Incidence and prediction of seed migration to the chest after iodine-125 brachytherapy for hepatocellular carcinoma

PURPOSE: The aims were to determine the incidence of seed migration to the chest and to analyze the predictive factors after iodine-125 brachytherapy for hepatocellular carcinoma. METHODS AND MATERIALS: Three hundred ninety-nine patients with hepatocellular carcinoma underwent iodine-125 seed brachytherapy. After seed implantation, chest X-ray radiograph or computerized tomography were undertaken to assess the occurrence and location of seed migration at 3 months after brachytherapy. The incidence of seed migration to the lung and heart was calculated. A statistical analysis of the influences of seed loss to the chest was performed between patients with and without seed migration. RESULTS: A total of 13,977 seeds were implanted in 399 patients. One hundred fifty of the 13,977 (1.07%) seeds migrated to the chest in 81 of the 399 (20.30%) patients. Of all the migrated seeds, 112 (74.67%) migrated to the lungs in 59 (67.82%) patients, and 38 (25.33%) seeds migrated to the heart in 28 (47.46%) patients. No case exhibited clinical symptoms related to the migrated seeds. The number of seeds implanted and the number of seed implantations were significantly associated with seed migration. CONCLUSIONS: The occurrence of seed migration to the lungs and heart was evaluated. Furthermore, the number of seeds implanted and the number of seed implantation procedures are significant predictors of seed migration. (C) 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.