Isoray - Innovative Brachytherapy

The Big Reason Why One Team Switched to Cesium Blu Brachytherapy

 “The potential to smooth out our workflow and increase our potential candidate pool for the procedure given the ability to do brachytherapy with Cesium Blu prior to EBRT is a compelling motivation for adding it to our prostate cancer treatment arsenal,”- Dr. Bobby Koneru first in Eastern Iowa using Cesium Blu for prostate brachytherapy.

Dr. Bobby Koneru knew he wanted to be a doctor from a very young age. The son of a 30-year practicing anesthesiologist, Dr. Koneru credits his father as his inspiration for his medical calling. Bobby realized that dream when he earned his MD from the University of Missouri Medical School.

Having developed an affinity for surgery and the operating room, Dr. Koneru chose general surgery for his post-graduate internship at Northwestern University Hospital before settling on Radiation Oncology as his specialty.  This affinity for the operating room has proven beneficial for Dr. Koneru, as he has become one of the next generation of physicians who will carry the torch of brachytherapy pioneers like Dr. John Sylvester, Dr. Bradley Prestidge, Dr. Brian Moran, and others.

“Brachytherapy presents a great blend of radiation delivery and hands-on procedure time in an operating room environment that has always been attractive to me,” Dr. Koneru told us.

Dr. Koneru is president and founder of the Paramount Oncology Group with practices and affiliations in Cedar Rapids, Ia., Dubuque, Ia. and Freeport, Il.

Until recently Dr. Koneru and his urologist colleague Dr. Thomas Richardson used Iodine-125 for their brachytherapy procedures. But given Iodine’s 59-day half-life, the team was forced to offer prostate brachytherapy solely following EBRT, constraining their workflow, patient options, and opportunities.

A programmatic approach to workflow refinement and patient convenience – The key to urology’s “buy-in”

“Brachytherapy outcomes for prostate cancer treatment are excellent for candidates regardless of the energy source, though Iodine does bring inconveniences,” he said. “Given its quite long half-life compared to Cesium Blu, residual side effects of Iodine for prostate brachytherapy remain with patients for months on end. Many prostate cancer patients have grandchildren they want to be near. Iodine delays that opportunity.”

Dr. Koneru added that brachytherapy with Iodine must be done following EBRT because of longer half-life. This restricts patient treatment opportunities and workflow refinement limiting the care team’s ability to administer the optimal therapy or package of therapies. Some patients experience side effects from EBRT that delay or potentially eliminate their candidacy for brachytherapy and its benefits when using Iodine.

“The potential to smooth out our workflow and increase our potential candidate pool for the procedure given the ability to do brachytherapy with Cesium Blu prior to EBRT is a compelling motivation for adding it to our prostate cancer treatment arsenal,” said Dr. Koneru.

“We are fortunate to have an excellent working relationship with our urology group, including Dr. Richardson, which is based on trust,” Dr. Koneru said. “He embraces brachytherapy as a modality and is a key reason our group is able to provide it as a benefit of prostate cancer patients throughout eastern Iowa and beyond.”

Transitioning process, training, team and results

In mid-2019, Dr. Koneru and his team including Dr. Richardson and Todd Steinberg, their medical physicist, traveled to Longview, Texas to learn about the nuances in procedural techniques and isotope transition nuances of progressing from Iodine to Cesium brachytherapy with Dr. Bill Taylor.

“Overall our experience with Dr. Taylor was fantastic,” Dr. Koneru said. “His team is exceptional. He is a fantastic teacher and he has a very straightforward technique, some elements of which we have already incorporated into our own. For example, we adjusted our implant technique after our training, which significantly improved the efficiency of our implant.  ”

Dr. Koneru described the travel and training process burdens as relatively painless when one considers the value of the outcome: a differentiator for the practice, an opportunity for patients to move beyond their cancer and its impact on their lives more quickly and adding a tool that significantly increases our brachytherapy opportunities and reduces procedure time by 50 percent or more.

Dr. Koneru said his practice is now able to complete brachytherapy procedures in an out-patient setting within 30 minutes. Prior to the team’s transition to Cesium Blu, procedures ran between 45 and 60 minutes.

In all combination therapies, the team now uses Cesium Blu brachytherapy first followed by EBRT in four to six weeks thanks to Cesium Blu’s short half-life and side effect resolution within four to six weeks.

The team is the sole provider of Cesium Blu brachytherapy in eastern Iowa and is focused on building their practice into a leading institution for the treatment of prostate cancer with brachytherapy.


Bobby Koneru, MD, is president and founder of  Paramount Oncology Group (POG). He is also an adjunct faculty at Loyola University Chicago Stritch School of Medicine.  Based in Dubuque, Iowa, Paramount Oncology Group provides radiation therapy to patients in Iowa, Wisconsin, and Illinois through multiple modalities across a range of cancer indications including prostate, breast, brain, lung, rectum, head and neck.

The views and opinions expressed in this article are those of the clinician and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.