At the Center for Thoracic Oncology at Boston Medical Center, we specialize in many of the latest and most effective cancer treatments, including seed implantation. Our team of highly trained and experienced specialists takes a collaborative approach to your treatment. We draw on medical expertise, state-of-the-art facilities, and a patient-centered environment to provide you with not only the best medicine, but the best patient care, in New England. Your physician may recommend seed implantation.
Lung cancer is the abnormal growth of cells in the lungs. At BMC, we use seed implantation as part of a treatment for early stage non-small cell lung cancer that combines surgical removal of lung tumors and/or part of a lung with internal radiotherapy to prevent the cancer from returning (called "local recurrence").
For seed implantation, your surgeon may use a wedge resection or segmentectomy, which are terms that refer to the removal of a triangle-shaped slice of tissue, usually the tumor and a small area of healthy tissue around it. This is a treatment used for early-stage cancer or disease.
To prevent any remaining cancer cells from growing, your surgeon also places a row of seed-like pellets or a mesh implant that contains radioactive seeds (tiny metal pellets that are attached to the mesh) near the cut margin of the remaining portion of the lung to prevent local recurrence. Unlike radiation treatment, which can affect healthy tissue as well as cancerous tissue, seed implantation is placed near the cut margin. The seeds remain in place for the rest of your life, and the level of radiation decreases over time.
How to Prepare
Seed implantation occurs at the same time as lung resection, which is typically performed under general anesthesia, meaning you will be given medication to fall asleep during the procedure. It is important to follow any instructions given to you by your physician, to prepare for surgery. These instructions generally include:
- Avoiding eating or drinking anything after midnight on the night before
- Bringing all of your medications with you to the hospital
- Arriving one hour prior to your surgery time
You may have a pre-admission appointment one to two weeks beforehand, in which you will have routine blood testing, any heart imaging, such as an electrocardiogram, and consultation with the anesthesiologist, who is the specialist that administers medicine to put you to sleep and to ease any pain.
If possible, engage in some mild physical activity such as walking, and eat a balanced diet leading up to your scheduled surgery. Please inform us of the following in the week before:
- If you drink alcohol on a regular basis, try to limit consumption to one to two glasses per day.
- If you smoke, make every effort to quit smoking because it may complicate your surgery and can lead to new cancers.
- If you have asthma or emphysema
- If you take medications, both prescription and over-the-counter, including herbs, supplements, aspirin, and corticosteroids
What to Expect
On the day before your procedure, you should receive a call from us. You will be given information about the following day, including where to go and when to arrive. Leave any jewelry, credit cards, or other valuables at home, and wear comfortable clothes.
When you arrive, you will be taken to a pre-surgery area so that we can take your temperature, blood pressure, pulse, and listen to your heart and lungs. Then, depending on your particular diagnosis and surgical plan, you may have your blood tested, an x-ray, or be attached to a heart monitor in the surgery room. We will place an intravenous (IV) line in your arm, so that medications may be administered before, during, and after the procedure.
To perform the wedge resection or segmentectomy, your surgeon may use thoracoscopy or thoracotomy.
- For a thoracoscopy, the physician will make short incisions in your chest and then insert a fiber-optic camera called a thorascope as well as surgical instruments. As the physician moves the thorascope around, images that provide important information are projected on a video monitor. The portion of the lung where the tumor is located is removed.
- For a thoracotomy, your surgeon makes a larger incision in the chest and removes the portion of the lung where the tumor is located.
With either approach, once the diseased portion of lung has been removed, your surgeon will complete the procedure by implanting the seeds in the cut margin. The entire procedure takes about 1 hour.
After surgery, you will be taken to the Post Anesthesia Unit and monitored for any changes in blood pressure, heart rate and breathing. An IV line will remain in your arm to keep you hydrated and administer pain medication, if necessary. You may also use a ventilator or other breathing assist device, such as an incentive spirometer (which encourages you to take deep breaths), to ensure air exchange and to prevent pneumonia. If an endotracheal tube was inserted during surgery to control your breathing, it may remain in place for a brief time.
Before you go home, your physician or nurse will teach you how to use the oxygen device, if applicable, and how to care for your incision. Gradually, over the course of a few weeks, you will regain your strength and be able to return to work and participate in physical activity. Be sure to call your doctor if you notice any of the following:
- High temperature
- Coughing up yellow, green, or bloody mucus
- Allergic reaction, such as redness, swelling, trouble breathing
Always take your medicine exactly as prescribed. Call us if you have any questions or changes.