This internal form of radiotherapy is delivered during a surgical procedure to remove cancerous tissue. When the resection is complete, the surgeon, in collaboration with the radiation oncologist implants seed-like radioactive pellets near the remaining portion of the lung to prevent new growth of cancer cells. The pellets remain in place for the rest of the patient’s life, although their level of radiation decreases over time.
How to Prepare for Seed Implantation or Lung Resection
Seed implantation occurs at the same time as lung resection, which is typically performed under general anesthesia. It is important to follow any physician instructions to prepare for surgery. These generally include:
- Avoiding eating or drinking anything after midnight on the night before
- Bringing all of one’s medications to the hospital
- Arriving one hour prior to surgery time
Patients may have a pre-admission appointment one to two weeks beforehand, in which they will have routine blood testing, any heart imaging, such as an electrocardiogram, and consultation with the anesthesiologist.
If possible, the patient should engage in some mild physical activity such as walking, and eat a balanced diet leading up to the scheduled surgery; this includes limiting alcohol consumption to 1-2 glasses per day. Smokers should make every effort to quit because it may complicate their surgery and can lead to new cancers. Patients should inform the medical team of the following in the week before:
- If they have asthma or emphysema
- If they take medications, both prescription and over-the-counter, including herbs, supplements, aspirin, and corticosteroids
What to Expect During Seed Implantation/Lung Resection
On the day before the procedure, the patient will be given information about the following day, including where to go and when to arrive. They should leave any valuables at home, and wear comfortable clothes.
On arrival, they will be taken to a pre-surgery area to measure their temperature, blood pressure, pulse, and to listen to their heart and lungs. Then, they may have their blood tested, an x-ray, or be attached to a heart monitor in the surgery room. An intravenous (IV) line will be inserted, so that medications may be administered before, during, and after the procedure.
To perform the wedge resection or segmentectomy, the surgeon may use thoracoscopy or thoracotomy.
- For a thoracoscopy, the physician makes short incisions in the 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, the 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, the surgeon will complete the procedure by implanting the seeds in the cut margin. The entire procedure takes about 1 hour.
Recovery from Seed Implantation/Lung Resection
After surgery, patients are taken to the Post Anesthesia Unit and monitored for any changes in blood pressure, heart rate and breathing. The IV line remains inserted, to keep the patient hydrated and administer pain medication, if necessary. The patient may also use a ventilator or other breathing assist device, such as an incentive spirometer (which encourages deep breaths), to ensure air exchange and to prevent pneumonia. If an endotracheal tube was inserted during surgery to control breathing, it may remain in place for a brief time.
Before the patient is discharged, the patient’s physician or nurse will instruct on how to use the oxygen device, if applicable, and how to care for the incision. Gradually, over the course of a few weeks, patients regain their strength and are able to return to work and participate in physical activity. Patients should take their medicine exactly as prescribed, and call their doctor if they have any questions or notice any of the following:
- Bleeding
- Infection
- High temperature
- Coughing up yellow, green, or bloody mucus
- Allergic reaction, such as redness, swelling, trouble breathing