Follow-up/Toxicity

Question 1

What are some early and late complications associated with plaque brachytherapy?

Answer 1

Early: pain, bleeding, diplopia, infection, edema

Late: retinopathy (42% at 5 yrs, increasing to 80%–90% thereafter), decreased visual acuity, cataracts, keratitis, optic neuropathy

Question 2

The use of what agent has recently been associated with a lower incidence of macular edema after plaque brachytherapy?

Answer 2

Triamcinolone (periocular injections). In an RCT, macular edema rates were 58% in the control group vs. 36% in the triamcinolone arm. (Horgan N, Ophthalmology 2009)

Question 3

What % of pts have loss of ≥6 lines of vision 3 yrs after plaque brachytherapy?

Answer 3

∼50% of pts have significant vision loss after plaque brachytherapy.

Question 4

What % of pts have cataracts 5 yrs after plaque brachytherapy?

Answer 4

83% of pts develop cataracts after plaque brachytherapy.

Question 5

How should pts treated with plaque brachytherapy be followed?

Answer 5

Plaque brachytherapy f/u: H&P, ocular US q3 mos × 1 yr, q4 mos in 2nd yr, q6 mos in 3rd and 4th yrs, then annually; CT C/A/P or liver US q6 mos with LFTs (can detect >95% of mets)

Question 6

Are periodic LFTs alone adequate to r/o liver mets?

Answer 6

No. There is very poor sensitivity (15%), PPV (46%), and NPV (71%), with a specificity of 92%. Adding liver US to LFTs increases the detection rate to 95%. (Eskelin S et al., Cancer 1999)

Question 7

What imaging modalities are useful in detecting liver mets? What is the main disadvantage of these modalities?

Answer 7

MRI, CT C/A/P or PET/CT are useful for the detection of liver mets. The cost and availability of such testing are the main disadvantages.