Postmortem radiation safety and issues pertaining to permanent prostate seed implantation in Japan

Takefumi Satoh; Takushi Dokiya; Hidetoshi Yamanaka; Shiro Saito; Hiromichi Ishiyama; Jun Itami; Hitoshi Shibuya; Takashi Nakano; Naoyuki Shigematsu; Manabu Aoki; Shin Egawa; Mitsuyasu Hashimoto; Tetsuo Nishimura; Atsunori Yorozu

doi:10.1016/j.brachy.2014.08.043

Postmortem radiation safety and issues pertaining to permanent prostate seed implantation in Japan

Brachytherapy. 2015 Mar-Apr;14(2):136-41. doi: 10.1016/j.brachy.2014.08.043. Epub 2014 Sep 6.

Authors

Affiliations

¹ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. Electronic address: tsatoh@kitasato-u.ac.jp.
² Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiation Oncology, Comprehensive Cancer Center, Saitama Medical University, Saitama, Japan.
³ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Institute for Preventive Medicine, Kurosawa Hospital, Gunma, Japan.
⁴ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Urology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
⁵ Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
⁶ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
⁷ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan.
⁸ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁹ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
¹⁰ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiology, Jikei University School of Medicine, Tokyo, Japan.
¹¹ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
¹² Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiological Sciences, International University of Health and Welfare, Tochigi, Japan.
¹³ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
¹⁴ Working Group for Promotion of Permanent Seed Implantation Therapy of Prostate Cancer, Subcommittee of Brachytherapy, Medical Science and Pharmaceutical Committee, Japan Radioisotope Association, Tokyo, Japan; Department of Radiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

PMID: 25200350
DOI: 10.1016/j.brachy.2014.08.043

Abstract

Purpose: If a prostate cancer patient treated with (125)I brachytherapy dies within 12 months after the treatment, prostate removal before cremation is recommended to avoid problems related to radioactivity in the ashes, such as inhalation of airborne particulate matter by crematorium staff or nearby residents. To provide guidance for such cases, a manual prepared under the editorial supervision of several professional associations was issued in 2008 in Japan. Herein, we investigated the incidence and causes of death, and the actions taken subsequent to death, among prostate cancer patients who died within 12 months after (125)I brachytherapy over a 10-year period in Japan; and we compared the results before and after the manual was issued.

Methods and materials: Data extracted from the Japan Radioisotope Association database for the period from September 2003 to the end of December 2013 were used.

Results: Of 27,976 patients who underwent (125)I brachytherapy during the specified period, 79 died within 12 months after implantation, including 3 who died in the 2011 earthquake and tsunami. The prostate and brachytherapy source were retrieved at autopsy from 69 of the 79 patients. Autopsy could not be performed on the other 10 patients, 2 of whom died in the earthquake. Autopsy and retrieval of the brachytherapy source were significantly more common after issuance of the manual than before (22/28 cases before; 47/49 cases after; p=0.021).

Conclusion: In most cases of early death after (125)I brachytherapy in Japan, the brachytherapy source was retrieved.

Keywords: Brachytherapy; Cremation; Prostate cancer; Radiation safety.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Autopsy / methods
Autopsy / standards*
Brachytherapy / methods*
Cremation / methods
Cremation / standards
Device Removal
Humans
Iodine Radioisotopes / therapeutic use*
Japan / epidemiology
Male
Practice Guidelines as Topic
Prostatectomy
Prostatic Neoplasms / mortality
Prostatic Neoplasms / radiotherapy*
Radiation Protection / methods
Radiation Protection / standards

Substances

Iodine Radioisotopes