-2006
ISBN-13: 978-0-08-044659-2
ISBN-10: 0-08-044659-0
Imprint: ELSEVIER
096/967
Last update: 26 Aug 2008
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